基于T细胞的新生儿隐性多药耐药结核感染的诊断

695PEDIATRICS2007727TLucaRicheldi,MD,PhDa,KatieEwer,PhDb,MonicaLosi,PhDa,BarbaraM.Bergamini,MDa,KerryMillington,BScb,c,LeonardoM.Fabbri,MDaandAjitLalvani,FRCP,DMb,caDepartmentsofRespiratoryDiseaseandPediatrics,UniversityofModenaandReggioEmilia,Modena,Italy;bTuberculosisImmu-nologyGroup,NuffieldDepartmentofClinicalMedicine,UniversityofOxford,JohnRadcliffeHospital,Oxford,UnitedKingdom;cTuberculosisImmunologyGroup,DepartmentofRespiratoryMedicine,NationalHeartandLungInstitute,WrightFlemingInsti-tuteofInfectionandImmunity,ImperialCollegeLondon,London,UnitedKingdomT161810(tuberculosis);(neonate);(diagnosis);(ELISpot)LTBI=latenttuberculosisinfectionTST=tuberculinskintestELISpot=enzyme-linkedimmunospotMDR=multidrug-resistantPPD=purifiedproteinderivativeESAT-6=earlysecretoryantigenictarget6CFP10=culturefiltrateprotein10SKSD=streptokinase-streptodornaseSFC=spot-formingcellAddresscorrespondencetoAjitLalvani,FRCP,DM,TuberculosisImmunologyGroup,WrightFlemingInstituteofInfectionandImmunity,NationalHeartandLungInstitute,ImperialCollegeLondon,NorfolkPlace,LondonW21NY,UnitedKingdom.E-mail:[e-mail]696RICHELDIetal(LTBI)HIV[1](TST)[2]150%[3,4]LTBITSTLTBI[5]2635TST[6]11TSTTSTTγLTBI[7]γT(ELISpot)(T-SPOT.TBOxfordImmunotecLtdAbingdonUnitedKingdom)3TST[8]ELISpotTSTLTBI[9]ELISpotTSTLTBIELISpotLTBITST1ELISpotLTBI(MDR)(Moldova)24Modena1wk(1A)33wk5411dTST(CentersforDis-easeControlandPreventionguidelines)[10]15mg·kg-1·d-120mg·kg-1·d-19moTSTELISpotModena116121824ELISpotTSTMantoux5IU(PPD)-Siebert(BiocineTestPPDChironCorpora-tion/SclavoSienaItaly)TSTPPD-697PEDIATRICS2007727Siebert(PPD49608)PPD72h5mm[2]TSTELISpotPPDELISpot6(ESAT-6)10(CFP10)6(3)[11](ICNBiomedicalsSolonOH)(SKSDWyethFarmaSAMadridSpain)T(AIDGmbHStrasburgGermany)ELISpot[11]250000[8,9,12]ESAT-6CFP10(SFC)10(2)ESAT-6CFP105SFC[8,9,12]T-SPOT.TBELISpot[8,9,11,1315]ESAT-63CFP10311ELISpot7wk(11)TST(2)6ELISpot1218TST(2)242wkELISpot10(2)SKSD()TST10mm(1B)8wkDNA(1C)ABC1AB24C(DNA)6110(RFLP)(IS6110RFLP)200111()200312()MDRIS6110RFLP698RICHELDIetalELISpot(2)11dMDR49mo18mo4TSTELISpot6TST18moELISpotLTBITSTLTBI11ELISpot7wkELISpotTSTPPDTSTELISpot[16]ELISpotESAT-6CFP10[13,17]12mo1T-SPOT.TB()12moELISpotTELISpot(antigen-specific)T[18]ELISpotTSTELISpot[14,18]0200400600050100150361218242733100SFCSFC/moTST0000101012/mm23yELISpotTSTELISpotESAT-6()CFP10()ELISpot63SFCESAT-6CFP10100SFC24SKSDTSKSD6(25SFC)24(26SFC)ESAT-612(3ESAT-616SFC3CFP1016SFC)24(ESAT-6122SFCCFP10136SFC)18CFP10ESAT-6CFP10T699PEDIATRICS2007727ELISpot[19]24LTBIDNA11d3mo11MDR[20]DNAMDRMDR[21][22]MDR912mo[10]9moMDRMDRELISpot[11,20,23]LTBIELISpotELISpotELISpot()1HorsburghCRJr.NEnglJMed2004;350:2060–20672AmericanThoracicSociety;CentersforDiseaseControlandPrevention.AmJRespirCritCareMed2000;161(4pt2):S221–S2473ShingadiaD,etal.LancetInfectDis2003;3:624–6324LewinsohnDA,etal.IntJTubercLungDis2004;8:658–6745KhanEA,etal.EmergInfectDis1995;1:115–1236LaartzBW,etal.InfectControlHospEpidemiol2002;23:573–5797SchlugerNW.AmJRespirCritCareMed2001;164:2020–20248LiebeschuetzS,etal.Lancet2004;364:2196–22039EwerK,etal.Lancet2003;361:1168–117310AmericanThoracicSociety.MMWRRecommRep2000;49(RR-6):1–5111RicheldiL,etal.AmJRespirCritCareMed2004;170:288–29512LalvaniA,etal.Lancet2001;357:2017–202113LalvaniA,etal.AmJRespirCritCareMed2001;163:824–82814LalvaniA,etal.JInfectDis2001;183:469–47715ChapmanAL,etal.AIDS2002;16:2285–229316RicheldiL,etal.Thorax2006;61:18017ShamsH,etal.AmJRespirCritCareMed2005;172:1161–116818PathanAA,etal.JImmunol2001;167:5217–522519LalvaniA.etal.ClinInfectDis2004;38:757–75920RicheldiL,etal.AnnInternMed2004;140:709–71321IsemanMD,etal.NEnglJMed1996;334:267;authorreply268–26922SchaafHS,etal.Pediatrics2002;109:765–77123SoysalA,etal.Lancet2005;366:1443–1451PEDIATRICS2007;119(1):e1–e5