Search

Introduction Alpha-gal syndrome is a potentially severe food allergy caused by the presence of alpha-gal-specific IgE. The aim of this study is to describe our series of 13 patients. Material and methods This work is a retrospective study of patients diagnosed in 2016 and 2017. Skin tests were performed with commercial extract and gelaspan as well as specific IgE determination for alpha-gal and different types of meat. Results Thirteen patients diagnosed with alpha-gal syndrome were analyzed; 9 of them had anaphylaxis, 6 of whom had been diagnosed with idiopathic anaphylaxis. All had a positive skin test with gelaspan, though this was not true with the commercial extracts, whose results were less conclusive. Conclusions We believe that a diagnosis of idiopathic anaphylaxis may prevent the identification of patients with alpha-gal syndrome. The gelaspan skin test is more useful than commercial extracts.

Purpose Accurate diagnosis of TB in children is hampered by poor specificity of symptoms in endemic countries and the paucibacillary nature of childhood TB. This study was done to compare the accuracy and agreement of the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-tube test (QFT) in diagnosing tuberculosis (TB) in a predominantly BCG-vaccinated population of children. Methods This retrospective cohort study enrolled all children aged 1–15 years who underwent TST and QFT testing as part of screening for TB. Children were classified according to the 2014 WHO case definition of TB, and statistical analysis was done to generate data on concordance between the TST and the QFT as well as sensitivity and specificity within WHO-defined groups. Results TST and QFT concordance was 83.9% overall (kappa 0.51), 79% in those with WHO-defined TB and 89% in those without TB. TST+/QFT-discordance was commoner than QFT+/TST- discordance across groups. The sensitivity of the TST vs. the QFT was 70.8% vs. 50% for WHO-defined TB, with comparable specificity at 89% vs. 90% respectively. Conclusions The higher sensitivity of the cheaper and simpler TST supports its use for TB diagnosis in a normally nourished population of BCG-vaccinated children.

The practice of food allergy (FA) for clinicians has boomed, with a dramatic rise in the number of patients and families seeking care and with many advances on several fronts. The practice itself sometimes is evidence-based science and sometimes an art of pattern and phenotype recognition. This article examines the tools for diagnosis and management and therapy options available to physicians providing care for patients with FA. The article touches on pressing needs of clinicians and highlights the rapid and important movements in national and international support and advances that will have a positive impact on the field of FA.

Latent tuberculosis infection (LTBI) is defined as a consistent immune response to Mycobacterium tuberculosis antigens without evidence of clinically evident active tuberculosis (TB). Diagnosis and treatment for LTBI are important for TB, especially in high-risk populations especially in high prevalent country like India. Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are used to diagnose LTBI. Therefore an unequivocal policy /of diagnosis and treatment of LTBI will serve to ameliorate the standards of the Indian health scenario and bring the TB infection to the propinquity of its ultimate elimination.

Background The objectives were to estimate the prevalence of latent tuberculosis infection (LTBI) among household contacts (HHCs) with active TB patients, and to identify their risk factors. Methods A prospective, cross sectional study was conducted from May to October 2018. All HHCs with active TB cases were included. The subjects underwent two tests: Quantiferon TB-Gold plus assay (QFT-Plus) and tuberculin skin test (TST). Data were analyzed using the Statistical Package for Social Sciences 25. Results Among 521 HHCs, 101 (24.05%) revealed positive TST and 80 (19.85%) positive QFT-Plus. The significant risk factors associated with positive TST individuals were ≥ 15 years, immunosuppressive therapy, and pulmonary TB (PTB) patients; whereas, those with QFT-Plus positive were ≥ 45 years, alcohol consumption, and immunosuppressive therapy. The concordance rate among 309 individuals who performed both tests was 0.88 %; the kappa value showed good agreement (k = 0.679) and significant correlation (P Conclusions The overall rate of LTBI was intermediate. Screening of LTBI should be routine among HHCs, regardless of the site of the disease. Age ≥ 15 years, alcoholics, immunosuppressive therapy, and PTB were potential risk factors. There was a good concordance between TST and QFT-Plus. A QFT-Plus can overcome the limitation of a BCG vaccinated individual, especially in early life.

