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Ghanaie RM, Karimi A, Azimi L, James S, Nasehi M, Mishkar AP, Sheikhi M, Fallah F, Tabatabaei SR, Hoseini-Alfatemi SM. Diagnosis of latent tuberculosis infection among pediatric household contacts of Iranian tuberculosis cases using tuberculin skin test, IFN- γ release assay and IFN-γ-induced protein-10. BMC Pediatr 2021; 21:76. [PMID: 33573613 PMCID: PMC7877026 DOI: 10.1186/s12887-021-02524-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although the World Health Organization has recommended the diagnosis and prophylactic treatment of latent tuberculous infection (LTBI) in child household contacts of tuberculosis (TB) cases, the national programs in high-burden TB regions rarely implement adequate screening of this high-risk group, mainly because of resource limitations. We aimed to evaluate the prevalence of LTBI among pediatric household contacts of TB cases in two high-burden provinces in Iran. METHODS We conducted a cohort study in children who had been in household contact with a TB index. All subjects were assessed for active TB disease. For LTBI diagnosis, tuberculin skin test (TST) and QuantiFERON®-TB Gold Plus (QFT-Plus) were performed at the time of the index TB case diagnosis, as well as, 3, 12, and 18 months, if the first results were negative. In addition, interferon-γ-induced protein-10(IP-10) concentrations were measured for all participants. RESULTS A total of 230 children were enrolled, who had contact with an index TB case. Three contacts were diagnosed with active TB. According to the TST/QFT-Plus results, 104 (45.2%) children were identified with LTBI during our study. Significantly increased IP-10 levels were found in LTBI patients compared to healthy contacts. Accordingly, more than 50% of LTBI contacts and about 10% of healthy contacts were considered as IP-10-positive. CONCLUSION This study alarmingly illustrates a high prevalence of LTBI among Iranian children exposed to TB cases. We, therefore, emphasize that the children living in close contact with an infectious TB case should be screened effectively and receive prophylactic therapy.
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Affiliation(s)
- Roxana Mansour Ghanaie
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdollah Karimi
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Azimi
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seddon James
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - Mahshid Nasehi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahnaz Sheikhi
- TB Coordinator of Deputy Health, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Fatemeh Fallah
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Rafiei Tabatabaei
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mahsan Hoseini-Alfatemi
- Pediatric Infections Research Center (PIRC), Research Institute for Children's Health (RICH), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Doosti-Irani A, Ayubi E, Mostafavi E. Tuberculin and QuantiFERON-TB-Gold tests for latent tuberculosis: a meta-analysis. Occup Med (Lond) 2016; 66:437-445. [PMID: 27121635 DOI: 10.1093/occmed/kqw035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Up to now, there has been no universal consensus on the agreement between the tuberculin skin test (TST) and the QuantiFERON-TB-Gold test (QFT) in the detection of latent tuberculosis infection (LTBI) among high-risk populations. AIMS To estimate the agreement between TST and QFT among health care workers (HCWs). METHODS A meta-analysis in which all major electronic databases, including Medline, Scopus, Web of Sciences and Ovid, were searched until June 2014. All cross-sectional and cohort studies addressing the agreement between TST and the QFT were included. The extracted data were analysed and the results were reported using random effect models. RESULTS The overall kappa statistic between TST and the QFT was 0.27 [95% confidence interval (CI) 0.22, 0.32] and the adjusted kappa statistic for prevalence and bias was 0.41 (95% CI 0.32, 0.50). The kappa for subjects with and without bacillus Calmette-Guérin (BCG) vaccination was 0.27 (95% CI 0.18, 0.36) and 0.31 (95% CI 0.15, 0.46) respectively. The figures were 0.30 (95% CI 0.16, 0.43) and 0.82 (95% CI 0.74, 0.90) for prevalence-adjusted and bias-adjusted kappa, respectively. CONCLUSIONS The overall agreement between TST and QFT in the detection of LTBI among HCWs was poor. After adjusting for the prevalence and bias indices, kappa statistics reached fair agreement. The utility of each of these two tests is dependent on the prevalence and burden of tuberculosis as well as the BCG vaccination status.
