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Published ahead of print on May 6, 2004, doi:10.1164/rccm.200403-307OC
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American Journal of Respiratory and Critical Care Medicine Vol 170. pp. 288-295, (2004)
© 2004 American Thoracic Society

Original Article

T Cell–Based Tracking of Multidrug Resistant Tuberculosis Infection after Brief Exposure

Luca Richeldi, Katie Ewer, Monica Losi, Barbara M. Bergamini, Pietro Roversi, Jonathan Deeks, Leonardo M. Fabbri and Ajit Lalvani

Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital; Centre for Statistics in Medicine, Institute of Health Sciences, Oxford, United Kingdom; Respiratory Disease and Pediatric Clinics, University of Modena and Reggio Emilia; and Azienda Ospedaliera Policlinico di Modena, Modena, Italy

Molecular epidemiology indicates significant transmission of Mycobacterium tuberculosis after casual contact with infectious tuberculosis cases. We investigated M. tuberculosis transmission after brief exposure using a T cell–based assay, the enzyme-linked-immunospot (ELISPOT) for IFN-{gamma}. After childbirth, a mother was diagnosed with sputum smear-positive multidrug-resistant tuberculosis. Forty-one neonates and 47 adults were present during her admission on the maternity unit; 11 weeks later, all underwent tuberculin skin testing (TST) and ELISPOT. We correlated test results with markers of exposure to the index case. The participants, who were asymptomatic and predominantly had no prior tuberculosis exposure, had 6.05 hours mean exposure (range: 0–65 hours) to the index case. Seventeen individuals, including two newborns, were ELISPOT-positive, and ELISPOT results correlated significantly with three of four predefined measures of tuberculosis exposure. For each hour sharing room air with the index case, the odds of a positive ELISPOT result increased by 1.05 (95% CI: 1.02–1.09, p = 0.003). Only four adults were TST-positive and TST results did not correlate with exposure. Thus, ELISPOT, but not TST, suggested quite extensive nosocomial transmission of multidrug-resistant M. tuberculosis after brief exposure. These results help to explain the apparent importance of casual contact for tuberculosis transmission, and may have implications for prevention.

Key Words: contact tracing • nosocomial • T cell • tuberculin skin test • tuberculosis




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