Background A large proportion of cow's milk (CM)-allergic children are able to tolerate extensively heated forms of CM such as baked goods. Little is known about whether ultra-heat-treated (UHT) forms of cow's milk are immunologically similar to extensively heated cow's milk and therefore may be tolerated by these children. Objective To determine whether skin test wheal size using UHT CM was significantly different from other forms of CM and CM extracts. Methods Children presenting for oral food challenges with either extensively heated or unheated cow's milk underwent skin prick test (SPT) to commercial CM, UHT CM, evaporated CM, and fresh whole CM. The results were compared between groups of children. Results At study exit, only 14% of children were avoiding all forms of CM, compared with 70% at study entry. No difference was seen in the mean SPT results for UHT CM between those children that could tolerate heated CM compared with those that could not. The mean SPT result for casein was significantly lower in those that could tolerate heated CM. However, within the group of heated milk–tolerant children, the mean SPT for UHT CM was significantly lower than the SPT for fresh whole CM. Conclusion Ultra-heat-treated CM does not behave significantly differently from other forms of CM when evaluated by SPT in heated milk–allergic vs heated milk–tolerant children. This suggests that UHT CM is not sufficiently immunologically different from unheated CM to be tolerated by heated CM–tolerant children.

Diagnosing latent tuberculosis (TB) infection (LTBI) is important globally for TB prevention. LTBI diagnosis requires a positive test for infection and negative evaluation for active disease. Current tests measure an immunologic response and include the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), T-SPOT.TB and QuantiFERON. The IGRAs are preferred in bacille Calmette-Guérin-vaccinated populations. The TST is still used when cost or logistical advantages over the IGRAs exist. Both TST and IGRAs have low positive predictive values. Tests that differentiate the TB spectrum and better predict future TB risk are needed.

Evidence indicates that abnormal phospholipase A2 (PLA2) levels and niacin insensitivity are present in individuals with schizophrenia. This study was designed to determine whether differences in plasma calcium-independent phospholipase A2 (iPLA2) and cytosolic phospholipase A2 (cPLA2) exist between those with schizophrenia and healthy controls, and to explore the correlation between PLA2s and the niacin skin reaction in schizophrenic patients. We performed ELISA experiments to measure the concentrations of plasma iPLA2 and cPLA2 and we conducted a series of niacin skin tests on schizophrenic patients from the Chinese Han population. In addition, a meta-analysis of the relationship between PLA2 and schizophrenia was conducted. The plasma concentration of iPLA2 in patients with schizophrenia was significantly higher than that in healthy controls while the plasma concentration of cPLA2 did not differ. The meta-analysis also revealed that the activity level of iPLA2 in individuals with schizophrenia was higher than that in healthy controls, whereas that of cPLA2 was not. Furthermore, a significant positive correlation was found between the concentration of iPLA2 and the score for the skin flushing response within 20 min. The abnormal plasma iPLA2 concentration and its relationship with the niacin skin test in schizophrenic patients has contributed to a deeper understanding of the pathology of schizophrenia, which may in turn provide new insights into the clinical diagnoses and treatment of schizophrenia.

Chronic spontaneous urticaria (CSU) is a chronic type characterized by episodes of wheals with or without angioedema. Autoantibody against the alpha subunit of Fc epsilon receptor (FcεRIa) was detected in CSU patients' sera. The study aims to evaluate the clinical utility of skin tests in CSU patients. In addition, it assesses the presence of circulating FcεRIa in CSU patients and their correlation with other clinical and immunological variables. The study includes 40 healthy controls and 40 CSU patients who had urticaria symptoms for at least 8 weeks. All subjects underwent the following tests: autologous serum skin test (ASST), autologous plasma skin test (APST), immunoglobulin E (IgE), antinuclear antibodies (ANA), antithyroid antibodies (ATA). An in-house enzyme-linked immunosorbent assay was used for FcεRIa detection. The prevalence of ANA and ATA in CSU was 7.5% and 20% respectively. Total IgE was significantly higher in CSU than in controls (p 0.0001). The study detected circulating antibody to FcεRIα in 2.5% of controls and 52.5% of CSU patients (p 0.0001). The prevalence of antibody to FcεRIa was 27.3% and 83.3% of ASST negative and positive patients respectively (p = 0.0004). But the prevalence was 17.6% and 78.3% of APST negative and positive patients respectively (p = 0.0002). In conclusion, Circulating antibody to FcεRIa has a role in the pathogenic mechanisms of CSU.

