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Saint-Pierre G, Conei D, Cantillana P, Raijmakers M, Vera A, Gutiérrez D, Kennedy C, Peralta P, Ramonda P. Comparison of Two Tuberculosis Infection Tests in a South American Tertiary Hospital: STANDARD F TB-Feron FIA vs. QIAreachTM QuantiFERON-TB. Diagnostics (Basel) 2023; 13:diagnostics13061162. [PMID: 36980470 PMCID: PMC10046924 DOI: 10.3390/diagnostics13061162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2023] Open
Abstract
Introduction: Tuberculosis (TB) is one of the most prevalent respiratory diseases in the world. In 2020 there were at least 9.9 million new infections, with 1.5 million deaths. Approximately 10% of people infected with Mycobacterium tuberculosis develop the disease during the first 2 to 5 years after infection. In South America, the diagnosis of Latent Tuberculosis Infections (LTBI) continues to be performed through the Mantoux tuberculin skin test (TST). Objective: The objective of our study was to compare the sensitivity of a new immunofluorescence IGRA test against a widely available IGRA kit on the market. Material and method: Close contact with infectious TB patients, HIV patients, or immunocompromised for another cause were recruited. Two interferon-gamma release assay (IGRA) diagnostic kits were used and compared with TST. Results: 76 patients were recruited, 93.42% were Chilean nationality, and 98.68% of the patients did not have immunosuppression. The sensitivity of the new technique was 88.89%, and the specificity was 92.50% in the study population compared to the IGRA previously used. In the subgroup older than 36 years, the sensitivity was 95.65%, and the specificity was 89.47%. Conclusion: IGRA techniques are a new resource in clinical laboratories to make an accurate diagnosis of LTBI in the region of the Americas. In our population, the greatest benefit of this new IGRA would be observed in people over 36 years of age, where the sensitivity of the technique was like that of the currently available test.
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Affiliation(s)
- Gustavo Saint-Pierre
- Unidad Microbiología Sección Koch, Hospital Barros Luco Trudeau, Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
- Programa de Virología, ICBM, Facultad de Medicina, Universidad de Chile, Independencia 1027, Santiago 8380453, Chile
- Correspondence:
| | - Daniel Conei
- Departamento de Ciencias de la Salud, Universidad de Aysén, Coyhaique 5951537, Chile;
| | - Patricia Cantillana
- Unidad Microbiología Sección Koch, Hospital Barros Luco Trudeau, Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
| | - Mariella Raijmakers
- Medicina Interna, University of Santiago, Santiago 9170022, Chile
- Departamento de Medicina Interna, Hospital Barros Luco Trudeau, Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
| | - Andrea Vera
- Unidad Microbiología Sección Koch, Hospital Barros Luco Trudeau, Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
| | - Daniela Gutiérrez
- Unidad Microbiología Sección Koch, Hospital Barros Luco Trudeau, Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
| | - Cristopher Kennedy
- Unidad Microbiología Sección Koch, Hospital Barros Luco Trudeau, Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
| | - Paulina Peralta
- Policlínico Infectología/Inmunología, Hospital Barros Luco Trudeau, Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
| | - Paulina Ramonda
- Servicio de Salud Metropolitano Sur, Santiago 8900000, Chile
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Montagnani C, Esposito S, Galli L, Chiappini E, Principi N, de Martino M. Recommendations for pediatric tuberculosis vaccination in Italy. Hum Vaccin Immunother 2017; 12:644-50. [PMID: 26587764 DOI: 10.1080/21645515.2015.1106657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Bacillus Calmette-Guérin (BCG) vaccine is still the only vaccine approved for the prevention of tuberculosis (TB), and is widely used in highly endemic countries, where all newborns receive a single intradermal dose immediately after birth; however, the recommendations concerning its use in Europe vary widely from country to country. This document describes the recommendations of a group of Italian scientific societies concerning its pediatric use in Italy, the persistence of the protection it provides, its safety, its interference with tuberculin skin test (TST) responses, and the children who should be vaccinated. The experts conclude that BCG vaccination provides a good level of protection against tuberculous meningitis and disseminated forms, and a fair level of protection against pulmonary disease; the protective effective lasts at least 10 years, and revaccination offers no advantages over a single administration. The vaccine is safe in immunocompetent subjects, and affects the response to a TST for at least 6 y On the basis of these observations, we recommend its use in Italy in all TST-negative immunocompetent newborns and breastfeeding infants aged <6 months, and all TST-negative children aged between 6 months and 5 y who come from highly epidemic areas, or whose parents come from highly endemic areas, or who have been in contact with a family member with active TB without contracting the disease themselves.