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Affiliation(s)
- A Doosti-Irani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, 6446-14155 Tehran, Iran.,Department of Epidemiology, Pasteur Institute of Iran, 1316943551 Tehran, Iran
| | - E Ayubi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, 6446-14155 Tehran, Iran.,Department of Epidemiology, Pasteur Institute of Iran, 1316943551 Tehran, Iran
| | - E Mostafavi
- Department of Epidemiology, Pasteur Institute of Iran, 1316943551 Tehran, Iran.,Research Center for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, 6556153145 Hamadan, Iran
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Khawcharoenporn T, Apisarnthanarak A, Sangkitporn S, Rudeeaneksin J, Srisungngam S, Bunchoo S, Phetsuksiri B. Tuberculin Skin Test and QuantiFERON(®)-TB Gold In-Tube Test for Diagnosing Latent Tuberculosis Infection among Thai Healthcare Workers. Jpn J Infect Dis 2015; 69:224-30. [PMID: 26255736 DOI: 10.7883/yoken.jjid.2015.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cross-sectional study was conducted on the performance of the tuberculin skin test (TST) and QuantiFERON(®)-TB Gold In-Tube test (QFT-IT) for detecting latent tuberculosis infection among Thai healthcare workers (HCWs). Each HCW underwent both the TST and QFT-IT during the annual health screening. Among the 260 HCWs enrolled, the median age was 30 years (range 19-60 years), 92% were women, 64% were nurses and nurse assistants, 78% were Bacillus Calmette Guérin vaccinated, and 37% had previously taken the TST. Correlation between TST reaction size and the interferon-γ level was weak (r = 0.29; P < 0.001). Of the HCWs, 38% and 20% had a reactive TST and a positive QFT-IT, respectively. Using QFT-IT positivity as a standard for latent tuberculosis diagnosis, the cut-off for TST reactivity with the best performance was ≥13 mm with a sensitivity, specificity, false positivity, and false negativity of 71%, 70%, 30%, and 29%, respectively (area under the curve 0.73; P < 0.001). The independent factor associated with a false reactive TST was a previous TST (adjusted odds ratio 1.83; P = 0.04). Our findings suggest that the QFT-IT may be the preferred test among HCWs with previous TST. In settings where the QFT-IT is not available, appropriate cut-offs for TST reactivity should be evaluated for use among HCWs.
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Monárrez-Espino J, Enciso-Moreno JA, Laflamme L, Serrano CJ. Serial QuantiFERON-TB Gold In-Tube assay and tuberculin skin test to diagnose latent tuberculosis in household Mexican contacts: conversion and reversion rates and associated factors using conventional and borderline zone definitions. Mem Inst Oswaldo Cruz 2015; 109:863-70. [PMID: 25410989 PMCID: PMC4296490 DOI: 10.1590/0074-0276140085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/19/2014] [Indexed: 01/19/2023] Open
Abstract
A cohort of 123 adult contacts was followed for 18‐24 months (86 completed the
follow-up) to compare conversion and reversion rates based on two serial measures of
QuantiFERON (QFT) and tuberculin skin test (TST) (PPD from TUBERSOL, Aventis Pasteur,
Canada) for diagnosing latent tuberculosis (TB) in household contacts of TB patients
using conventional (C) and borderline zone (BZ) definitions. Questionnaires were used
to obtain information regarding TB exposure, TB risk factors and socio-demographic
data. QFT (IU/mL) conversion was defined as <0.35 to ≥0.35 (C) or <0.35 to
>0.70 (BZ) and reversion was defined as ≥0.35 to <0.35 (C) or ≥0.35 to <0.20
(BZ); TST (mm) conversion was defined as <5 to ≥5 (C) or <5 to >10 (BZ) and
reversion was defined as ≥5 to <5 (C). The QFT conversion and reversion rates were
10.5% and 7% with C and 8.1% and 4.7% with the BZ definitions, respectively. The TST
rates were higher compared with QFT, especially with the C definitions (conversion
23.3%, reversion 9.3%). The QFT conversion and reversion rates were higher for TST
≥5; for TST, both rates were lower for QFT <0.35. No risk factors were associated
with the probability of converting or reverting. The inconsistency and apparent
randomness of serial testing is confusing and adds to the limitations of these tests
and definitions to follow-up close TB contacts.