Introduction Some studies indicate high prevalences of latent tuberculosis infection (LTBI) in the immigrant population, which is relevant because 5–10% of cases will develop active tuberculosis. The objective of this study is to describe the results of a sequential strategy in the newly-arrived immigrant population for the diagnosis of LTBI using the tuberculin skin test (TST) and IGRAs. Methods A retrospective descriptive study was carried out with immigrants between 6 and 35 years of age from shelters, referred to an international health unit between July 2013 and June 2016. The TST was performed and when it was ≥5 mm, IGRAs were conducted. LTBI was defined as an IGRA ≥0.35 IU/ml and normal chest X -ray. Results Of the 184 cases, 138 (75.0%) were men, 23.0 years of age. The most common geographical areas were: 63 (34.2%) from Asia, 42 (22.8%) from Eastern Europe and 41 (22.3%) from sub-Saharan Africa. The TST was ≥10 mm in 79 cases (42.9%). The prevalence of LTBI using the sequential strategy was 33/184 (17.9%). Cohen's Kappa index (between TST ≥ 10 mm and IGRAs) was 0.226. Conclusion Basing LTBI screening on the TST alone could give rise to an overestimation. Some studies show that sequential screening would be the most cost-effective; this seems most evident in BCG-vaccinated populations.

Background Omalizumab is a recombinant anti-immunoglobulin E (IgE) antibody used in the treatment of patients with chronic spontaneous urticaria (CSU). Objective This multicentric study assessed the safety and efficacy of omalizumab in patients (n=322) with CSU refractory to second-generation antihistamines, also investigating predictors of poor treatment outcome and time lag to response to anti-IgE therapy by serum auto-reactivity. Methods This retrospective observational study comprised a 4-week pretreatment period, a 24-week treatment period with omalizumab (300 mg/month), and a 16-week follow-up period. Primary efficacy endpoints were mean and median change in 7-day urticaria activity score (UAS7), weekly itch severity score (ISS), and hive score from baseline to 4-, 12-, and 24-week values. Secondary endpoints included the proportion of patients (defined “responders”) with well-controlled urticaria (UAS7 ≤ 6) and complete treatment response (UAS7=0). Safety in terms of side effects was also assessed. Results Omalizumab significantly and consistently reduced the mean UAS7, ISS, and hive score from baseline to weeks 4, 12, and 24, with a clear decreasing trend over time. At the end of the treatment period (week 24), 84.2% of patients had a UAS7 score of 6 or less and 66.7% had a UAS7 of 0. Higher pretreatment IgE levels were less likely to be associated with poor treatment response (ie, UAS7 > 6). Patients with a positive autologus serum skin test (ASST) were significantly more likely to be “slow responders” to omalizumab treatment (ie, response beyond 8 days since omalizumab administration) than ASST-negative patients (P Conclusion Monitoring baseline characteristics of patients before introduction of omalizumab therapy may help to predict treatment outcome in CSU patients.

Purpose Immunocompromised patients with latent tuberculosis infection (LTBI) are at high risk of progression to active tuberculosis. Detection and treatment of LTBI in this group of patients are very important to control active tuberculosis. Tuberculin skin test (TST) and interferon gamma release assays (IGRAs) are two methods for detection of LTBI. Diagnostic agreement between two tests are poor especially in Bacillus Calmette-Guerin (BCG) vaccinated immunocompromised patients. In this study, we tried to figure out if the use of a higher cut-off for TST increases diagnostic agreement with IGRAs and TST specificity and or not. Materials/Methods In this retrospective study, BCG vaccinated solid organ transplantation (SOT) candidates and patients scheduled for anti-tumor necrosis factor-alpha (anti- TNFα) treatment patients who underwent both TST and IGRAs between 2011 and 2017 were enrolled in the study. Diagnostic agreement between the two tests was assessed for 5, 10, 15 mm cut-off values for all participants, SOT candidates and anti- TNFα treatment subgroups separately. Results Fifty female and 55 male total 105 patients were included. In the anti- TNFα treatment group 92.8% of the patients were receiving at least one immunosuppressive drug. For all participants kappa (κ) values were 0.303, 0.370, 0.321 respectively for 5, 10 and 15 mm cut-offs. For SOT candidates κ values were 0.488, 0.422, 0.288 respectively. For anti- TNFα treatment group κ values were 0.235, 0.332, 0.275 respectively. Conclusions In BCG vaccinated immunocompromised patients, the agreement between TST and QFT-GIT was poor regardless of cut-off value. And increasing the cut-off does not improve agreement.

Effective disease management of wildlife relies on the strategic application of ante-mortem diagnostic tests for early identification and removal of M. bovis-infected animals. To improve diagnostic performance, interferon-gamma release assays (IGRAs) are often used in conjunction with the tuberculin skin test (TST). Since buffaloes are major maintenance hosts of M. bovis, optimal application of bovine TB diagnostic tests are especially important. We aimed to determine whether the timing of blood collection relative to the TST has an influence on IFN-γ production and diagnostic outcome in African buffaloes. Release of IFN-γ in response to bovine purified protein derivative (PPD), avian PPD and PC-HP® and PC-EC® peptides was measured by Bovigam® and an in-house IGRA in a group of Bovigam®-positive and – negative buffaloes at the time the TST was performed and three days later. There was significantly lower IFN-γ release in response to these antigens post-TST in Bovigam®-positive buffaloes, but no significant changes in Bovigam®-negative buffaloes. Also, a significantly greater proportion of buffaloes were Bovigam®-positive prior to the TST than three days later. We therefore recommend that blood samples for use in IGRAs be collected prior to or at the time the TST is performed to facilitate the correct identification of greater numbers of IGRA-positive buffaloes.

