TB Infection

  • Guadalupe García-Elorriaga
  • Guillermo del Rey-Pineda
Part of the SpringerBriefs in Microbiology book series (BRIEFSMICROBIOL)


There are currently two available methods for the detection of M. tuberculosis (MTB) infection in the United States. These are: (1) the tuberculin skin test (TST) and (2) the interferon-gamma release assay (IGRA). The TST demonstrates the existence of host hypersensitivity to the tuberculosis bacillus (TB) proteins, usually as a result of MTB infection although it can also be induced with the Calmette–Guérin bacillus (BCG) or infection with environmental mycobacteria. TST provokes an inflammatory reaction with a significant dermal infiltrate at the site of tuberculin inoculation. TST requires the use of 5 PPD units. The result is expressed in terms of millimeters of induration but its interpretation is complex and depends on many variables that may influence not only the size of the reaction but also the development of false negative and false positive results, especially in cases that have been previously immunized with BCG. Until recently, there were no alternatives to TST for LTBI diagnosis. But now, there is the option of a new in vitro test: IGRA. Current evidence suggests that IGRA, especially if based on RD1 antigen cocktails, will potentially be a useful diagnostic test in the clinic and in the public health field. If this potential is attained in practice, it will have to be confirmed in large, well-designed trials and after long-term follow-up.


IGRA Immune response Patient immunosuppressed TB infection TST Tuberculin 


  1. 1.
    Achkar JM, Chan J, Casadevall A. B cells and antibodies in the defense against Mycobacterium tuberculosis infection. Immunol Rev. 2015;264:167–81.PubMedCrossRefGoogle Scholar
  2. 2.
    American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors. July 1999. This statement was endorsed by the Council of the Infectious Disease of America, September 1999. Am J Respir Crit Care Med. 2000a;161:1376–95.Google Scholar
  3. 3.
    American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the Board of Directors, July 1999. This is a joint statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America (IDSA), September 1999, and the sections of this statement as it relates to infants and children were endorsed by the American Academy of Pediatrics (AAP), August 1999. Am J Respir Crit Care Med. 2000b;161(4 Pt 2):221–47.Google Scholar
  4. 4.
    Arias Guillén M. Advances in the diagnosis of tuberculosis infection. Arch Bronconeumol. 2011;47:521–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Cliff JM, Kaufmann SHE, McShane H, Van Helden P, O’Garra A. The human immune response to tuberculosis and its treatment: a view from the blood. Immunol Rev. 2015;264:88–102.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Craviotto FG, Limongi L. Controversias en el uso del derivado proteico purificado de tuberculina (PPD) y las nuevas técnicas en la detección in vitro de los niveles de interferón gamma (IGRAs) en un país con alta tasa de infección por tuberculosis. Rev Am Med Respir. 2012;2:44–53.Google Scholar
  7. 7.
    García-Elorriaga G, Martínez-Velázquez M, Gaona-Flores V, Del Rey-Pineda G, González-Bonilla C. Interferon γ in patients with HIV/AIDS and suspicion or latent tuberculosis infection. Asian Pac J Trop Med. 2013;6:135–8. doi: 10.1016/S1995-7645(13)60009-7.PubMedCrossRefGoogle Scholar
  8. 8.
    Jasenosky LD, Scriba TJ, Hanekom WA, Goldfeld AE. T cells and adaptive immunity to Mycobacterium tuberculosis in humans. Immunol Rev. 2015;264:74–87.PubMedCrossRefGoogle Scholar
  9. 9.
    Majlessi L, Prados-Rosales R, Casadevall A, Brosch R. Release of mycobacterial antigens. Immunol Rev. 2015;264:25–45.PubMedCrossRefGoogle Scholar
  10. 10.
    Mayer-Barber KD. Cytokine and lipid mediator networks in tuberculosis. Immunol Rev. 2015;264:264–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Nathan C. What can immunology contribute to the control of the world’s leading cause of death from bacterial infection? Immunol Rev. 2015;264:2–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Guadalupe García-Elorriaga
    • 1
  • Guillermo del Rey-Pineda
    • 2
  1. 1.Mexican Social Security Institute, IMSSNational Medical Center La Raza, CMNRMexico CityMexico
  2. 2.Department of InfectologyFederico Gomez Children’s HospitalMexico CityMexico

Personalised recommendations