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Affiliation(s)
| | | | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Carmen J Serrano
- Medical Research Unit Zacatecas, Mexican Institute of Social Security, Zacatecas, Mexico
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Bagheri Amiri F, Saifi M, Gouya MM, 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; 47:536-41. [PMID: 25832455 DOI: 10.3109/23744235.2015.1026934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate of the concordance between the results of the tuberculin skin test (TST) and an interferon-γ release assay (QuantiFERON test, QFT-GIT) for diagnosis of latent tuberculosis infection (LTBI) in homeless people in Tehran city, Iran. METHODS This cross-sectional study was conducted from June to August 2012. Homeless people were eligible to participate in the study if they were 18-60 years old. RESULTS Among 569 homeless people, 46.22% (95% confidence interval (CI) = 42.16-50.33%) and 20.39% (95% CI = 17.28-23.9%) were QFT-GIT and TST positive, respectively. Among these participants, the prevalence of LTBI with positivity of at least one of the tests was 52.2%. The overall agreement between QFT-GIT and TST was 62.21% (kappa = 0.21, 95% CI = 0.13-0.29, p < 0.001). Factors associated with positive results in QFT-GIT and TST were older age, being male, having a longer history of homelessness and having a history of incarceration in the last 10 years. CONCLUSIONS A high prevalence of LTBI was seen among homeless people in this study. There was a poor concordance between QFT-GIT and TST among this group. To better assess the utility of QFT-GIT in detection of LTBI further studies with a low prevalence of LTBI in this group are recommended.
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Young JAH, Weisdorf DJ. Infections in Recipients of Hematopoietic Stem Cell Transplants. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152282 DOI: 10.1016/b978-1-4557-4801-3.00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gran G, Aßmus J, Dyrhol-Riise AM. Screening for latent tuberculosis in Norwegian health care workers: high frequency of discordant tuberculin skin test positive and interferon-gamma release assay negative results. BMC Public Health 2013; 13:353. [PMID: 23590619 PMCID: PMC3637593 DOI: 10.1186/1471-2458-13-353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) presents globally a significant health problem and health care workers (HCW) are at increased risk of contracting TB infection. There is no diagnostic gold standard for latent TB infection (LTBI), but both blood based interferon-gamma release assays (IGRA) and the tuberculin skin test (TST) are used. According to the national guidelines, HCW who have been exposed for TB should be screened and offered preventive anti-TB chemotherapy, but the role of IGRA in HCW screening is still unclear. Methods A total of 387 HCW working in clinical and laboratory departments in three major hospitals in the Western region of Norway with possible exposure to TB were included in a cross-sectional study. The HCW were asked for risk factors for TB and tested with TST and the QuantiFERON®TB Gold In-Tube test (QFT). A logistic regression model analyzed the associations between risk factors for TB and positive QFT or TST. Results A total of 13 (3.4%) demonstrated a persistent positive QFT, whereas 214 (55.3%) had a positive TST (≥ 6 mm) and 53 (13.7%) a TST ≥ 15 mm. Only ten (4.7%) of the HCW with a positive TST were QFT positive. Origin from a TB-endemic country was the only risk factor associated with a positive QFT (OR 14.13, 95% CI 1.37 - 145.38, p = 0.026), whereas there was no significant association between risk factors for TB and TST ≥ 15 mm. The five HCW with an initial positive QFT that retested negative all had low interferon-gamma (IFN-γ) responses below 0.70 IU/ml when first tested. Conclusions We demonstrate a low prevalence of LTBI in HCW working in hospitals with TB patients in our region. The “IGRA-only” seems like a desirable screening strategy despite its limitations in serial testing, due to the high numbers of discordant TST positive/IGRA negative results in HCW, probably caused by BCG vaccination or boosting due to repetitive TST testing. Thus, guidelines for TB screening in HCW should be updated in order to secure accurate diagnosis of LTBI and offer proper treatment and follow-up.
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Using QuantiFERON-TB Gold In-Tube for field-based tuberculosis contact investigations in congregate settings. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:E11-3. [PMID: 23529019 DOI: 10.1097/phh.0b013e318268af0b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Contact investigations are crucial to controlling tuberculosis in the United States. In these investigations, the tuberculin skin test has been the primary test to detect tuberculosis infection. Interferon-γ release assays, such as the QuantiFERON-TB Gold In-Tube test, were recently introduced and are intended to address limitations of the tuberculin skin test. However, there are limited data on the use of these tests in contact investigations in congregate settings. We present 2 field-based investigations to highlight potential advantages, limitations, and feasibility of using the QuantiFERON-TB Gold In-Tube test in congregate setting investigations.
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Trajman A, Steffen RE, Menzies D. Interferon-Gamma Release Assays versus Tuberculin Skin Testing for the Diagnosis of Latent Tuberculosis Infection: An Overview of the Evidence. Pulm Med 2013; 2013:601737. [PMID: 23476763 PMCID: PMC3582085 DOI: 10.1155/2013/601737] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022] Open
Abstract
A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays. Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for different indications for the use of these tests. We conclude that both tests are accurate to detect latent tuberculosis, although interferon-gamma release assays have higher specificity than tuberculin skin testing in BCG-vaccinated populations, particularly if BCG is received after infancy. However, both tests perform poorly to predict risk for progression to active tuberculosis. Interferon-gamma release assays have significant limitations in serial testing because of spontaneous variability and lack of a validated definition of conversion and reversion, making it difficult for clinicians to interpret changes in category (conversions and reversions). So far, the most important clinical evidence, that is, that isoniazid preventive therapy reduces the risk for progression to disease, has been produced only in tuberculin skin test-positive individuals.