Background: Optimal screening and management of latent tuberculosis infection (LTBI) and active tuberculosis (TB) in solid organ transplant (SOT) candidates and recipients is necessary to prevent morbidity and mortality.Methods: We conducted a cross-sectional survey of TB and transplant experts across the United States reviewing the clinical practice preferences on key management issues related to LTBI and TB in SOT candidates and recipients.Results: Thirty TB and 13 SOT experts were surveyed (response rate = 53.8%). Both groups agreed that tuberculin skin test (TST) and chest x-ray screening in SOT candidates was useful (78.6% and 84.6%, respectively). TST after SOT was not useful for most transplant experts and TB experts (0% vs. 32.1%, respectively), but both groups were split on usefulness of interferon gamma release assays (IGRA) in SOT recipients (42.9% TB experts vs. 46.2% SOT experts). Most experts recommend LTBI treatment prior to SOT if close monitoring is assured (82.1% TB experts vs. 76.9% transplant experts). LTBI treatment with isoniazid was preferred for patients on calcineurin inhibitors. Evaluation for suspected TB in SOT recipients varied, but most TB experts favored sputum testing (88.9%) whereas most transplant experts favored bronchoscopic testing (69.2%). Preferred TB treatment regimens in SOT recipients were similar to regimens recommended for immunocompetent patients.Conclusions: Most TB and transplant experts recommend evaluation and treatment for LTBI in SOT candidates. Liver transplant candidates, however, should only be treated if close monitoring can be assured and after consulting with a hepatologist. Practice preferences varied regarding the initial diagnostic approach for suspected TB in SOT recipients; however, most experts agreed that SOT recipients should receive similar treatments as immunocompetent patients. Keywords: Tuberculosis, Transplantation, Survey

Background Percutaneous allergen skin testing remains an established benchmark for diagnosing atopic disease. The reliability of skin testing depends greatly on the performance of allergen extracts used, methods used, and the presence of antihistamine medications. Objective To determine the differential effect of cetirizine on 2 different concentrations of histamine control solution and 5 common allergens used for percutaneous skin testing. Methods Twelve individuals underwent skin testing with histamine (1 and 6 mg/mL), control diluent, and 5 common aeroallergens. Wheal and flare measurements were measured in a masked fashion by a single operator. Cetirizine was administered for 4 consecutive days to determine the effect on both histamine and allergen wheal and flare responses. Results A total of 384 skin tests were performed on 12 volunteers. Cetirizine began to suppress wheal and flare responses at 1 hour ( P P Conclusion The use of a 6-mg/mL histamine control for some percutaneous skin test devices may result in more false-negative allergen responses because of the inability to detect the presence of antihistamines.

The use of monoclonal antibodies (mAbs) has become broader because of their recognized effectiveness in the treatment of autoimmune, neoplastic, and inflammatory diseases. Consequently, hypersensitivity reactions (HSR) secondary to mAbs are being reported more often, and each mAb-related HSR presents specific features. This article discusses the main biological agents and associated HSR, the clinical presentation of such reactions, and the role of tryptase and skin testing in the diagnosis. Rapid drug desensitization procedures to mAbs enable selected allergic patients to receive full therapeutic doses in a safe manner and are also discussed.

Taxanes are an important class of antineoplastic agents used in the treatment of a wide variety of cancers. However, paclitaxel and docetaxel, which are the most commonly used taxanes, elicit immediate hypersensitivity reactions (HSRs) in 5% to 10% of patients. Almost all patients that experience these reactions can be safely re-exposed to taxanes either through desensitization or challenge. This article describes the clinical presentation, diagnosis, and management of HSRs to taxanes and discusses the different options for their safe readministration.

