       Document 0363
 DOCN  M9460363
 TI    Rapid, early and specific diagnosis of tuberculosis and other
       mycobacterial diseases in Burundi.
 DT    9404
 AU    Barihuta T; Rigouts L; Barette M; Collart JP; De Bruyn J; Kadende P;
       Kamamfu G; Douglas JT; Portaels F; Centre Hospitalo Universitaire
       Kamenge, Bujumbura, Burundi.
 SO    Ann Soc Belg Med Trop. 1993;73 Suppl 1:41-51. Unique Identifier :
       AIDSLINE MED/94175628
 AB    The potential usefulness of ELISA based serological tests to assist in
       rapid, early and specific diagnosis of tuberculosis was investigated.
       The materials were selected, based on published data and on our
       preliminary findings. Initially screening tests were performed using
       crude antigens such as Purified Protein Derivate (PPD) and a
       BCG-filtrate. Unfortunately, the results with these antigens were not
       promising. The specificity of both antigens using sera from 94 healthy
       controls was 64%. As a consequence of these findings, the crude antigens
       were excluded from further tests, and the study was continued with
       purified antigens. The work focused on 2 purified proteins: Antigen 60
       (A60), a lipopolysaccharide-protein complex, and P32, a stress protein
       produced in zinc deprived cultures, identified as Antigen 85 A in the
       BCG reference system, both isolated from Mycobacterium bovis BCG. The
       commercial A60 based ELISA and our own P32 based ELISA were used to test
       a total of 300 sera from HIV positive, negative and unscreened
       individuals, mainly originating from Burundi. These sera were collected
       from clinical established cases of pulmonary TB, extrapulmonary TB, and
       patients with non-tuberculous tropical diseases such as salmonellosis,
       trypanosomiasis, malaria, etc. and healthy individuals. The A60 based
       ELISA had a sensitivity of 76.8% for the proven cases of active
       pulmonary tuberculosis and 61.9% for the extrapulmonary tuberculosis
       cases. No difference was shown between HIV positive and HIV negative
       patients. Specificity reached 95.2% for healthy individuals, but dropped
       to 68.1% when persons with active non-tuberculous tropical diseases were
       included. Eighty-six percent of the pulmonary cases and 87.7% of the
       extrapulmonary cases were detected by the ELISA-P32. These findings
       suggest that this test might be useful as a confirmatory test for the
       diagnosis of extrapulmonary tuberculosis. Again no difference was
       noticed between HIV negative and positive patients. The main
       contraindication for the use of the ELISA-P32 for the diagnosis of
       tuberculosis is its low specificity: 70.2% with sera from healthy
       controls and 22.2% for hospitalised patients and persons with
       non-tuberculous tropical diseases. In a small recent prospective study 4
       out of 10 HIV+ persons with no evidence for TB yielded a positive result
       for the ELISA-P32. Two of them developed pulmonary tuberculosis within 6
       months, whereas 2 P32-positives and 6 P32-negatives remained up to now
       without any manifestations of tuberculosis. The difference was not
       significant, but the number of cases was limited.(ABSTRACT TRUNCATED AT
       400 WORDS)
 DE    Antigens, Bacterial/*ISOLATION & PURIF  Burundi  Enzyme-Linked
       Immunosorbent Assay/METHODS  Human  HIV Seronegativity  HIV
       Seropositivity  Mycobacterium tuberculosis/*IMMUNOLOGY  Sensitivity and
       Specificity  Support, Non-U.S. Gov't  Tuberculosis/IMMUNOLOGY
       Tuberculosis, Pulmonary/IMMUNOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