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Affiliation(s)
- A. Trajman
- Gama Filho University, 20740-900 Rio de Janeiro, RJ, Brazil
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
| | - R. E. Steffen
- Federal University of Rio de Janeiro, 21941-913 Rio de Janeiro, RJ, Brazil
| | - D. Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada H2X 2P4
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Moon HW, Kim H, Hur M, Yun YM, Lee A. Latent tuberculosis infection screening for laboratory personnel using interferon-γ release assay and tuberculin skin test in Korea: an intermediate incidence setting. J Clin Lab Anal 2012; 25:382-8. [PMID: 22086790 DOI: 10.1002/jcla.20479] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though recent reports have indicated a higher prevalence of latent tuberculosis infection (LTBI) in laboratory personnel than in other healthcare workers, these studies included only a limited number of laboratory personnel. METHODS We have thus focused on the laboratory personnel, who had a high level of exposure to specimens from patients with TB. We recruited 173 laboratory personnel and performed QuantiFERON-TB Gold In-Tube test (QFT-G) and tuberculin skin test (TST). RESULTS QFT-G was positive in 21.4% of the enrolled laboratory personnel, and TST was positive in 33.3%. The agreement between the two tests was fair (κ = 0.234). In multivariate analyses, household contactwith TBpatients (P = 0.013), the laboratory sections of microbiology (P = 0.045) and chemistry/immunology (P = 0.014) were shown to be significantly associated with positive QFT-G results. CONCLUSION Our data show a high prevalence of TST and QFT-G positivity in laboratory personnel and emphasize the importance of LTBI screening for laboratory personnel. In BCG-vaccinated populations with an intermediate incidence setting, QFT-G seems to be superior to TST as a screening tool for the detection of LTBI. Further study, including results of follow-up tests will be helpful for confirmation of our findings.
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Affiliation(s)
- Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Abstract
After more than a century of relying on skin testing for the diagnosis of latent TB infection, clinicians now have access to blood-based diagnostics in the form of interferon γ release assays (IGRAs). These tests are generally associated with higher sensitivity and specificity for diagnosis of latent TB infection. This article reviews the indications for testing and treatment of latent TB infection in the overall context of a TB control program and describes how IGRAs might be used in specific clinical settings and populations, including people having close contact with an active case of TB, the foreign born, and health-care workers.
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Affiliation(s)
- Neil W Schluger
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY 10032, USA.
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Person AK, Goswami ND, Bissette DJ, Turner DS, Baker AV, Gadkowski LB, Naggie S, Erlandson K, Chen L, Lalani T, Cox GM, Stout JE. Pairing QuantiFERON gold in-tube with opt-out HIV testing in a tuberculosis contact investigation in the Southeastern United States. AIDS Patient Care STDS 2010; 24:539-43. [PMID: 20731612 DOI: 10.1089/apc.2010.0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Knowing one's HIV status is particularly important in the setting of recent tuberculosis (TB) exposure. Blood tests for assessment of tuberculosis infection, such as the QuantiFERON Gold in-tube test (QFT; Cellestis Limited, Carnegie, Victoria, Australia), offer the possibility of simultaneous screening for TB and HIV with a single blood draw. We performed a cross-sectional analysis of all contacts to a highly infectious TB case in a large meatpacking factory. Twenty-two percent were foreign-born and 73% were black. Contacts were tested with both tuberculin skin testing (TST) and QFT. HIV testing was offered on an opt-out basis. Persons with TST >or=10 mm, positive QFT, and/or positive HIV test were offered latent TB treatment. Three hundred twenty-six contacts were screened: TST results were available for 266 people and an additional 24 reported a prior positive TST for a total of 290 persons with any TST result (89.0%). Adequate QFT specimens were obtained for 312 (95.7%) of persons. Thirty-two persons had QFT results but did not return for TST reading. Twenty-two percent met the criteria for latent TB infection. Eighty-eight percent accepted HIV testing. Two (0.7%) were HIV seropositive; both individuals were already aware of their HIV status, but one had stopped care a year previously. None of the HIV-seropositive persons had latent TB, but all were offered latent TB treatment per standard guidelines. This demonstrates that opt-out HIV testing combined with QFT in a large TB contact investigation was feasible and useful. HIV testing was also widely accepted. Pairing QFT with opt-out HIV testing should be strongly considered when possible.