Resumen Introduccion La dermatitis de contacto es un motivo de consulta frecuente en Colombia, donde existe poca informacion sobre su epidemiologia y su etiologia. Objetivo Describir las caracteristicas clinicas, epidemiologicas y los resultados de las pruebas epicutaneas realizadas en el Centro Dermatologico Federico Lleras Acosta de Bogota (Colombia). Materiales y metodos Se llevo a cabo un estudio descriptivo y el analisis de las caracteristicas demograficas y epidemiologicas de los pacientes a quienes se les realizo pruebas epicutaneas con la bateria estandar europea de contactantes. Resultados El 68% de los pacientes presento positividad en las pruebas epicutaneas. El alergeno mas frecuente fue el niquel, seguido por el balsamo del Peru y las fragancias. Los grupos de edad entre 20 a 29 y 50 a 59 anos fueron los mas afectados. La ocupacion y la actividad extralaboral mas frecuente fueron las labores del hogar. Las zonas del cuerpo mas afectadas fueron las manos (27,4%). Las placas eritematodescamativas se observaron en el 52% de los afectados y se encontro relevancia actual en el 80% de los pacientes estudiados. Conclusiones Las mujeres fueron mas afectadas que los hombres. El niquel, las fragancias y los preservantes fueron los alergenos que predominaron, lo cual concuerda con lo publicado en la literatura internacional. Contactantes como la budesonida no demostro ninguna positividad, lo que evidencia la necesidad de desarrollar estudios multicentricos en Colombia que permitan incluir nuevos alergenos y descartar otros.

Latent tuberculosis infection (LTBI) lacks diagnostic gold method. Effective method is important to the control of tuberculosis. IFN-γ responses in 600 military recruits were tested by ELISA using whole blood incubation with latent protein Rv2029c, Rv2659c and recombinant protein CFP10-ESAT6 (rCE) respectively. They also received tuberculin skin test. Their BCG vaccination status was recorded. When 30.7% (184/600) of recruits gave higher IFN-γ responses (≥470pg/mL) to rCE as LTBI, the rests as healthy control, the AUC of rRv2029c was 0.856 and rRv2659c was 0.827 for LTBI diagnosis. IFN-γ responses to rCE were higher in PPD-positive group (≥5mm) than negative group (5mm) (p0.05), while for rRv2029c and rRv2659c were not (p0.05). IFN-γ responses induced by rRv2029c and rRv2659c were higher in the moderately-positive group (≥5,15mm) than the strongly-positive group (≥15mm) (p0.05), while for rCE were not (p0.05). IFN-γ levels to three antigens were not related to BCG vaccination status (p0.05). Rv2659c and Rv2029c are good candidate antigens to complement the role of rCE for LTBI diagnosis, which provide a basis for developing cost-effective LTBI screening methods in the army.

Bilirubin, a bile pigment, is associated with several diseases and systemic pathologies. The measurement of bilirubin is important for diagnosis and therapy, and many expensive methods are used to measure the bilirubin amount in blood. In this study, a new bilirubin biosensor using quartz crystal microbalances immobilized with albumin is proposed. To measure the effectiveness of the biosensor, a series of experiments was realized with various concentrations of bilirubin, including 1 mg/dL, 2 mg/dL, 5 mg/dL and 10 mg/dL. Comparing blood gas analyzers, laboratory analyzers, skin test devices and nonchemical photometric devices, blood gas analyzers have a range of 0.5–35 mg/dL, laboratory analyzers have a range of 0–30 mg/dL, skin test devices could be used up to 11.7 mg/dL, and nonchemical photometric devices could be evaluated as reliable up to 14.6 mg/dL. The low limit range of the bilirubin detection is between 0.099 mg/dL and 0.146 mg/dL for some special commercial bilirubin measurement devices. Nevertheless, this study presents measurements with a high sensitivity and includes the advantage of reusability by using cheaper materials. To prove albumin immobilization and the bilirubin–albumin interaction atomic force microscopy (AFM) was used, and a good correlation was achieved from AFM images. In conclusion, considering the cost-effectiveness side of the proposed method, a low cost and more sensitive bilirubin measurement device which is effective and reusable was developed instead of the current commercial products.

