Diagnosis of Latent Tuberculous Infection
Authors: Colin L. Crawford
Journal: Annals of Internal Medicine (2016)

Letters20 September 2016Diagnosis of Latent Tuberculous InfectionColin L. Crawford, MBChBColin L. Crawford, MBChBFrom London, United Kingdom.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0193 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The epithelioid cell in tuberculosis (TB) is secretory and not a macrophage (1). The immune response to Mycobacterium tuberculosis antigens is therefore indirect. Collins and colleagues (2) agree that TB leaves an ‘‘indirect immunologic footprint.’’ Developing a specific diagnostic test using mycobacterial antigens is therefore unlikely.In an autoimmune model of tuberculoid leprosy, skin testing using a human peripheral nerve antigen produced secretory epithelioid cells in which the cytoplasm contained rough endoplasmic reticulum filled with an electron-dense product similar to the epithelioid cells in human TB (3). The antigen is active in doses of 1 µg. In ...References1. Crawford CL. The epithelioid cell in tuberculosis is secretory and not a macrophage [Letter]. J Infect Dis. 2015;212:1172-3. [PMID: 25801654] doi:10.1093/infdis/jiv155 CrossrefMedlineGoogle Scholar2. Collins LF, Geadas C, Ellner JJ. Diagnosis of latent tuberculosis infection: too soon to pull the plug on the tuberculin skin test. Ann Intern Med. 2016;164:122-4. [PMID: 26642354]. doi:10.7326/M15-1522 LinkGoogle Scholar3. Crawford CL, Hardwicke PM, Evans DH, Evans EM. Granulomatous hypersensitivity induced by sensory peripheral nerve. Nature. 1977;265:457-9. [PMID: 834298] CrossrefMedlineGoogle Scholar4. Sheffield EA, Mitchell DN, Dewar A, Corrin B. The ultrastructural features of developing Kveim test granulomas. Sarcoidosis. 1989;6 Suppl 1:6-7. [PMID: 2623379] MedlineGoogle Scholar5. Cella M, Jarrossay D, Facchetti F, Alebardi O, Nakajima H, Lanzavecchia A, et al. Plasmacytoid monocytes migrate to inflamed lymph nodes and produce large amounts of type I interferon. Nat Med. 1999;5:919-23. [PMID: 10426316] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From London, United Kingdom.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=L16-0193. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis of Latent Tuberculosis Infection: Too Soon to Pull the Plug on the Tuberculin Skin Test Lauren F. Collins , Carolina Geadas , and Jerrold J. Ellner Diagnosis of Latent Tuberculous Infection Thomas C. Bailey Diagnosis of Latent Tuberculous Infection Lauren F. Collins , Carolina Geadas , and Jerrold J. Ellner Metrics Cited byExperimental Leprosy Granulomas 20 September 2016Volume 165, Issue 6Page: 447KeywordsAntigensGranulomasHypersensitivityLeprosyLymph nodesNervesNeuronsRabbitsSarcoidosisSkin tests ePublished: 20 September 2016 Issue Published: 20 September 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...