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 Table of Contents  
COMMENTARY
Year : 2018  |  Volume : 2  |  Issue : 1  |  Page : 85-86

Commentary on “Maes R. Tuberculosis serology is useful in rural areas: BBRJ 2017;1(2):85-93”


1 JB Tropical Disease Research Centre, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
2 Bioinformatics Centre, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Web Publication5-Mar-2018

Correspondence Address:
Dr. Bhaskar C Harinath
JB Tropical Disease Research Centre, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha - 442 102, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_100_17

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How to cite this article:
Harinath BC, Jena L. Commentary on “Maes R. Tuberculosis serology is useful in rural areas: BBRJ 2017;1(2):85-93”. Biomed Biotechnol Res J 2018;2:85-6

How to cite this URL:
Harinath BC, Jena L. Commentary on “Maes R. Tuberculosis serology is useful in rural areas: BBRJ 2017;1(2):85-93”. Biomed Biotechnol Res J [serial online] 2018 [cited 2020 Apr 3];2:85-6. Available from: http://www.bmbtrj.org/text.asp?2018/2/1/85/226571



The review on levels of serum immunoglobulins (IgG, IgM, and IgA) in tuberculosis (TB) before and during treatment, and in particular, latent infection is very informative and useful. Further, the immunosuppressive effect of drugs, relapse, and resistance cases do influence the immunoglobulin levels. Assay of IgG subclasses is likely to make the test more specific to active infection.[1] The need for exploration and development of serum-circulating and immunocomplexed antigen assay associated with pathogen shows promise for better diagnosis and should have been emphasized for promoting serological research.[2],[3],[4],[5],[6] Individual immune status plays an important role in elimination or worsening of TB infection as observed in our study.[7] The assessment of TB serology in Bacillus Calmette-Guérin-vaccinated infants briefly reviewed by Maes will be of interest in monitoring TB vaccination studies for control of TB.[8] Childhood TB poses greater diagnostic challenge than adult TB. Serum antibodies can be detected by simple formats that can provide extremely rapid results. Based on the study of antibody responses to mycobacterial antigens, Achkar and Ziegenbalg suggested potential adjunctive value of serodiagnosis in the diagnosis of childhood TB.[9] Lagrange et al. conducted a multicentric prospective study in India to assess the accuracy of a serological test as an additional tool for diagnosing active TB (ATB). In particular, they compared an assay based on enzyme-linked immunosorbent assay (ELISA) using a phenolic glycolipid-TB 1 or a fusion protein (early secretory antigenic target-6/culture filtrate protein 10) to the tuberculin skin test and the microbiological results according to human immunodeficiency virus (HIV) status. After analyzing the ELISA results with the microbiological results, they observed that the sensitivity of both serology tests was independent of the ATB patients' smear microscopy (SM) status and grade. Combining the results of SM with both ELISA, the detection of ATB patients significantly increased (P < 0.0001), particularly in those with extrapulmonary TB (EPTB) (up to 45.1%) or HIV infection (up to 83.3%). Further, they concluded that the combination of two rapid tests, such as SM and serology, might be useful in detecting ATB, especially in HIV-infected patients.[10] Shende et al. performed tuberculous excretory–secretory (ES) 31 and ES-20 antigens in different pathogenic grades of lymph node TB and showed promise of serology in detecting ATB in HIV-infected patients.[7]

The story of boosting of the Xpert/rifampicin test for drug-resistant TB and its endorsement for EPTB and PTB in children with patronage of the World Health Organization (WHO) is thoroughly exposed.[11] The ban on TB serological test and its publicity in newspapers are not justified unless with ulterior motive of elimination of opposition from serology. People and laboratories should have been educated, discussed by intellectuals in seminars on the positive and negative aspects of serology than drastic recommendation of banning a diagnostic test in haste for the first time by the WHO does not reflect well on its wisdom. It is unfortunate that the effect of ban on serological tests on the actual status of TB diagnosis in the rural hospital and the misuse of gamma interferon assay for ATB infection is not monitored. After ban of TB serodiagnostics by the WHO, it is encouraging to see the report of five promising novel protein biomarkers for the rapid serodiagnosis of PTB and EPTB by Singh et al.[12] Another study by Jones et al. also identified few promising lipid antigen candidates for serological assays that could be used to diagnose PTB.[13]