Background: There are controversies regarding the use of the interferon-γ release assay (IGRA) or tuberculin skin test (TST) for the detection of latent tuberculosis infection (LTBI). We assessed three factors relevant to the detection of LTBI: predictive value of progression to active TB, target value of preventive treatment, and the necessity of combination of IGRA and TST. Methods: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies until April 2019. We calculated the risk ratio (RR) for the rates of disease progression in persons with positive versus negative test to assess the predictive value. We calculated the positive predictive value (PPV) and RR for the rates of disease progression in untreated versus treated persons of the positive test to assess the target value of preventive treatment. We calculated the proportion of disease progression in the combination groups and RR for rates of disease progression in untreated versus treated persons to assess the necessity of combination. Findings: A total of 31 relevant studies including 46775 persons were included in the final analysis. The strength of the association between IGRA+ results, as well as TST+, and development of active TB was high. However, IGRA+ was higher than TST+. The PPV of IGRA+ persons was higher than TST+, and the PPV of QuantiFERON®-TB (QFT) was the highest. The association between untreated and development with QFT+ was strong, unlike that of other single tests. The proportion of progressed IGRA+/TST+ persons was the highest in the combination tests. Moreover, the proportion of progressed persons in the IGRA+/TST− group was significantly higher than that observed in the IGRA−/TST+ and IGRA−/TST− groups. The association between untreated and development with IGRA+/TST+ group was stronger than that of any other single use group. Interpretation: Both IGRA and TST can predict the subsequent development of active TB; however, IGRA is more reliable than TST. IGRA is more accurate for targeting preventive treatment and offers more benefit from treatment than TST. Furthermore, QFT is a optimal recommendation for single use, and the combination of IGRA and TST is unnecessary. Funding Statement: National Natural Science Foundation of China (grant numbers 81860644, 81560596, and 31560051), and Natural Foundation of Yunnan Province (grant numbers 2017FE467-001 and 2014FA011). Declaration of Interests: The authors declare no potential conflicts of interest.

Background: An alarming increase in number of patients with chronic and recurrent dermatophytosis has invoked the need to study immunological parameters of the host in addition to traditional pathogens studies. This study was done to evaluate delayed type of hypersensitivity (DTH) response by estimating TH1 cells along with TH17 cells and immediate hypersensitivity (IH) response by estimating TH2 cells population in peripheral blood along with intradermal trichophytin skin test in patients with recurrent dermatophytosis. Methods: In this case-control study, 100 patients with recurrent dermatophytosis and 50 controls were included. Flow-cytometric evaluation of TH1, TH17 and TH2 cells in peripheral blood along with intradermal trichophytin extract test was done. Dermatophytes pathogens were isolated on culture and antifungal drug susceptibility test was done. Relevant risk factors for recurrent disease were analysed and serum IgE levels were estimated. Findings: TH1 cells were reduced in 72.6 % cases vs 52 % controls (p=0.01) and TH17 cells were reduced in 49.4% cases vs 26 % controls (p=0.006). Intradermal trichophytin test demonstrated negative DTH response in 100 % of cases (p=0.0001). Positive IH response was observed in 91% cases vs 68% controls (p=0.0001). T.mentagrophytes complex (95.8%) was the most common species isolated followed by T.rubrum (4.16%). The risk factors associated were family history of tinea, sharing of towels and clothes and corticosteroids use in recent past (p= 0.007, p=0.009, p=0.0001). Serum IgE was elevated in 83.15 % cases (p=0.01). Interpretations:Our study demonstrated impaired DTH response and reduced TH1 and TH17 cell population in patients with recurrent dermatophytosis. Funding Statement: The authors declare: "None ." Declaration of Interests: The authors declare: "None." Ethics Approval Statement: The study protocol was approved by the Institutional Ethics Committee (Intramural) of the Postgraduate Institute of Medical Education and Research, Chandigarh.

Objective To understand the anti-virus adaptive immune response occurring during SARS-Cov-2 infection is necessary to have methods to investigate cellular and humoral components. The goal of this study has been to investigate the utility of a specific spike-DTH test using a coronavirus recombinant protein in COVID-19 patients. Methods DTH studies were performed by intradermal injection of a commercial recombinant spike protein from SARS-CoV-2 along with conventional serology studies. Results Fifty-one COVID-19 patients were studied showing 84,3% of concordance with spike-DTH and anti-RBD-IgG. Spike-DTH was superior to identify seven more COVID-19 individuals. A high specificity was found with no positive spike DTH reactions in the non-sick individuals. The skin test also showed more stable results over time while specific anti-RBD-IgG decreased gradually. Clinical severity groups also showed a progressive gradient of larger positive spike-DTH. Conclusion Specific spike DTH test seems to be an easy method to study cell immune response.

Silicosis continues to be a serious health issue in many countries and its elimination by 2030 (a target set by WHO and the International Labour Organization in 1995) is virtually impossible. The risk to develop pulmonary tuberculosis for silicosis patients is higher than for non-silicosis people, and there is also an increased risk of both pulmonary and extrapulmonary tuberculosis in individuals exposed to silica. HIV coinfection adds further to the risk, and in some countries, such as South Africa, miners living with HIV are a considerable number. The diagnosis of active tuberculosis superimposed on silicosis is often problematic, especially in initial phases, and chest X-ray and smear examination are particularly important for the diagnosis of pulmonary tuberculosis. Treatment is difficult; directly observed therapy is recommended, a duration of at least eight months is probably needed, drug reactions are frequent and the risk of relapse higher than in non-silicosis patients. TB prevention in silicosis patients is essential and include active surveillance of the workers, periodic chest X-rays, tuberculin skin test or interferon-gamma releasing assay testing, and, importantly, adoption of measures to reduce the exposure to silica dust. Chemoprophylaxis is possible with different regimens and needs to be expanded around the world, but efficacy is unfortunately limited. Silico-tuberculosis is still a challenging health problem in many countries and deserves attention worldwide.