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Affiliation(s)
- Anna K. Person
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Neela D. Goswami
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | | | - Ann V. Baker
- Wake County Human Services, Raleigh, North Carolina
| | - L. Beth Gadkowski
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Susanna Naggie
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Luke Chen
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tahaniyat Lalani
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gary M. Cox
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jason E. Stout
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Wake County Human Services, Raleigh, North Carolina
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Schablon A, Harling M, Diel R, Nienhaus A. Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study. BMC Infect Dis 2010; 10:107. [PMID: 20429957 PMCID: PMC2877045 DOI: 10.1186/1471-2334-10-107] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 04/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare workers are still recognised as a high-risk group for latent TB infection (LTBI). Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to infection control programmes in German hospitals. It was the aim of the study to determine the prevalence and putative risk factors of LTBI. METHODS We tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT) test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB high-risk groups following German OSH legislation. RESULTS A positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was 14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology), 6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.4-2.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR 3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination, workplace or profession. CONCLUSION The prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk. Pre-employment screening might be helpful in this endeavour.
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Affiliation(s)
- Anja Schablon
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Department of Occupational Health Research, Pappelallee 35-37, 22089 Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Martinistraße 52, 20246 Hamburg, Germany
| | - Melanie Harling
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Department of Occupational Health Research, Pappelallee 35-37, 22089 Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Martinistraße 52, 20246 Hamburg, Germany
| | - Roland Diel
- Department of Pulmonary Medicine, Hannover Medical School (MHH), Carl-Neuberg-Straße1, 30625 Hannover, Germany
| | - Albert Nienhaus
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Martinistraße 52, 20246 Hamburg, Germany
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Sadatsafavi M, Shahidi N, Marra F, FitzGerald MJ, Elwood KR, Guo N, Marra CA. A statistical method was used for the meta-analysis of tests for latent TB in the absence of a gold standard, combining random-effect and latent-class methods to estimate test accuracy. J Clin Epidemiol 2010; 63:257-69. [PMID: 19692208 DOI: 10.1016/j.jclinepi.2009.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 04/10/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Because of the lack of a gold standard, the diagnostic performance of tests for the detection of latent tuberculosis infection (LTBI) is not known. However, statistical methods can be used to estimate the accuracy from the studies reporting the concordance among the tests. STUDY DESIGN AND SETTING We developed a random-effect latent-class model to estimate performance characteristics of three LTBI diagnostic tests: tuberculin skin test (TST, at 10-mm cutoff), QuantiFERON-TB gold (QFG), and TSPOT-TB from the studies evaluating agreement among the tests. RESULTS Nineteen studies were included. QFG had a sensitivity of 0.642 (95% confidence interval [CI]: 0.593-0.691) and specificity of 0.996 (95% CI: 0.989-1.000), TSPOT-TB had a sensitivity of 0.500 (95% CI: 0.334-0.666) and specificity of 0.906 (95% CI: 0.882-0.929), and TST had a sensitivity of 0.709 (95% CI: 0.658-0.761) and specificity of 0.683 (95% CI: 0.522-0.844). Results were not sensitive to the inclusion of any single study. When only the three studies that reported on TSPOT were removed, estimates for the other two tests varied minimally. CONCLUSIONS Statistical methods can help estimate the accuracy of LTBI tests. Although the specificities were close to their reported values in the literature, the estimates for sensitivities were low; a finding that should be carefully evaluated.