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Affiliation(s)
- Carlotta Montagnani
- a Pediatric Clinic, Meyer Hospital, University of Florence , Florence , Italy
| | - Susanna Esposito
- b Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Luisa Galli
- a Pediatric Clinic, Meyer Hospital, University of Florence , Florence , Italy
| | - Elena Chiappini
- a Pediatric Clinic, Meyer Hospital, University of Florence , Florence , Italy
| | - Nicola Principi
- b Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Maurizio de Martino
- a Pediatric Clinic, Meyer Hospital, University of Florence , Florence , Italy
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Gudjónsdóttir MJ, Kötz K, Nielsen RS, Wilmar P, Olausson S, Wallmyr D, Trollfors B. Relation between BCG vaccine scar and an interferon-gamma release assay in immigrant children with "positive" tuberculin skin test (≥10 mm). BMC Infect Dis 2016; 16:540. [PMID: 27716176 PMCID: PMC5052808 DOI: 10.1186/s12879-016-1872-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/27/2016] [Indexed: 11/18/2022] Open
Abstract
Background Immigrants from countries with high incidence of tuberculosis (TB) are usually offered screening when they arrive to low incidence countries. The tuberculin skin test (TST) is often used. The interferon gamma release assays (IGRAs) are more specific and not affected by BCG vaccination. The aims of this study were 1. To see if there if there is a correlation between a positive IGRA (QFT) and presence of a BCG scar in children with TST ≥10 mm, 2. To compare the TST diameter with QFT result, 3. To see if chest X-ray can be omitted in QFT negative children despite TST ≥10 mm. Methods 762 healthy children/adolescents (median age 14 years) arriving to Gothenburg and surroundings with TST ≥10 mm were tested with QFT. Results A total of 163/492 (33 %) children with BCG scar had positive QFT, whereas 205/270 (76 %) without BCG scar had positive QFT (p < 0.0001). The median TST was 12 mm in QFT negative and 18 mm in QFT positive children (p < 0.0001) but with considerable overlap. Median TST was the same (12 mm) in QFT negative children with and without BCG scar. Among the QFT positive children 25/368 had chest X-ray changes compared to 2/393 among the QFT negative children (p < 0.0007). Conclusions Previous BCG vaccination had an effect on the TST diameter so an IGRA is recommended to diagnose latent TB. Using only TST for screening of latent TB would lead to overdiagnosis. The TST diameter was larger in QFT positive than in QFT negative children but could not predict QFT in the individual patient. Chest X ray contributes little to the diagnosis of TB in QFT negative children but can not be omitted because of late seroconversion of QFT in some patients. Trial registration Not applicable.
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Affiliation(s)
- Margret Johansson Gudjónsdóttir
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. .,Department of Pediatrics, Neonatology, Sahlgrenska University Hospital, 41685, Gothenburg, Sweden.
| | - Karsten Kötz
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ruth Stangebye Nielsen
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Philip Wilmar
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Sofia Olausson
- Department of Paediatrics, Angered Hospital, Gothenburg, Sweden
| | - Daniel Wallmyr
- Department of Child Health, South Älvsborg Hospital, Borås, Sweden
| | - Birger Trollfors
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Kwong W, Krahn T, Cleland A, Gordon J, Wobeser W. Potential role for interferon-γ release assays in tuberculosis screening in a remote Canadian community: a case series. CMAJ Open 2016; 4:E535-E537. [PMID: 27730117 PMCID: PMC5047837 DOI: 10.9778/cmajo.20160032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Current Canadian guidelines suggest that neonatal Bacille Calmette-Guérin (BCG) vaccination does not result in false-positive tuberculosis (TB) skin tests, despite a growing body of evidence that interferon-γ release assays may be a more specific alternative in identifying latent tuberculosis infections in vaccinated populations. We set out to evaluate the relationship between TB skin tests and interferon-γ release assays in patients who previously received neonatal BCG vaccine. METHODS All children with a positive skin test at age 14 years in a remote community north of Sioux Lookout, Ontario, were considered for interferon-γ release assay testing. RESULTS Of the 11 children who underwent routine screening at 14 years of age for latent TB infection, 7 had a positive TB skin test (≥ 10 mm). All 7 of these children had received the BCG vaccine as newborns and all had a negative TB skin test during their routine screening at 4 years of age. No potential exposure to active TB could be identified. Chest radiographs were normal, and none of the children had symptoms suggestive of active TB. The 7 children underwent interferon-γ release assay testing using QuantiFERON Gold. All 7 tests were negative. INTERPRETATION With the addition of interferon-γ release assays to routine skin test screening, we provide evidence that neonatal BCG vaccination may contribute to a false-positive skin test in youth at 14 years of age. Consideration should be given to the possibility that neonatal BCG may contribute to false-positive TB skin tests.
