Identification of cytokines in whole blood for differential diagnosis of tuberculosis versus pneumonia

Clin Vaccine Immunol. 2010 May;17(5):771-7. doi: 10.1128/CVI.00526-09. Epub 2010 Mar 17.

Abstract

Differentiating tuberculosis (TB) from pneumonia remains a challenge. We evaluated the cytokine profiles of whole blood cells from patients with TB (n = 38) or pneumonia (n = 30) and from healthy individuals (n = 30) before and after stimulating cells with ESAT-6 or lipopolysaccharide (LPS). When the percent change in the levels of gamma interferon (IFN-gamma) after stimulation with ESAT-6 was used in receiver operating characteristics (ROC) analysis (a graphic method to determine the diagnostic accuracy of a test) to identify a patient with TB, the area under the curve (AUC) was 90.4%, and a cutoff point of a 3.59% change produced a corresponding sensitivity, specificity, and accuracy of over 80%. When the change in IFN-gamma after stimulation of blood cells with LPS was used to identify a patient with pneumonia, the AUC reached 89.1%, and a cutoff point of 3.59% produced a sensitivity, specificity, and accuracy of approximately 80% each. When the change in interleukin-12 (IL-12) after stimulation of blood cells with LPS was selected to define a patient with pneumonia, the AUC was 85.2%, and a cutoff point of 2.08% gave a sensitivity, specificity, and accuracy of 80.0%, 78.9%, and 79.4%, respectively. We conclude that the percent change in IFN-gamma after stimulation of whole blood cells with ESAT-6 may differentiate patients with TB from patients with pneumonia. The percent change in IFN-gamma and IL-12 after LPS stimulation of whole blood cells could differentiate patients with pneumonia from patients with TB.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antigens, Bacterial / immunology
  • Bacterial Proteins / immunology
  • Blood / immunology*
  • Cytokines / blood*
  • Diagnosis, Differential
  • Female
  • Humans
  • Leukocytes / immunology
  • Lipopolysaccharides / immunology
  • Lymphocyte Activation
  • Male
  • Middle Aged
  • Pneumonia / diagnosis*
  • Pneumonia / immunology
  • ROC Curve
  • Sensitivity and Specificity
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / immunology

Substances

  • Antigens, Bacterial
  • Bacterial Proteins
  • Cytokines
  • ESAT-6 protein, Mycobacterium tuberculosis
  • Lipopolysaccharides