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Costa JT, Silva R, Sá R, Cardoso MJ, Ribeiro C, Nienhaus A. Comparação do teste de libertação do interferão-γ e da prova de tuberculina no rastreio de profissionais de saúde. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30022-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lee K, Han MK, Choi HR, Choi CM, Oh YM, Lee SD, Kim WS, Kim DS, Woo JH, Shim TS. Annual incidence of latent tuberculosis infection among newly employed nurses at a tertiary care university hospital. Infect Control Hosp Epidemiol 2010; 30:1218-22. [PMID: 19848602 DOI: 10.1086/648082] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the annual rate of tuberculosis (TB) infection among newly employed nurses using both tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT-G; Cellestis Limited) assay. DESIGN A prospective cohort study involving newly employed nurses. SETTING A tertiary care university hospital in South Korea. METHODS All participants (n = 196) were tested with the TST and QFT-G assay at baseline. After 1 year, the TST and QFT-G assay were reperformed for subjects who had negative TST results at baseline and for all subjects, respectively. RESULTS The baseline TST and QFT-G assays were positive for 101 subjects (51.5%) and 28 subjects (14.3%), respectively; 22 subjects (11.2%) had positive results of both tests. Although the overall between-test agreement was 54.9% (k = 0.151) [95% confidence interval, 0.047-0.245]), agreement improved to 78.5% (k = 0.462 [95% confidence interval, 0.007-0.917]) for subjects who had not received bacille Calmette-Guérin vaccination. After 1 year, the TST yielded positive results for 16 (21.3%) of 75 nurses with negative baseline results, and the QFT-G assay yielded positive results for 21 (14.4%) of 146 subjects with negative baseline results. Collectively, 5 subjects (3.0%) experienced conversion to positive results with both tests, and 32 subjects (18.9%) experienced conversion to positive results with one of the tests. Neither the employing hospital department nor exposure to patients with TB affected test conversion status. CONCLUSIONS The poor overall agreement between TST and QFT-G results may have been caused by the confounding effect of bacille Calmette-Guérin vaccination. The annual risk of TB infection among newly employed nurses was at least 3% on the basis of results of both the TST and QFT-G test. Stricter preventive strategies against TB spread should be implemented in our hospital.
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Affiliation(s)
- Kwangha Lee
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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van Zyl-Smit RN, Zwerling A, Dheda K, Pai M. Within-subject variability of interferon-g assay results for tuberculosis and boosting effect of tuberculin skin testing: a systematic review. PLoS One 2009; 4:e8517. [PMID: 20041113 PMCID: PMC2795193 DOI: 10.1371/journal.pone.0008517] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 12/09/2009] [Indexed: 11/29/2022] Open
Abstract
Background Variability in interferon-gamma release assays (IGRAs) results for tuberculosis has implications for interpretation of results close to the cut-point, and for defining thresholds for test conversion and reversion. However, little is known about the within-subject variability (reproducibility) of IGRAs. Several national guidelines recommend a two-step testing procedure (tuberculin skin test [TST] followed by IGRA) for the diagnosis of LTBI. However, the effect of a preceding TST on subsequent IGRA results has been reported in studies with apparently conflicting results. Methodology/Findings We conducted a systematic review to synthesize evidence on within-subject variability of IGRA results and the potential boosting effect of TST. We searched several databases and reviewed citations of previous reviews on IGRAs. We included studies using commercial IGRAs, in addition to non-commercial versions of the ELISPOT assay. Four studies, fulfilling our predefined criteria, examined within-subject variability and 13 studies evaluated TST effects on subsequent IGRA responses. Meta-analysis was not considered appropriate because of heterogeneity in study methods, assays, and populations. Although based on limited data, within-subject variability was present in all studies but the magnitude varied (16-80%) across studies. A TST induced “boosting” of IGRA responses was demonstrated in several studies and although more pronounced in IGRA-positive (i.e. sensitized) individuals, also occurred in a smaller but not insignificant proportion of IGRA-negative subjects. The TST appeared to affect IGRA responses only after 3 days and may apparently persist for several months, but evidence for this is weak. Conclusions/Significance Although reproducibility data are scarce, significant within person IGRA variability has been reported. If confirmed in more studies, this has implications for the interpretation of results close to the cut-point and for definition of conversions and reversions. Although the effect of TST on IGRA results is likely to be inconsequential in IGRA-positive subjects, in IGRA-negative subjects, the interpretation of results may be confounded by a preceding TST if administered more than 3 days prior to an IGRA.
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Affiliation(s)
- Richard N. van Zyl-Smit
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Alice Zwerling
- Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada
- Montreal Chest Institute, Montreal, Canada
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
- Centre for Infectious Diseases and International Health, University College Medical School, London, United Kingdom
| | - Madhukar Pai
- Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada
- Montreal Chest Institute, Montreal, Canada
- * E-mail:
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Tripodi D, Brunet-Courtois B, Nael V, Audrain M, Chailleux E, Germaud P, Naudin F, Muller JY, Bourrut-Lacouture M, Durand-Perdriel MH, Gordeeff C, Guillaumin G, Houdebine M, Raffi F, Boutoille D, Biron C, Potel G, Roedlich C, Geraut C, Schablon A, Nienhaus A. Evaluation of the tuberculin skin test and the interferon-gamma release assay for TB screening in French healthcare workers. J Occup Med Toxicol 2009; 4:30. [PMID: 19948042 PMCID: PMC2790451 DOI: 10.1186/1745-6673-4-30] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 11/30/2009] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Using French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-gamma Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients. METHODS Between May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST >/= 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered. RESULTS All HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST >/= 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation. CONCLUSION The introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.