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Affiliation(s)
- Wilson Kwong
- Department of Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Medicine (Krahn, Wobeser), Queen's University, Kingston, Ont.; Sioux Lookout First Nations Health Authority (Cleland, Gordon), Sioux Lookout, Ont
| | - Thomas Krahn
- Department of Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Medicine (Krahn, Wobeser), Queen's University, Kingston, Ont.; Sioux Lookout First Nations Health Authority (Cleland, Gordon), Sioux Lookout, Ont
| | - Ann Cleland
- Department of Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Medicine (Krahn, Wobeser), Queen's University, Kingston, Ont.; Sioux Lookout First Nations Health Authority (Cleland, Gordon), Sioux Lookout, Ont
| | - Janet Gordon
- Department of Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Medicine (Krahn, Wobeser), Queen's University, Kingston, Ont.; Sioux Lookout First Nations Health Authority (Cleland, Gordon), Sioux Lookout, Ont
| | - Wendy Wobeser
- Department of Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Medicine (Krahn, Wobeser), Queen's University, Kingston, Ont.; Sioux Lookout First Nations Health Authority (Cleland, Gordon), Sioux Lookout, Ont
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Rose W, Read SE, Bitnun A, Rea E, Stephens D, Pongsamart W, Kitai I. Relating Tuberculosis (TB) Contact Characteristics to QuantiFERON-TB-Gold and Tuberculin Skin Test Results in the Toronto Pediatric TB Clinic. J Pediatric Infect Dis Soc 2015; 4:96-103. [PMID: 26407408 DOI: 10.1093/jpids/piu024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/01/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Few data relate interferon-γ-release-assay results in children to source case sputum status, the best predictor of infectiousness of tuberculosis (TB) patients. We evaluated the QuantiFERON-Gold-in-tube assay (QFT) and tuberculin skin test (TST) in children with different types of TB exposure. METHODS The TST and QFT were performed in referred TB-exposed children and adolescents who had not undergone prior TST screening (tested in parallel), and the QFT was performed in referred TST-positive individuals. Source case characteristics were obtained from referring public health units. We excluded children with known immunocompromising conditions and those known to have TB disease at the time of evaluation. RESULTS For 103 patients tested in parallel, overall test agreement was very good in the Bacillus Calmette-Guerein (BCG) unimmunized contacts (κ = 0.83) and contacts of household smear-positive (HS+) cases (κ = 0.67), but test agreement was poor in those with lower-risk contact (κ = 0.34). Only 3 of 59 HS+ patients were QFT-positive and TST-negative. On multivariate analysis, a positive QFT was strongly associated with HS+ exposure (odds ratio [OR], 6.6; 95% confidence interval [CI], 2.2-20]) but not BCG; and a positive TST was associated with BCG alone. For 92 referred TST-positive individuals, the QFT was negative in 21% of HS+ contacts, 65% of lower-risk contacts (OR, 6.8; 95% CI, 1.9-25), and 82% of the patients with unknown contact history (OR, 15.5; 95% CI, 5-54). Application of the Canadian 2010 guidelines would exclude from treatment 43 (72%) of the 73 TST+, QFT- patients. CONCLUSIONS For close contacts of HS+ individuals, the QFT added little sensitivity to the TST for detection of TB infection. The QFT correlated much better with exposure than the TST, especially in BCG-immunized children, and it has the greatest potential benefit for evaluation of those at lower risk of latent TB infection.
