Author/Editor		Skralovnik-Štern, Aleksandra; Škoberne, Mojca; Malovrh, Tadej; Terčelj, Marjeta; Turel, Matjaž
Title		Novejši pogledi na tuberkulinski test
Translated title		Tuberculin test - new aspects
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 38, št. Suppl 7
Publication year		1999
Volume		str. 113-9
Language		slo
Abstract		Host immunity plays an important role in the host-pathogen interaction occuring in persons exposed to Mycobacterium tuberculosis. In the last few years, numerous in vitro studies made it possible to define the type and number of cells which produce cytokines, the interactions between them and to reveal the concentrations in which cytokines are produced. In clinical practice there is a recognized need for a better, faster, more sensitive and evaluable in vitro tuberculin test which would require no return visit for skin test reading and no painful local reactions. In 11 healthy persons, interferon gamma assay and a novel CD 69 antigen determination after stimulation of whole blood with PPD correlate with their tuberculin skin tests. It takes only 24 hours to obtain the results. Blast transformation test, the fundamental test for the evaluation of the role of lymphocytes in vitro, also correlates with the interferon gamma assay and CD 69 antigen determination. Further studies are planned to adress the issue of sensitivity and specificity, especially in immunosupressed patients (these are patients after transplantation, those receiving immunosupressive drugs and those infected with HIV). Systemic effects of tuberculin, well known from Koch's experiments with intradernal challenge of tuberculosis patients with large quantities of tuberculin, are of interest again. Booster effect - the phenomenon of increased tuberculin skin reaction upon retesting after a few days - is believed to result from the reactivation of the preexisting delayed type hypersensitivity and indicates the systemic effects of tuberculin skin tests which are believed to be safe and often repeatable.
Summary		Pri okužbi z Mycobacterium tuberculosis stopa v ospredje vloga imunskega odziva gostitelja. V zadnjih letih vse številnejši in vitro imunološki testi omogočajo podrobnejši vpogled v reakcije in opredelitev vrste, števila in koncentracije vpletenih celic in številnih citokinov. V praksi je zlasti zaželen boljši, hitrejši, občutljivejši in bolje merljiv in vitro tuberkulinski test. Preiskovancem se ni treba vračati na odčitavanje, možnih bolečin lokalnih reakcij ni. Pri 11 zdravih preiskovancih smo ugotovili, da določanje interferona gama in na novo uvedeno določanje antigena CD 69 v venski krvi, stimulirani s PPD (angl. Purified protein derivate), merita iste pojave kot kožni tuberkulinski test. Rezultati so dostopni že dan po odvzemu krvi. Oba testa sta primerljiva s testom blastnega preoblikovanja limfocitov, temeljnim testom, s katerim merimo dejavnosti limfocitov in vitro. Potrebne so nadaljnje raziskave specifičnosti in občutljivosti obeh testov. Zlasti pri imunosuprimiranih (transplantiranci in drugi bolniki, ki dobivajo imunosupresivno delujoča zdravila, ter bolniki, okuženi s HIV) je dobrodošel bolj občutljiv test. Znova je postal zanimiv vpliv aplikacije višjih koncentracij tuberkulina na imunski odziv pri bolnikih s tuberkulozo - Kochov fenomen. Booster učinek - pozitivni tuberkulinski test po retestiranju šele čez nekaj dni - razlagajo z vzpodbuditvijo že prej prisotne pozne preobčutljivosti in nakazuje sistemski učinek kožnega tuberkulinskega testa, ki ga sicer štejemo za povsem neškodljivega in velikokrat ponovljivega.
Descriptors		TUBERCULIN TEST TUBERCULOSIS ANTIGENS, CD LYMPHOCYTE TRANSFORMATION