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Affiliation(s)
- Dominique Tripodi
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | | | - Virginie Nael
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Marie Audrain
- Department of Immunology, University Hospital of Nantes, France
| | - Edmond Chailleux
- Department of Pneumology, Laënnec Hospital, University Hospital of Nantes, France
| | - Patrick Germaud
- Department of Pneumology, Laënnec Hospital, University Hospital of Nantes, France
| | - Frederique Naudin
- Tuberculosis Public Health Clinic, 6 rue Hippolyte Durand Gasselin, Nantes, France
| | | | | | | | - Claire Gordeeff
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Guyonne Guillaumin
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Marietherese Houdebine
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Francois Raffi
- Department of the Infectious and Tropical illnesses, Hospital, CHU Nantes, France
| | - David Boutoille
- Department of the Infectious and Tropical illnesses, Hospital, CHU Nantes, France
| | - Charlotte Biron
- Department of the Infectious and Tropical illnesses, Hospital, CHU Nantes, France
| | - Gilles Potel
- Emergency Department, University Hospital of Nantes, France
| | - Claude Roedlich
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Christian Geraut
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Anja Schablon
- Accident Insurance and Prevention in the Health and Welfare Services, Germany
| | - Albert Nienhaus
- Accident Insurance and Prevention in the Health and Welfare Services, Germany
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Dodig S, Zrinski-Topić R. Serial Interferon Gamma Release Assay in Latent Tuberculosis Infection: Table 1. Lab Med 2009. [DOI: 10.1309/lmj62bpkl7akrvyj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Alvarez-León EE, Espinosa-Vega E, Santana-Rodríguez E, Molina-Cabrillana JM, Pérez-Arellano JL, Caminero JA, Serrano-Aguilar P. Screening for tuberculosis infection in spanish healthcare workers: Comparison of the QuantiFERON-TB gold in-tube test with the tuberculin skin test. Infect Control Hosp Epidemiol 2009; 30:876-83. [PMID: 19614541 DOI: 10.1086/598519] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The risk of latent tuberculosis (LTBI) in healthcare workers (HCWs) is high. Until recently, the tuberculin skin test (TST) was the only diagnostic test available for Mycobacterium tuberculosis infection. A new enzyme-linked immunosorbent assay test, the QuantiFERON-TB Gold (QFT-G) test, was recommended by the US Centers for Disease Control and Prevention as an alternative test for the diagnosis of LTBI in HCWs. The purpose of our study was to compare the TST and the QFT-G test in Spanish HCWs in order to improve procedures for the detection of LTBI. METHODS A cross-sectional study with blinded comparison of TST and QFT-G test results was carried out among 134 HCWs at an 800-bed Spanish university hospital. The level of interferon-gamma production stimulated by the QFT-G test was measured. A concentration of at least 0.35 IU/mL was considered a positive result. An induration of at least 5 mm in non-BCG-vaccinated or at least 15 mm in BCG-vaccinated HCWs for the TST was considered positive. RESULTS Of the 134 HCWs included (mean age, 33.4 years; 101 [75.4%] women; 47 [35.1%] BCG vaccinated), the LTBI prevalence diagnosed with any test was 11.2% (95% confidence interval, 6.6%-18.1%), with the TST was 8.96%, and with the QFT-G test was 5.97% (nonsignificant differences). The QFT-G test value was higher in subjects with TST induration of at least 15 mm than in subjects with TST induration of less than 15 mm (P < .001). Overall agreement between the results of the two tests was found in 94% of HCWs (kappa = 0.56), but agreement was only 59% in HCWs who had a positive result for both tests. Disagreement was present in the results found for 5% of HCWs. CONCLUSIONS Few studies have compared both tests in populations with high M. tuberculosis exposure but low BCG vaccination prevalence. Agreement between both tests is high, especially among negative results. Studies are needed to clarify the reasons for disagreement and to establish the best TST and QFT-G test cutoff point.
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Affiliation(s)
- Eva Elisa Alvarez-León
- Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas, Gran Canaria, Spain.