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Affiliation(s)
- Winsley Rose
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Stanley E Read
- Division of Infectious Diseases Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada
| | - Ari Bitnun
- Division of Infectious Diseases Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada
| | - Elizabeth Rea
- Toronto Public Health, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Derek Stephens
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Wanatpreeya Pongsamart
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ian Kitai
- Division of Infectious Diseases Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada
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Alvarez GG, Van Dyk DD, Davies N, Aaron SD, Cameron DW, Desjardins M, Mallick R, Obed N, Baikie M. The feasibility of the interferon gamma release assay and predictors of discordance with the tuberculin skin test for the diagnosis of latent tuberculosis infection in a remote Aboriginal community. PLoS One 2014; 9:e111986. [PMID: 25386908 PMCID: PMC4227715 DOI: 10.1371/journal.pone.0111986] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/10/2014] [Indexed: 12/21/2022] Open
Abstract
Background The tuberculin skin test (TST) is the standard test used to screen for latent TB infection (LTBI) in the northern Canadian territory of Nunavut. Interferon gamma release assays (IGRA) are T cell blood-based assays to diagnose LTBI. The Bacillus Calmette-Guerin (BCG) vaccine is part of the routine immunization schedule in Nunavut. The objective of this study was to test the feasibility, and predictors of discordance between the Tuberculin Skin Test (TST) and the IGRA assay in a medically under-serviced remote arctic Aboriginal population. Methods Both the TST and QuantiFERON-TB Gold (Qiagen group) IGRA tests were offered to people in their homes as part of a public health campaign aimed at high TB risk residential areas in Iqaluit, Nunavut, Canada. Feasibility was measured by the capacity of the staff to do the test successfully as measured by the proportion of results obtained. Results In this population of predominantly young Inuit who were mostly BCG vaccinated, the use of IGRA for the diagnosis of LTBI was feasible. IGRA testing resulted in more available test results reaching patients (95.6% vs 90.9% p = 0.02) but took longer (median 8 days (IGRA) vs 2 days (TST), p value <0.0001). 44/256 participants (17.2%) had discordant results. Multivariable regression analysis suggested that discordant results were most likely to have received multiple BCG vaccinations (RR 20.03, 95% CI, 3.94–101.82)), followed by BCG given post infancy (RR 8.13, 95% CI, 2.54–26.03)) and then to a lesser degree when BCG was given in infancy (RR 6.43, 95% CI, 1.72–24.85). Interpretation IGRA is feasible in Iqaluit, Nunavut, a remote Arctic community. IGRA testing results in more test results available to patients compared to TST. This test could result in fewer patients requiring latent TB treatment among those previously vaccinated with BCG in a region with limited public health human resources.
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Affiliation(s)
- Gonzalo G. Alvarez
- Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada
- * E-mail:
| | - Deborah D. Van Dyk
- Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Government of Nunavut, Department of Health, Iqaluit, Nunavut
| | - Naomi Davies
- Government of Nunavut, Department of Health, Iqaluit, Nunavut
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - D. William Cameron
- Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc Desjardins
- Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, University of Ottawa, Divisions of Respirology and Infectious Diseases, Departments of Medicine and Microbiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Maureen Baikie
- Government of Nunavut, Department of Health, Iqaluit, Nunavut
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Islam S, Grinsdale J, Bristow L, Higashi J. Tuberculin Skin Test and QuantiFERON Performance, and Testing of Populations at Low Risk for Tuberculosis Infection. Clin Infect Dis 2014; 59:1187-8. [DOI: 10.1093/cid/ciu518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McMullen SE, Pegues DA, Shofer FS, Sheller AC. Reply to Islam et al and Mendy et al. Clin Infect Dis 2014; 59:1189-90. [DOI: 10.1093/cid/ciu519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Painter JA, Graviss EA, Hai HH, Nhung DTC, Nga TTT, Ha NP, Wall K, Loan LTH, Parker M, Manangan L, O’Brien R, Maloney SA, Hoekstra RM, Reves R. Tuberculosis screening by tuberculosis skin test or QuantiFERON-TB Gold In-Tube Assay among an immigrant population with a high prevalence of tuberculosis and BCG vaccination. PLoS One 2013; 8:e82727. [PMID: 24367546 PMCID: PMC3868593 DOI: 10.1371/journal.pone.0082727] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/28/2013] [Indexed: 12/31/2022] Open
