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The aim of this study was to evaluate the diagnostic accuracy of the IGRA, TST, and TBST by combining diagnostic test accuracy (DTA) analysis and network meta-analysis (NMA) to increase the reliability and accuracy of diagnostic methods and promote the eradication of TB. An electronic search of the PubMed, Embase, and Cochrane databases was conducted, from the date of establishment to September 30, 2024. Data were synthesized with frequentist random-effects network meta-analyses, a single-group rate meta-analysis algorithm, and a bivariate mixed-effects logistic regression model. Summarized receiver operating characteristic curves and Fagan nomograms were used to assess diagnostic accuracy and clinical utility. Deeks’ funnel plots and the Quality Assessment of Diagnostic Accuracy Studies 2 tools were used to assess publication bias and risk of bias. Sources of heterogeneity were investigated using subgroup analyses. Forty-nine studies were identified. The diagnostic performance of the three diagnostic methods for TB infection is summarized as follows: the pooled sensitivity was 77.9% (95% confidence interval [CI], 0.69–0.856), and the pooled specificity was 80.3% (95% CI, 0.75–0.86). The sensitivity and specificity of the IGRA were 82.1% (95% CI, 0.78–0.86) and 81.1% (95% CI, 0.75–0.86), respectively, both higher than the TST. However, the TBST exhibited the highest specificity, at 98.5% (95% CI, 0.96–1.00), with a sensitivity of 78.7% (95% CI, 0.68–0.88), which was between that of the IGRA and TST. Subgroup analysis found that population categories and reference standards, among other factors, may be attributed to heterogeneity. In addition, the TST and IGRA add-on TBST can significantly improve diagnostic accuracy. In our study, the IGRA showed higher sensitivity, whereas the TBST showed higher specificity. Interestingly, under certain conditions, TST add-on TBST and IGRA add-on TBST showed better accuracy than TST and IGRA alone and could provide more effective guidance for clinical practice (PROSPERO CRD42023420136). Full article

Latent tuberculosis infection (LTBI) represents a subclinical, asymptomatic mycobacterial state affecting approximately 25% of the global population. The substantial prevalence of LTBI, combined with the risk of progressing to active tuberculosis, underscores its central role in the increasing incidence of tuberculosis (TB). Accurate identification and timely treatment are vital to contain and reduce the spread of the disease, forming a critical component of the global strategy known as “End TB.” This review aims to examine and highlight the most recent scientific evidence related to new diagnostic approaches and emerging therapeutic treatments for LTBI. While prevalent diagnostic methods include the tuberculin skin test (TST) and interferon gamma release assay (IGRA), WHO’s approval of two specific IGRAs for Mycobacterium tuberculosis (MTB) marked a significant advancement. However, the need for a specific test with global application viability has propelled research into diagnostic tests based on molecular diagnostics, pulmonary immunity, epigenetics, metabolomics, and a current focus on next-generation MTB antigen-based skin test (TBST). It is within these emerging methods that the potential for accurate distinction between LTBI and active TB has been demonstrated. Therapeutically, in addition to traditional first-line therapies, anti-LTBI drugs, anti-resistant TB drugs, and innovative candidates in preclinical and clinical stages are being explored. Although the advancements are promising, it is crucial to recognize that further research and clinical evidence are needed to solidify the effectiveness and safety of these new approaches, in addition to ensuring access to new drugs and diagnostic methods across all health centers. The fight against TB is evolving with the development of more precise diagnostic tools that differentiate the various stages of the infection and with more effective and targeted treatments. Once consolidated, current advancements have the potential to transform the prevention and treatment landscape of TB, reinforcing the global mission to eradicate this disease. Full article

Introduction: Diagnostics of latent tuberculosis infection (LTBI) has been based on a century-old tuberculin skin test (TST). However, a positive reaction can result not only from infection with Mycobacterium tuberculosis, but also from BCG vaccination or cross-reaction with nontuberculous mycobacteria. T-SPOT.TB assay is a new test to diagnose tuberculosis infection by measuring in vitro T-cell interferon-gamma release in response to two Mycobacterium tuberculosis-specific antigens: ESAT-6 and CFP-10. Material and methods: T-SPOT.TB assay was performed on samples of whole blood (n = 137) from March to September 2010. Tuberculin skin test was carried out in 96 participants. A positive TST result was considered to be an induration of 10 mm or more. Results: Of the 137 patients tested, T-SPOT.TB assay results were positive in 37 (27%), negative in 98 (71.5%) and indeterminate in only 2 (1.5%) persons. We analyzed T-SPOT.TB and TST results in 96 patients who were subjected to both tests. Concordance between T-SPOT.TB and TST results (a 10-mm skin reaction interpreted as positive) was 79%. Fifteen (15.6%) patients had a positive TST result and a negative T-SPOT.TB, and 5 (5.2%) patients had a negative TST result and a positive T-SPOT.TB. We observed a good correlation between positive T-SPOT.TB results and the diameter of induration of ≥15 mm in TST results. Conclusions: T-SPOT.TB offers a more accurate approach than TST in the identification of tuberculosis infection. The study showed that the test T-SPOT.TB is a good diagnostic tool in identifying persons with tuberculosis infection. For a full confirmation of this assessment, it is necessary to examine more cases. Full article