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Casas I, Latorre I, Esteve M, Ruiz-Manzano J, Rodriguez D, Prat C, García-Olivé I, Lacoma A, Ausina V, Domínguez J. Evaluation of interferon-gamma release assays in the diagnosis of recent tuberculosis infection in health care workers. PLoS One 2009; 4:e6686. [PMID: 19701460 PMCID: PMC2726945 DOI: 10.1371/journal.pone.0006686] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 08/01/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health care workers (HCWs) are a group at risk of latent tuberculosis infection (LTBI). The aims of this study were to determine IFN-gamma response by QuantiFERON-TB GOLD In Tube (QFN-G-IT) and T-SPOT.TB in HCWs, comparing the results with tuberculin skin test (TST); and to analyze the capacity of IFN-gamma tests to detect recent versus remote LTBI with a prolonged stimulation test (PST). METHODOLOGY/PRINCIPAL FINDINGS A total of 147 HCWs were enrolled; 23 of whom were BCG vaccinated. 95 HCWs (64.6%) had a previous positive TST and were not retested; and 52 HCWs had a previous negative TST or were tested for the first time. When we analysed individuals without previous positive TST, the number of positive results for T-SPOT.TB was 12/52 (23.1%); and for QFN-G-IT, 9/52 (17.3%). The global concordance (kappa) between T-SPOT.TB and QFN-G-IT with TST was 0.754 and 0.929 respectively. Of individuals with previous positive TST, T-SPOT.TB and QFN-G-IT were negative in 51.6% (49/95) and 62.1% (59/95) respectively, decreasing the concordance to 0.321 and 0.288, respectively. In non-BCG vaccinated HCWs with previous positive TST a positive IFN-gamma test was associated with degree of exposure and diameter of TST. PST was performed in 24 HCW with previous positive TST and negative IFN-gamma tests. PST was developed in 3 cell cultures stimulated with medium alone, ESAT-6 and CFP-10, respectively. In the third and sixth day of incubation period, part of the supernatants were replaced with complete medium supplemented with (rIL)-2. On day 9, ELISPOT assay was performed. In 14 samples PST was not valid due to not having enough cells. In 8 cases, the response was negative, and in 2 cases positive, suggesting that these patients were infected with Mycobacterium tuberculosis in some point in the past. CONCLUSIONS Both IFN-gamma tests showed a similar number of positive results, and concordance between the tests was excellent. None of the tests was affected by prior BCG vaccination. IFN-gamma tests are a useful tool for detecting recent infection in HCW population.
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Affiliation(s)
- Irma Casas
- Servei de Medicina Preventiva, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Irene Latorre
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Maria Esteve
- Servei de Medicina Preventiva, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Ruiz-Manzano
- Servei de Pneumologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Dora Rodriguez
- Servei de Medicina Preventiva, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Cristina Prat
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Ignasi García-Olivé
- Servei de Pneumologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Alicia Lacoma
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Vicente Ausina
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Jose Domínguez
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
- * E-mail:
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Swindells JE, Aliyu SH, Enoch DA, Abubakar I. Role of interferon-gamma release assays in healthcare workers. J Hosp Infect 2009; 73:101-8. [PMID: 19699551 DOI: 10.1016/j.jhin.2009.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Indexed: 10/20/2022]
Abstract
The advent of interferon-gamma release assays (IGRAs) provides new options for detection of latent tuberculosis infection (LTBI). This is particularly relevant to healthcare workers (HCWs), who are at higher risk of infection, but who have often also been vaccinated. In this article, we discuss the role of IGRAs for the diagnosis of LTBI in various healthcare settings. A search was performed for studies that reported data on IGRAs in HCWs in the last 18 years. Twenty-two studies met the inclusion criteria. IGRAs showed poor agreement with the tuberculin skin test (TST), except in countries with high incidences of tuberculosis (TB), but generally correlated better with markers of exposure to TB including during contact investigation. The T-SPOT.TB assay has not been adequately assessed in HCWs; the few studies available showed enhanced specificity of T-SPOT.TB when compared to TST. This review confirms the utility of IGRAs as important tools in the prevention and control of tuberculosis in healthcare settings.
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Affiliation(s)
- J E Swindells
- Department of Microbiology, City Hospital, Dudley Road, Birmingham, UK
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Abu El-Asrar AM, Herbort CP, Tabbara KF. A clinical approach to the diagnosis of retinal vasculitis. Int Ophthalmol 2009; 30:149-73. [DOI: 10.1007/s10792-009-9301-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 01/14/2009] [Indexed: 11/29/2022]
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25
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Chun JK, Kim CK, Kim HS, Jung GY, Lee TJ, Kim KH, Kim DS. The role of a whole blood interferon-γ assay for the detection of latent tuberculosis infection in Bacille Calmette–Guérin vaccinated children. Diagn Microbiol Infect Dis 2008; 62:389-94. [DOI: 10.1016/j.diagmicrobio.2008.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 08/26/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
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