Abstract
Rationale Each year 1 million persons acquire permanent U.S. residency visas after tuberculosis (TB) screening. Most applicants undergo a 2-stage screening with tuberculin skin test (TST) followed by CXR only if TST-positive at > 5 mm. Due to cross reaction with bacillus Calmette-Guérin (BCG), TST may yield false positive results in BCG-vaccinated persons. Interferon gamma release assays exclude antigens found in BCG. In Vietnam, like most high TB-prevalence countries, there is universal BCG vaccination at birth. Objectives 1. Compare the sensitivity of QuantiFERON ®-TB Gold In-Tube Assay (QFT) and TST for culture-positive pulmonary TB. 2. Compare the age-specific and overall prevalence of positive TST and QFT among applicants with normal and abnormal CXR. Methods We obtained TST and QFT results on 996 applicants with abnormal CXR, of whom 132 had TB, and 479 with normal CXR. Results The sensitivity for tuberculosis was 86.4% for QFT; 89.4%, 81.1%, and 52.3% for TST at 5, 10, and 15 mm. The estimated prevalence of positive results at age 15–19 years was 22% and 42% for QFT and TST at 10 mm, respectively. The prevalence increased thereafter by 0.7% year of age for TST and 2.1% for QFT, the latter being more consistent with the increase in TB among applicants. Conclusions During 2-stage screening, QFT is as sensitive as TST in detecting TB with fewer requiring CXR and being diagnosed with LTBI. These data support the use of QFT over TST in this population.
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Affiliation(s)
- John A. Painter
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Edward A. Graviss
- The Methodist Hospital Research Institute, Houston, Texas, United States of America
| | - Hoang Hoa Hai
- Cho Ray Hospital, Visa Medical Unit, Ho Chi Minh City, Vietnam
| | | | | | - Ngan P. Ha
- The Methodist Hospital Research Institute, Houston, Texas, United States of America
| | - Kirsten Wall
- Denver Health and Hospital Authority, Denver, Colorado, United States of America
| | | | - Matt Parker
- Denver Health and Hospital Authority, Denver, Colorado, United States of America
| | - Lilia Manangan
- National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rick O’Brien
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Susan A. Maloney
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - R. M. Hoekstra
- Biostatistics and Information Management Office, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Randall Reves
- Denver Health and Hospital Authority, Denver, Colorado, United States of America
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Whitworth HS, Aranday-Cortes E, Lalvani A. Biomarkers of tuberculosis: a research roadmap. Biomark Med 2013; 7:349-62. [PMID: 23734796 DOI: 10.2217/bmm.13.53] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) continues to represent a major public health problem worldwide. Prompt and accurate diagnosis and effective treatment are fundamental to reducing morbidity and mortality and curtailing spread of infection. Furthermore, tackling the large reservoir of latent infection is the cornerstone to TB control in many high income low TB incidence countries. However, our existing toolkit for prevention, diagnosis and treatment remains outdated and inadequate. Here, we discuss the key targets for biomarker research and discovery in TB and recent developments in the field. We focus on host biomarkers, in particular: correlates of vaccine efficacy and sterilizing immunity; biomarkers of latent TB infection, including diagnosis, risk of progression to active TB and response to treatment; and markers of active TB, including diagnosis, response to treatment and risk of relapse. Recent scientific and technological advances have contributed to significant recent progression in biomarker discovery. Although there are clear remaining paucities, continued efforts within scientific, translational and clinical studies are likely to yield a number of clinically useful biomarkers of TB in the foreseeable future.