Summary Objectives In the USA, tuberculosis disease rates are highest in older adults. Diagnostic testing for latent tuberculosis infection (LTBI) has not been evaluated carefully in this group. The aim of this study was to define the relationship between tuberculin skin test (TST) results, T-SPOT. TB results, and T-cell responses to Mycobacterium tuberculosis antigens. Methods Long-term care facility residents with known prior TST results (positive or negative) were retested with TSTs and T-SPOT. TB . Prior exposure to M. tuberculosis was assessed by quantifying T-cell activation to mycobacterial antigens in vitro. Results The median age of the 37 participants was 77 years (range 57–98 years). Among 18 participants with a prior positive TST, three (16.7%) had a negative TST when retested (TST reversion); two had a negative T-SPOT. TB . Of the 15 who were historically and currently TST-positive, four (26.7%) had a negative T-SPOT. TB and one (6.7%) had a borderline result. Percentages of CD4+ T-cells responding to mycobacterial antigens were higher in participants with positive TST and T-SPOT. TB (18.2%) compared to those with a positive TST but negative T-SPOT. TB (6.4%, p =0.16) and negative TST and T-SPOT. TB (5.9%, p Conclusions LTBI testing in older adults is complicated by TST reversion and TST-positive/T-SPOT. TB -negative discordance, which may reflect clearance of infection or waning immunity.

A population survey was conducted to explore the prevalence and factors associated with Leishmania infection in the Fercal region of the Federal District. The Fercal region is a group of neighborhoods in Brasília in which the first cases of visceral leishmaniasis were described. Leishmania infection was established by a positive leishmanin test. Although other tests were performed in the study (an immunochromatographic assay (Kalazar detect®) and a molecular assay), only the leishmanin skin test provided sufficient results for the measurement of the disease prevalence. Data on the epidemiological, clinical and environmental characteristics of individuals were collected along with the diagnostic tests. After sampling and enrollment, seven hundred people from 2 to 14 years of age were included in the study. The prevalence of Leishmania infection was 33.28% (95% CI 29.87–36.84). The factors associated with Leishmania infection according to the multivariate analysis were age of more than seven years and the presence of opossums near the home. Age is a known factor associated with Leishmania infection; however, the presence of wild animals, as described, is an understudied factor. The presence of opossums, which are known reservoirs of Leishmania, in peri-urban areas could be the link between the rural and urban occurrence of visceral leishmaniasis in the outskirts of largest Brazilian cities, as suggested by previous studies. Keywords: Visceral leishmaniasis, Brazil, Didelphis albiventris, Leishmanin

Summary Objectives The diagnosis of tuberculosis (TB) in children is challenging due to insufficient specimen material and the scarcity of bacilli in specimens. This study aimed to evaluate methods for diagnosing TB in children in Sudan. Methods Patients ( N =197) were subjected to the tuberculin skin test (TST). Gastric lavage or sputum specimens were then collected, processed, and cultured as per standard procedures. Results Culture on Lowenstein–Jensen medium, the reference standard, revealed growth in 16.2% of the specimens. Comparative analysis showed that 43.7% were positive for the TST (sensitivity 100%, specificity 67.3%), 8.1% were positive by Ziehl–Neelsen stain (sensitivity 43.8%, specificity 98.8%), 11.2% by auramine stain (sensitivity 56.3%, specificity 98.8%), and 17.8% were positive for PCR amplification of the IS 6110 sequence (sensitivity 100%, specificity 98.8%). Conclusions It is concluded that whilst TST and IS 6110 achieved 100% sensitivity based on the reference standard of culture, the latter was more specific. The TST is recommended for routine diagnosis and the use of PCR for particular cases, depending on the facilities and the urgency.

Tuberculosis risk is increased in patients with chronic inflammatory diseases receiving any immunosuppressive treatment, notably tumor necrosis factor (TNF) antagonists therapy. Screening for the presence of latent infection with Mycobacterium tuberculosis and targeted preventive treatment to reduce the risk of progression to TB is mandatory in these patients. This Consensus Document summarizes the current knowledge and expert opinion of biologic therapies including TNF-blocking treatments. It provides recommendations for the use of interferon-gamma release assays (IGRA) and tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection in these patients, and for the type and duration of preventive therapy.

