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The Inducible System: History of Development of Immunology as a Component of Host-Parasite Interactions
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Not all of the early attempts to immunize against disease were successful. In 1882, Robert Koch identified the bacillus Mycobacterium tuberculosis as the causative agent of tuberculosis. He attempted to immunize individuals by injecting them with spent medium from cultures of human tubercle bacilli. No immunity resulted from the injection, but a febrile reaction and swelling at the site of the injection occurred twenty-four to forty-eight hours later in people who were harboring the tubercle bacillus. This reaction was later shown to be diagnostic for tuberculosis and it is still widely used today. The type of material Koch used is now called “old tuberculin.” Today we use an extract of old tuberculin called “purified protein derivative” (PPD) to test for tuberculosis, in Koch′s honor the tuberculin reaction was called the Koch phenomenon.
Application of Next-Generation Plant-Derived Nanobiofabricated Drugs for the Management of Tuberculosis
Published in Richard L. K. Glover, Daniel Nyanganyura, Rofhiwa Bridget Mulaudzi, Maluta Steven Mufamadi, Green Synthesis in Nanomedicine and Human Health, 2021
Charles Oluwaseun Adetunji, Olugbenga Samuel Michael, Muhammad Akram, Kadiri Oseni, Ajayi Kolawole Temidayo, Osikemekha Anthony Anani, Akinola Samson Olayinka, Olerimi Samson E, Wilson Nwankwo, Iram Ghaffar, Juliana Bunmi Adetunji
The bacilli spread, as they multiply, by way of lymphatic channels or through the bloodstream to other distant sites of body tissues and organs, including but not limited to the lung apices, vertebrate, peritoneum, meninges, larynx, spleen, liver, lymph nodes and genitourinary tract (CDC, 2013; Dunn et al., 2016). Within 2–8 weeks after the initial infection, the macrophages (special immune cells) ingest the tubercle bacilli and present them to other white blood cells which destroy or encapsulate most of the bacilli, leading to the formation of a barrier shell called granuloma that keeps the bacilli contained and that under control but retain the potential for reactivation. At this point, latent tuberculosis infection (LTBI) has been established. Most patients are asymptomatic within this period and often have no radiologic evidence of TB disease, but they develop cell-mediated immunity, and tests of tuberculosis infection – the tuberculin skin test (TST) or an interferon-gamma (IFN-γ) release assays (IGRAs) – become positive (CDC, 2013; Dunn et al., 2016).
Tuberculosis Epidemic ControlA Comprehensive Strategy to Drive Down Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Salmaan Keshavjee, Tom Nicholson, Aamir J. Khan, Lucica Ditiu, Paul E. Farmer, Mercedes C. Becerra
People who are infected with TB bacteria have a 10% risk of becoming sick with TB disease at some point in their lives. Testing a person for TB infection can be done using the tuberculin skin test (TST) or the interferon gamma-release assay (IGRA) blood test. If a person tests positive for TB infection, then treatment with appropriate preventive therapy can significantly reduce the person's chance of developing active TB disease. Treatment with isoniazid given daily for at least 6 months is the most common regimen for preventive therapy, but there are also other therapies that are shorter, easier to deliver, and shown to be as effective (e.g., isoniazid and rifapentine given once weekly for 3 months).78 Decades of clinical studies have shown that preventive therapy can keep people with TB infection from becoming sick with TB. In adults with TB infection who do not have HIV and have otherwise healthy immune systems, isoniazid preventive therapy can reduce the risk of developing active disease by 60%, and one person will be saved from TB if 35 infected people take isoniazid for 6 months.51
Maintaining a ‘fit’ immune system: the role of vaccines
Published in Expert Review of Vaccines, 2023
Béatrice Laupèze, T. Mark Doherty
Another approach has been to try and evaluate population levels of ‘trained immunity’ using tuberculin immunoreactivity as a proxy. A positive tuberculin test using the Mantoux test, or an interferon gamma release assay is used to identify latent tuberculosis (TB), suggestive of immunity in the absence of active TB disease. A positive Mantoux test can also indicate environmental exposure to Mycobacterium species – including antigens present in the BCG vaccine. Persistence of tuberculin immunoreactivity is associated with reduced mortality from non-TB diseases and has been proposed to estimate the level of ‘trained immunity’ in the population [44]. Population-based data for Europe report the prevalence of latent TB in different countries. An analysis of COVID-19 and the prevalence of latent TB in individual European countries showed a strong negative correlation, with lower rates of COVID-19 cases and mortality in countries where latent TB was more prevalent [44]. These results can only be considered suggestive – the observational study in question highlights the need for careful selection of controls in studies of ‘trained immunity’ given the many types of immune stimuli that can influence the epigenome.
