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Overlooked, dismissed, and downplayed: reversion of Mycobacterium tuberculosis immunoreactivity.
Dale, Katie D; Schwalb, Alvaro; Coussens, Anna K; Gibney, Katherine B; Abboud, Alison J; Watts, Krista; Denholm, Justin T.
Afiliación
  • Dale KD; Victorian Tuberculosis Program, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia katie.dale@mh.org.au.
  • Schwalb A; TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK.
  • Coussens AK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
  • Gibney KB; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
  • Abboud AJ; Infectious Diseases and Immune Defence Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
  • Watts K; Department of Medical Biology, University of Melbourne, Parkville, Australia.
  • Denholm JT; Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa.
Eur Respir Rev ; 33(173)2024 Jul.
Article en En | MEDLINE | ID: mdl-39048129
ABSTRACT
Tuberculosis (TB) is caused by Mycobacterium tuberculosis (Mtb). Following infection, immune responses to Mtb antigens can be measured using the tuberculin skin test or an interferon-γ release assay. The gain of Mtb immunoreactivity, a change from a negative to a positive tuberculin skin test or interferon-γ release assay result, is called conversion and has long been used as a measure of Mtb exposure. However, the loss of immunoreactivity (reversion; a positive followed by a negative result) has often been overlooked. Instead, in clinical and epidemiological circles, Mtb immunoreactivity is commonly considered to persist lifelong and confer a lifetime of disease risk. We present a critical review, describing the evidence for reversion from cohort studies, ecological studies and studies of TB progression risk. We outline the inconsistent reasons why reversion has been dismissed from common understanding and present evidence demonstrating that, just as conversion predominantly indicates prior exposure to Mtb antigens, so its opposite, reversion, suggests the reduction or absence of exposure (endogenous or exogenous). Mtb immunoreactivity is dynamic in both individuals and populations and this is why it is useful for stratifying short-term TB progression risk. The neglect of reversion has shaped TB research and policy at all levels, influencing clinical management and skewing Mtb infection risk estimation and transmission modelling, leading to an underestimation of the contribution of re-exposure to the burden of TB, a serious oversight for an infectious disease. More than a century after it was first demonstrated, it is time to incorporate reversion into our understanding of the natural history of TB.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tuberculosis / Prueba de Tuberculina / Valor Predictivo de las Pruebas / Ensayos de Liberación de Interferón gamma / Mycobacterium tuberculosis Límite: Humans Idioma: En Revista: Eur Respir Rev Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tuberculosis / Prueba de Tuberculina / Valor Predictivo de las Pruebas / Ensayos de Liberación de Interferón gamma / Mycobacterium tuberculosis Límite: Humans Idioma: En Revista: Eur Respir Rev Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido