Evaluation of the QuantiFERON®-TB Gold In-Tube Assay and Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in an Iranian Referral Hospital

Author(s): Babak Pourakbari, Korosh Yousefi, Shima Mahmoudi, Reihaneh H. Sadeghi, Setareh Mamishi*.

Journal Name: Infectious Disorders - Drug Targets
(Formerly Current Drug Targets - Infectious Disorders)

Volume 19 , Issue 2 , 2019

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Graphical Abstract:


Abstract:

Background: Mycobacterium tuberculosis remains as a vital threat to global health and its diagnosis is still complicated. Since there is no gold standard for the diagnosis of latent tuberculosis infection (LTBI), its diagnosis routinely relies on measurement of host immune responses to M. tuberculosis antigens using the Tuberculin Skin Test (TST) and Interferon-Y Release Assays (IGRAs).

Objective: The aim of this study was to evaluate LTBI among hospitalized children and their parents/ guardians as general populations.

Methods: A cross-sectional study comparing TST and IGRA for the diagnosis of suspected LTBI was performed in children and their guardians (as general population) in Children Medical Center, an Iranian referral hospital.

Results: In this study, 81 patients hospitalized in CMC and 102 patient's guardians were included. A total of 57 patients (70.4%) had performed a TST and were interpreted during the study. Among them, 32 (56%) had a positive test result when a cut-off of 10 mm induration. There were fewer positive IGRA test results than positive TST results (33% versus 56%) in children. Among guardians, TST and IGRA were positive in 41% and 40% respectively. The agreement between the IGRA test and the TST among them was 0.7, while this was as slightly lower in children (0.63).

Conclusion: The results of our study indicate that the IGRA test has a higher specificity than TST, especially in children, while the frequency of positive results with both tests in adults was similar. Considering the false positive results reported with the TST, replacement of the IGRA test with TST in children is recommended.

Keywords: Latent tuberculosis infection, children, adults, TST, IGRA, mycobacterium.

[1]
Mamishi, S.; Pourakbari, B.; Marjani, M.; Mahmoudi, S. Diagnosis of latent tuberculosis infection among immunodeficient individuals: review of concordance between interferon-gamma release assays and the tuberculin skin test. Br. J. Biomed. Sci., 2014, 71(3), 115-124.
[2]
Auguste, P.; Tsertsvadze, A.; Pink, J.; Court, R.; McCarthy, N.; Sutcliffe, P.; Clarke, A. Comparing interferon-gamma release assays with tuberculin skin test for identifying latent tuberculosis infection that progresses to active tuberculosis: systematic review and meta-analysis. BMC Infect. Dis., 2017, 17(1), 200.
[3]
Goletti, D.; Carrara, S.; Vincenti, D.; Saltini, C.; Rizzi, E.B.; Schininà, V.; Ippolito, G.; Amicosante, M.; Girardi, E. Accuracy of an immune diagnostic assay based on RD1 selected epitopes for active tuberculosis in a clinical setting: a pilot study. Clin. Microbiol. Infect., 2006, 12(6), 544-550.
[4]
Tesfa, L.; Koch, F.W.; Pankow, W.; Volk, H.D.; Kern, F. Confirmation of Mycobacterium tuberculosis infection by flow cytometry after ex vivo incubation of peripheral blood T cells with an ESAT-6-derived peptide pool. Cytometry B Clin. Cytom., 2004, 60(1), 47-53.
[5]
Pai, M.; Riley, L.W.; Colford, J.M., Jr Interferon-γ assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect. Dis., 2004, 4(12), 761-776.
[6]
Biselli, R.; Mariotti, S.; Sargentini, V.; Sauzullo, I.; Lastilla, M.; Mengoni, F.; Vanini, V.; Girardi, E.; Goletti, D.; D’ Amelio, R.; Nisini, R. Detection of interleukin-2 in addition to interferon-gamma discriminates active tuberculosis patients, latently infected individuals, and controls. Clin. Microbiol. Infect., 2010, 16(8), 1282-1284.
[7]
Olivieri, R.; Scarnera, S.; Ciabattini, A.; De Vuono, G.; Manzi, P.; Pozzi, G.; Battista, G.; Medaglini, D. Using IFN-gamma release assay to confirm tuberculin skin test improves the screening of latent tuberculosis infection in Italian healthcare workers. J. Occup. Med. Toxicol., 2016, 11, 29.
[8]
Vinton, P.; Mihrshahi, S.; Johnson, P.; Jenkin, G.A.; Jolley, D.; Biggs, B.A. Comparison of QuantiFERON-TB Gold In-Tube Test and tuberculin skin test for identification of latent Mycobacterium tuberculosis infection in healthcare staff and association between positive test results and known risk factors for infection. Infect. Control Hosp. Epidemiol., 2009, 30(3), 215-221.
[9]
Bergamini, B.M.; Losi, M.; Vaienti, F.; D’Amico, R.; Meccugni, B.; Meacci, M.; De Giovanni, D.; Rumpianesi, F.; Fabbri, L.M.; Balli, F.; Richeldi, L. Performance of commercial blood tests for the diagnosis of latent tuberculosis infection in children and adolescents. Pediatrics, 2009, 123(3), e419-e424.
[10]
Mazurek, G.H.; LoBue, P.A.; Daley, C.L.; Bernardo, J.; Lardizabal, A.A.; Bishai, W.R.; Iademarco, M.F.; Rothel, J.S. Comparison of a whole-blood interferon gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection. JAMA, 2001, 286(14), 1740-1747.
[11]
Connell, T.G.; Curtis, N.; Ranganathan, S.C.; Buttery, J.P. Performance of a whole blood interferon gamma assay for detecting latent infection with Mycobacterium tuberculosis in children. Thorax, 2006, 61(7), 616-620.
[12]
Yun, K.W.; Kim, Y.K.; Kim, H.R.; Lee, M.K.; Lim, I.S. Usefulness of interferon-γ release assay for the diagnosis of latent tuberculosis infection in young children. Korean J. Pediatr., 2016, 59(6), 256-261.
[13]
Dogra, S.; Narang, P.; Mendiratta, D.K.; Chaturvedi, P.; Reingold, A.L.; Colford, J.M., Jr; Riley, L.W.; Pai, M. Comparison of a whole blood interferon-gamma assay with tuberculin skin testing for the detection of tuberculosis infection in hospitalized children in rural India. J. Infect., 2007, 54(3), 267-276.
[14]
van Pinxteren, L.A.; Ravn, P.; Agger, E.M.; Pollock, J.; Andersen, P. Diagnosis of tuberculosis based on the two specific antigens ESAT-6 and CFP10. Clin. Diagn. Lab. Immunol., 2000, 7(2), 155-160.
[15]
Pavić, I.; Katalinić-Janković, V.; Čepin-Bogović, J.; Rešić, A.; Dodig, S. Discordance Between Tuberculin Skin Test and Interferon-γ Release Assay in Children Younger Than 5 Years Who Have Been Vaccinated With Bacillus Calmette-Guérin. Lab. Med., 2015, 46(3), 200-206.
[16]
Bagheri Amiri, F.; Saifi, M.; Gouya, M.M.; Rohani, M.; Mostafavi, E. Comparison of an interferon-gamma release assay and the tuberculin skin test for diagnosis of latent tuberculosis in homeless people in Iran: a cross-sectional study. Infect. Dis. (Lond.), 2015, 47(8), 536-541.
[17]
Jang, J.Y.; Park, I.W.; Choi, B.W.; Choi, J.C. The Usefulness of the Tuberculosis Skin Test and the Interferon-gamma Release Assay in the Diagnosis of Latent Tuberculosis Infection in South Korea. Osong Public Health Res. Perspect., 2014, 5(Suppl.), S18-S23.
[18]
Song, S.E.; Yang, J.; Lee, K.S.; Kim, H.; Kim, Y.M.; Kim, S.; Park, M.S.; Oh, S.Y.; Lee, J.B.; Lee, E.; Park, S.H.; Kim, H.J. Comparison of the tuberculin skin test and interferon gamma release assay for the screening of tuberculosis in adolescents in close contact with tuberculosis TB patients. PLoS One, 2014, 9(7)e100267
[19]
Diel, R.; Loddenkemper, R.; Niemann, S.; Meywald-Walter, K.; Nienhaus, A. Negative and positive predictive value of a whole-blood interferon-γ release assay for developing active tuberculosis: an update. Am. J. Respir. Crit. Care Med., 2011, 183(1), 88-95.
[20]
Dheda, K.; van Zyl Smit, R.; Badri, M.; Pai, M. T-cell interferon-gamma release assays for the rapid immunodiagnosis of tuberculosis: clinical utility in high-burden vs. low-burden settings. Curr. Opin. Pulm. Med., 2009, 15(3), 188-200.
[21]
Mandalakas, A.M.; Detjen, A.K.; Hesseling, A.C.; Benedetti, A.; Menzies, D. Interferon-gamma release assays and childhood tuberculosis: systematic review and meta-analysis. Int. J. Tuberc. Lung Dis., 2011, 15(8), 1018-1032.
[22]
Adetifa, I.M.; Ota, M.O.; Jeffries, D.J.; Hammond, A.; Lugos, M.D.; Donkor, S.; Patrick, O.; Adegbola, R.A.; Hill, P.C. Commercial interferon gamma release assays compared to the tuberculin skin test for diagnosis of latent Mycobacterium tuberculosis infection in childhood contacts in the Gambia. Pediatr. Infect. Dis. J., 2010, 29(5), 439-443.


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Article Details

VOLUME: 19
ISSUE: 2
Year: 2019
Page: [141 - 144]
Pages: 4
DOI: 10.2174/1871526518666180228164036
Price: $58

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