Identification of cytokines in whole blood for differential diagnosis of tuberculosis versus pneumonia.
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.
Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Sec. 6, Mincyuan E. Rd., Neihu District, Taipei City 114, Taiwan, Republic of China.
Wen-Lin
WL
Su
Wann-Cherng
WC
Perng
Ching-Hui
CH
Huang
Cheng-Yu
CY
Yang
Chin-Pyng
CP
Wu
Feng-Yee
FY
Chang
Jenn-Han
JH
Chen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000276:immunology; D001426:Bacterial Proteins / Q000276:immunology; D001769:Blood / Q000276:immunology*; D016207:Cytokines / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000276:immunology; D008070:Lipopolysaccharides / Q000276:immunology; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000276:immunology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000276:immunology
D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D016207:Cytokines; C093276:ESAT-6 protein, Mycobacterium tuberculosis; D008070:Lipopolysaccharides