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Affiliation(s)
- Hilary S Whitworth
- Tuberculosis Research Unit, Department of Respiratory Medicine, National Heart & Lung Institute, Imperial College London, London W2 1PG, UK
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Hu Y, Zhao Q, Wu L, Wang W, Yuan Z, Xu B. Prevalence of latent tuberculosis infection and its risk factors in schoolchildren and adolescents in Shanghai, China. Eur J Public Health 2013; 23:1064-9. [DOI: 10.1093/eurpub/ckt105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Whitworth HS, Scott M, Connell DW, Dongés B, Lalvani A. IGRAs--the gateway to T cell based TB diagnosis. Methods 2013; 61:52-62. [PMID: 23296020 DOI: 10.1016/j.ymeth.2012.12.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/18/2012] [Accepted: 12/24/2012] [Indexed: 12/16/2022] Open
Abstract
Development of Interferon-Gamma Release Assays (IGRAs) and implementation of their use in clinical practice almost 10 years ago has revolutionised diagnosis of latent tuberculosis (TB) infection (LTBI). The commercially available IGRAs, TSPOT.TB (Oxford Immunotech, Oxford, UK) and QuantiFERON Gold In-Tube (Cellestis, Victoria, Australia), allow detection of TB infection with greater specificity and sensitivity than the tuberculin skin test (TST) and are now recommended for diagnosis of LTBI. The TSPOT.TB assay is a simplified enzyme-linked immunospot assay (ELISpot) that enumerates TB-specific T lymphocytes (T cells) secreting interferon-gamma (IFNγ). In comparison, the QuantiFERON Gold In-Tube assay constitutes an enzyme-linked immunosorbent assay (ELISA) to quantify IFNγ released into blood plasma after incubation of whole blood with TB antigens. Release of IFNγ, as a result of antigen stimulation of TB-specific T cells within blood, is indicative of TB infection. Although IGRAs have significant advantages over the TST in diagnosis of latent TB, they have significant limitations. Discovery of new antigens and advances in methodology for measuring cellular immunity have recently paved the way for novel tests that overcome these limitations. By establishing for the first time technological platforms for T cell based diagnosis in diagnostic service laboratories, IGRAs provide a bridgehead to clinical application of T cell based diagnosis in routine practice.
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Affiliation(s)
- Hilary S Whitworth
- Tuberculosis Research Unit, Respiratory Infection Section, National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
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Kowada A. Cost Effectiveness of Interferon-Gamma Release Assay for School-Based Tuberculosis Screening. Mol Diagn Ther 2012; 16:181-90. [DOI: 10.1007/bf03262207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chiappini E, Bonsignori F, Accetta G, Boddi V, Galli L, Biggeri A, De Martino M. Interferon-γ release assays for the diagnosis of Mycobacterium tuberculosis infection in children: a literature review. Int J Immunopathol Pharmacol 2012; 25:335-43. [PMID: 22697065 DOI: 10.1177/039463201202500203] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The role of interferon-gamma release assays (IGRAs) for immunologic diagnosis of tuberculosis in children is under debate. We carried out a narrative review on the studies on IGRAs in paediatric populations. A literature search was conducted using multiple keywords and standardized terminology in Medline, EMBASE and Cochrane databases, up to January 27th, 2011. Study quality was assessed using the MOOSE checklist and results of relevant studies were summarized. Sixty-seven paediatric studies (study population ranging from 14 to 5,244 children) were identified. Non-commercial ELISPOT assay (by means of ESAT-6 and CFP-10 antigens) had been carried out in 11 studies. QuantiFERON-TB Gold (QFT-G), QuantiFERON-TB Gold In-tube (QFT-G-IT), and T-SPOT.TB assays had been performed in 10, 44 and 18 studies, respectively. Most studies reported higher specificity of IGRA than tuberculin skin test (TST), but interpretation of the results is complicated by the fact that a gold standard for the diagnosis of latent TB is lacking. The reported sensitivity for active TB ranged from 51-93 percent for QFT-G/QFT-G-IT and 40-100 percent for ELISPOT assays, suggesting that a negative IGRA result may not exclude tuberculosis. Combining TST and IGRA results increased the diagnostic sensitivity. Rates of indeterminate results largely varied (0 to 35 percent). Most of the studies on young (less than 5 years) or immune-compromised children reported a proportion of indeterminate results exceeding 4 percent. Agreement among TST and IGRA, assessed by the k statistics, ranged from -0.03 to 0.87. Higher rates of discordance were reported in BCG-vaccinated than in non-BCG-vaccinated children. Studies on children less than 5 years and immunocompromised children reported conflicting results, as did studies on serial IGRA determinations. Despite the large amount of literature data, the role of IGRA in the pediatric population is still unclear, especially in young children. Combined use of TST/IGRA may increase diagnostic sensitivity but interpretation of discordant results remains a challenging issue.
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