Objectives To observe the clinical efficacy of photodynamic therapy mediated by hemoporfin (HMME-PDT) for port-wine stains (PWS) on extremities and explore its possible influencing factors. Methods Four patients with PWS in extremities were treated by HMME-PDT, and patients with negative results in the skin test were given an intravenous injection of 5 mg/kg of HMME. The patients were irradiated with 532 nm LED green light, and immediately applied cold compress after treatment. These patients were informed to stay away from light for two weeks. A follow-up every 2 weeks was conducted with treatment for 2 or 3 times in total. After the end of treatment, a follow-up was carried out for 6–12 months and the efficacy and safety were evaluated. Result Three of the four patients were considered cured, and the treatment was ineffective for one patient. During the follow-up observation, all patients had different degrees of edema, and there were no signs of chromatosis or scarring. Conclusion PDT treatment for patients with extremity PWS demonstrate high efficiency and safety, without obvious adverse reactions and recurrence.

Objective To evaluate risk factors for developing latent tuberculosis (LTB) in Thai nurses. Methods A comparison study was conducted at Srinagarind Hospital, Khon Kaen, Thailand. Clinical factors were compared between persons with tuberculin conversion and those without tuberculin conversion identified by tuberculin skin test. Results There were 173 eligible persons with the LTB (34.7%). There were five workplaces where participants worked regularly including the general ward, surgical ward, pediatric ward, medical ward and critical care ward. In a multivariate model, two factors were significantly associated with LTB including age and history of tuberculosis in colleagues. The adjusted odds ratio (95% confidence interval) of both variables were 1.056 (1.004–1.104) and 0.202 (0.044–0.941). Conclusions Older age is associated with latent tuberculosis in nurses. LTB should be screened routinely and treated if diagnosed for nurses.

Background Allergen skin prick testing remains an essential tool for diagnosing atopic disease and guiding treatment. Sensitivity needs to be defined for newly introduced devices. Objective Our aim was to compare the performance of 10 current allergy skin prick test devices. Methods Single- and multiheaded skin test devices (n = 10) were applied by a single operator in a prospective randomized manner. Histamine (1 and 6 mg/mL) and control diluent were introduced at 6 randomized locations onto the upper and lower arms of healthy subjects. Wheal and flare reactions were measured independently by 2 masked technicians. Results Twenty-four subjects provided consent, and 768 skin tests were placed. Mean wheal diameter among devices differed from 3.0 mm (ComforTen; Hollister-Stier, Spokane, Wash) to 6.8 mm (UniTest PC; Lincoln Diagnostics, Decatur, Ill) using 1 mg/mL histamine ( P P Conclusions All 10 skin prick test devices displayed good analytical sensitivity and specificity; however, 3 mm cannot arbitrarily be used as a positive threshold. The use of histamine at 1 mg/mL is unacceptable for certain devices but may be preferable for the most sensitive devices. On average, there was no pain score difference between multiheaded and single-head devices.

Introduction Sri Lanka is a moderate burden middle-income setting where healthcare workers (HCWs) are not routinely screened for TB infection, even in moderate to high transmission risk settings. This study evaluated the use of a commercial interferon gamma release assay (IGRA) in HCW screening in comparison to the tuberculin skin test (TST) in a regional chest clinic. Methods HCWs ( n =39) serving at the study clinic, where over 500 TB patients are registered and treated every year, were screened for LTBI with both the TST and an IGRA. Factors associated with positive test results as well as agreement between the two tests were evaluated. Results 47.2% of HCWs screened were TST positive (10mmcut-off) and positivity was associated with working in poorly ventilated areas ( P =0.019, OR 5.133 (95% CI 1.23 – 21.35)), although not associated with working in the sputum laboratory or TB treatment room, age or gender. IGRA positivity was significantly lower, 15.7%( P =0.003). Positivity was associated with male gender ( P =0.046) and a shorter duration of service at the chest clinic ( P =0.036), though it was not associated with work in risk areas. Agreement between tests (TST 10mm cut-off) was fair with a kappa of 0.30 ( P =0.013). Positive IGRA results were seen only in TST-positive subjects who had a TST reading of >15mm. Conclusions Occupational and non-occupational factors associated with TST and IGRA positivity differed between tests. Short duration of service was associated with IGRA positivity. The IGRA showed no advantage over the TST as a test for LTBI in this setting.