In the interest of developing doctor-friendly diagnostic test, it is time to reconsider the hastily taken decision by the WHO and support research to explore serological tests for subclasses of immunoglobulins and circulating and immunocomplexed antigens showing promise in TB diagnosis. Tests for immunomonitoring during chemotherapy will also help the clinicians in the assessment of therapy and prognosis of disease in rural areas, in particular, for successful management of patients with PTB, EPTB, and HIV-TB coinfections.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gupta S, Shende N, Bhatia AS, Kumar S, Harinath BC. IgG subclass antibody response to mycobacterial serine protease at different stages of pulmonary tuberculosis. Med Sci Monit 2005;11:CR585-8.  Back to cited text no. 1
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2.
Shende N, Gupta S, Kumar S, Harinath BC. Levels of antibody, free antigen and immune-complexed antigen by ELISA in different grades of sputum positive patients of pulmonary tuberculosis. Indian J Pathol Microbiol 2004;47:438-40.  Back to cited text no. 2
    
3.
Shende N, Gupta S, Bhatia AS, Kumar S, Harinath BC. Detection of free and immune-complexed serine protease and its antibody in TB patients with and without HIV co-infection. Int J Tuberc Lung Dis 2005;9:915-9.  Back to cited text no. 3
    
4.
Waghmare P, Wankhade G, Mazumdar A, Wandile K, Badole CM, Harinath BC. SEVA TB ELISA – Multi antigen and antibody assays for serodiagnosis of suspected cases of pulmonary and extra pulmonary tuberculosis in tertiary care hospital – A retrospective study. Asian Pac J Trop Dis 2012;2:S827-32.  Back to cited text no. 4
    
5.
Waghmare P, Wankhade G, Jena L, Harinath BC. Excretory secretory proteins released during growth of Mycobacterium tuberculosis (H37Ra), with diagnostic potential in pulmonary and extra pulmonary tuberculosis. Mycobact Dis 2016;6:215.  Back to cited text no. 5
    
6.
Kashyap RS, Rajan AN, Ramteke SS, Agrawal VS, Kelkar SS, Purohit HJ, et al. Diagnosis of tuberculosis in an Indian population by an indirect ELISA protocol based on detection of Antigen 85 complex: A prospective cohort study. BMC Infect Dis 2007;7:74.  Back to cited text no. 6
    
7.
Shende N, Upadhye V, Kumar S, Gangane N, Harinath BC. Study of M. Tuberculosis ES-31 and ES-20 antigen levels in different pathogenic grades of lymph node tuberculosis. Int J Tuberc Lung Dis 2007;11:222-6.  Back to cited text no. 7
    
8.
Maes R. Tuberculosis serology is useful in rural areas. Biomed Biotechnol Res J 2017;1:85-93.  Back to cited text no. 8
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9.
Achkar JM, Ziegenbalg A. Antibody responses to mycobacterial antigens in children with tuberculosis: Challenges and potential diagnostic value. Clin Vaccine Immunol 2012;19:1898-906.  Back to cited text no. 9
    
10.
Lagrange PH, Thangaraj SK, Dayal R, Deshpande A, Ganguly NK, Girardi E, et al. Atoolbox for tuberculosis (TB) diagnosis: An Indian multi-centric study (2006-2008); evaluation of serological assays based on PGL-tb1 and ESAT-6/CFP10 antigens for TB diagnosis. PLoS One 2014;9:e96367.  Back to cited text no. 10
    
11.
Harinath BC. Tuberculosis serodiagnostics: Ban and after. Int J Mycobacteriol 2017;6:323-5.  Back to cited text no. 11
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12.
Singh A, Kumar Gupta A, Gopinath K, Sharma P, Singh S. Evaluation of 5 novel protein biomarkers for the rapid diagnosis of pulmonary and extra-pulmonary tuberculosis: Preliminary results. Sci Rep 2017;7:44121.  Back to cited text no. 12
    
13.
Jones A, Pitts M, Al Dulayymi JR, Gibbons J, Ramsay A, Goletti D, et al. New synthetic lipid antigens for rapid serological diagnosis of tuberculosis. PLoS One 2017;12:e0181414.  Back to cited text no. 13
    




 

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