Volume 65, Issue 5, Pages (May 2004)

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Volume 65, Issue 5, Pages 1826-1834 (May 2004) Tuberculin skin testing underestimates a high prevalence of latent tuberculosis infection in hemodialysis patients Martina Sester, Urban Sester, Peter Clauer, Gunnar Heine, Ulrich Mack, Thomas Moll, Gerhard W. Sybrecht, Ajit Lalvani, Hans Köhler Kidney International Volume 65, Issue 5, Pages 1826-1834 (May 2004) DOI: 10.1111/j.1523-1755.2004.00586.x Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 1 Flow-cytometric quantitation of purified protein derivative (PPD)-specific CD4T cells. Representative dot plots of individuals with (A) or without (B) detectable specific T-cell reactivity toward PPD. Whole blood was stimulated with control antigen (diluent) or PPD and specifically induced interferon γ (IFNγ) induction in CD4T cells was analyzed using flow cytometry. Numbers indicate the percentage of specifically stimulated CD4T cells. Kidney International 2004 65, 1826-1834DOI: (10.1111/j.1523-1755.2004.00586.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 2 Heterogeneous frequencies of purified protein derivative (PPD)-specific CD4T cells in immunocompetent individuals (N = 52, control patients) and hemodialysis patients (N = 68, HD patients) with PPD-specific T-cell reactivity. Neither median T-cell frequencies nor the frequency distribution differed between control individuals (median 0.17%, range from >0.05% to 3.75%) and hemodialysis patients (median 0.26%, range from >0.05% to 4.12%; P = 0.28). Kidney International 2004 65, 1826-1834DOI: (10.1111/j.1523-1755.2004.00586.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 3 Phenotypic characterization of purified protein derivative (PPD)-specific CD4T cells. Dot plots of the flow-cytometric analysis of CD45RO and CD27 expression among cytokine-positive CD4T cells after stimulation with PPD (A). Numbers denote the frequencies of activated (CD69-positive) interferon γ (INFγ) or tumor necrosis factorα (TNFα)-positive T cells among all CD4T cells (upper panel), or the percentage of CD27- or CD45RO-positive T cells among cytokine-positive cells (lower panel). A significant correlation exists between the percentage of PPD-specific CD4T cells producing IFNγ or TNFα, respectively (r = 0.96, P < 0.0001; N = 134) (B). Kidney International 2004 65, 1826-1834DOI: (10.1111/j.1523-1755.2004.00586.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 4 Correlation between induration and purified protein derivative (PPD)-specific T-cell frequencies. A significant correlation exists between the frequency of PPD-specific CD4T cells and the induration in skin test in control individuals (A) (health care workers and immunocompetent control patients, r = 0.72, P < 0.0001, N = 56) and hemodialysis patients (r = 0.64, P < 0.0001, N = 63) (B). Kidney International 2004 65, 1826-1834DOI: (10.1111/j.1523-1755.2004.00586.x) Copyright © 2004 International Society of Nephrology Terms and Conditions

Figure 5 Identification of latently infected individuals using the early secretory antigenic target-6 (ESAT-6) antigen. Representative dot plots of individuals with or without a specific T-cell reactivity toward purified protein derivative (PPD) or ESAT-6 (A-C). Whole blood was stimulated with control antigen (diluent, not shown), PPD, or ESAT-6, and specifically induced interferon γ (IFNγ) induction in CD4T cells was analyzed using flow cytometry. Numbers indicate the percentage of specifically stimulated CD4T cells. Specific T-cell frequencies toward ESAT-6 were analyzed in 36 PPD-positive hemodialysis patients, and 18 individuals had ESAT-6–specific T cells above 0.05% (D). T-cell frequencies toward PPD and ESAT-6 showed a significant correlation (r = 0.70, P < 0.0001). Kidney International 2004 65, 1826-1834DOI: (10.1111/j.1523-1755.2004.00586.x) Copyright © 2004 International Society of Nephrology Terms and Conditions