Tuberculin Skin Testing Induces Bilateral Tuberculous Uveitis in a Junior High School Student
Published in Ocular Immunology and Inflammation, 2022
A 12-year-old boy presented with decreased vision in both eyes lasting ten days. At the time of presentation, the best-corrected visual acuity (BCVA) was 20/1000 in both eyes (OU). On slit lamp examination, mild inflammation was seen in the anterior chamber (cells +1 and flare1+) and the vitreous (cells +2). Fundus examination showed multifocal grayish-yellow choroidal tubercles, swelling of the optic disc, and macular edema (Figure 1a,b). Optical coherence tomography (OCT) revealed vitreous cells, serous neurosensory detachment in the fovea, and infiltration of the outer retina and choroid (Figure 1c, d). Twelve days before the onset of symptoms, TST was conducted as part of a school tuberculosis screening program. Two units of tuberculin (TB-PPD, Beijing Sanroad Biological Products Co., Ltd.) were injected into the left forearm using the intradermal technique. At 48 h, the skin reaction was intensely positive, showing an induration of 24 mm. A chest X-ray on the same day was normal. The patient’s past medical history, provided by his parents, was negative. They reported no fever, cough, or night sweat. BCG vaccination was never inoculated. His grandfather had been smear-positive for pulmonary tuberculosis when the current patient was two years old. A chest computed tomography examination was also negative. The results of laboratory examinations, including interferon-gamma release assay (T-SPOT.TB, Oxford Immunotec Co, Oxford, UK), Mycodot, and erythrocyte sedimentation rate, were normal or negative.
The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study
Published in Pathogens and Global Health, 2021
Serife Torun, Sevket Ozkaya, Nazan Şen, Fikret Kanat, Irem Karaman, Sebnem Yosunkaya, Ozlem Sengoren Dikis, Ali Asan, Selma Aydogan Eroglu, Sefa Semih Atal, Omer Ayten, Nimet Aksel, Hilal Ermiş, Neslihan Özçelik, Meryem Demirelli, Iskender Kara, Sua Sümer, Kamile Marakoğlu, Fatih Üzer, Yasin Uyar, Tuba Çiçek, Zuhal E Ünsal, Husamettin Vatansev, Berna Botan Yildirim, Tuba Kuruoğlu, Aynur Atilla, Yasemin Ersoy, Bahar Kandemir, Yasemin Durduran, Fatma Goksin Cihan, Nur Demirbaş, Fatma Yıldırım, Dursun Tatar, M Sule Akcay
On the other side, Urban et al.identified that cross-reactive heterologous cell-mediated adaptive immunity may exist between BCG-Pasteur strain proteome and peptides of SARS-CoV-2 [22]. Singh et al.brought a different perspective into the topic of ‘‘trained immunity” from Mycobacterium spp. exposure or BCG vaccination and COVID-19 outcomes, and suggested that the prevalence of tuberculin immunoreactivity – a measure of cell-mediated immunity persistence as a result of Mycobacterium spp. (including BCG vaccine) exposure of the populations – was consistently negatively correlated with COVID-19 infections and mortality [23]. They also suggested that not the countries’ BCG policies but their cell-mediated tuberculin immunoreactivity prevalence should be argued when assessing the functional potentially protective trained immunity and cell-mediated immunity of a population [23]. These studies together show that immunological responses produced by tuberculosis infection and exposure to M. tuberculosis bacillus without an active infection (including BCG) can be different, and sometime opposite. While infection with tuberculosis bacillus might have inhibitory effects on trained immunity, tuberculin immunoreactivity as a result of Mycobacterium spp. (including BCG vaccine) exposure stimulates it. Therefore, the impact of M. tuberculosis exposure on trained and adaptive immunity and its effect on COVID-19 severity remains to be determined.