title: Detecting latent tuberculosis in compromised patients.
abstract: OBJECTIVE
  The detection of latent tuberculosis infection (LTBI) in different categories of compromised patients is reviewed with focus on the role of strategies incorporating immunodiagnostic tests and analysis of epidemiological and clinical risk factors.
  
  
  RESULTS
  The development of active tuberculosis (TB) is increased in compromised patients and is closely related to determinants for disease reactivation or newly acquired TB infection. A targeted detection of LTBI in these high-risk groups should be performed especially if preventive treatment is planned. The performance of immunodiagnostic tests is highly variable among different groups of immunocompromised individuals. Findings of cross-sectional studies indicate a better diagnostic accuracy of interferon-γ release assays over the tuberculin skin test. The critical issue is that in low-incidence countries, the positive and negative predictive values of any of immunodiagnostic tests were very poor. A targeted testing process involving analysis of TB risk factors increases the predictive positive values of immunodiagnostic tests and may improve LTBI detection.
  
  
  CONCLUSIONS
  The LTBI detection in immunocompromised patients is a challenge. The development of new immunological biomarkers and integrated clinical and epidemiological strategies are needed to identify LTBI in compromised individuals and to plan preventive chemotherapies in those at risk of developing active TB.
authors.affiliation: Department of Public Health and Infectious Diseases, Istituto Pasteur - Fondazione Cenci Bolognetti, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Sauzullo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo
authors.forename: Claudio M
authors.initials: CM
authors.lastname: Mastroianni
mesh_terms: D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D019317:Evidence-Based Medicine; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D059425:Interferon-gamma Release Tests / Q000379:methods; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015203:Reproducibility of Results; D012307:Risk Factors; D014374:Tuberculin Test / Q000379:methods
chemical_list: D015415:Biomarkers