Tuberculosis skin test, but not interferon-γ-releasing assays is affected by BCG vaccination in HIV patients

2013 ◽  
Vol 66 (4) ◽  
pp. 376-380 ◽  
Author(s):  
T. Wolf ◽  
U. Goetsch ◽  
G. Oremek ◽  
M. Bickel ◽  
P. Khaykin ◽  
...  
Keyword(s):  
Skin Test ◽  
Interferon Γ ◽  
Hiv Patients ◽  
Bcg Vaccination ◽  
Tuberculosis Skin Test

scholarly journals Screening for latent tuberculosis infection: performance of tuberculin skin test and interferon-γ release assays under real-life conditions

2012 ◽  
Vol 71 (11) ◽  
pp. 1791-1795 ◽  
Author(s):  
S Kleinert ◽  
H-P Tony ◽  
K Krueger ◽  
J Detert ◽  
F Mielke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Interferon Γ ◽  
Clinical Risk Factors ◽  
Test Results ◽  
Bcg Vaccination ◽  
Rheumatological Disease

ObjectivesTo characterise optimal screening strategies for latent tuberculosis infection (LTBI) prior to the initiation of anti-tumour necrosis factor therapy.MethodsPatients in 62 German rheumatology centres were evaluated for LTBI. Each patient was screened with a tuberculin skin test (TST) and one form of an interferon-γ release assay (IGRA), either TSPOT.TB (TSPOT) or Quantiferon TB Gold (QFT).ResultsA total of 1529 patients with rheumatological disease were tested with a TST, 844 with TSPOT and 685 with QFT. TST was positive in 11.3% (n=173). The prevalence of LTBI was 8.0% when defined as a positive TST and no previous Bacille Calmette-Guérin (BCG) vaccination and 7.9% when based on a positive IGRA. Combining both estimates increased the prevalence of LTBI to 11.1%. Clinical risk factors for LTBI were found in 122 patients (34 with a history of prior TB, 81 close contacts and 27 with suggestive chest x-ray lesions). A compound risk factor (CRF) was defined as the presence of at least one of these three risk factors. Statistical analyses were conducted to examine the association between CRF and LTBI test outcomes. In multivariate analysis, TST was influenced by CRF (OR 6.2; CI 4.08 to 9.44, p<0.001) and BCG vaccination status (OR 2.9; CI 2.00 to 4.35, p<0.001). QFT and TSPOT were only influenced by CRF (QFT: OR 2.6; CI 1.15 to 5.98, p=0.021; TSPOT: OR 8.7; CI 4.83 to 15.82, p<0.001). ORs and the agreement of TST and IGRA test results varied by rheumatological disease.ConclusionLTBI test results in an individual patient need to be considered in the context of prior BCG vaccination and clinical risk factors. In patient populations with low rates of TB incidence and BCG vaccination, the use of both TST and IGRA may maximise sensitivity in detecting LTBI but may also reduce specificity.

scholarly journals 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 ◽  
Vol 8 (12) ◽  
pp. e82727 ◽  
Author(s):  
John A. Painter ◽  
Edward A. Graviss ◽  
Hoang Hoa Hai ◽  
Duong Thi Cam Nhung ◽  
Tran Thi Thanh Nga ◽  
...  
Keyword(s):  
Skin Test ◽  
Immigrant Population ◽  
Tuberculosis Screening ◽  
Bcg Vaccination ◽  
High Prevalence ◽  
Tuberculosis Skin Test

A Summary of the Third Global Interferon-γ Release Assay Symposium

2013 ◽  
Vol 34 (6) ◽  
pp. 619-624 ◽  
Author(s):  
Antonino Catanzaro ◽  
Charles Daley
Keyword(s):  
Immune Response ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Interferon Γ ◽  
Enzyme Linked Immunosorbent Assay ◽  
In Vitro Tests ◽  
The Third ◽  
Specific Antigens ◽  
Ifn Γ

Studies over the past several decades have dramatically increased our understanding of the immune response to Mycobacterium tuberculosis infection, and advances in proteomics and genomics have led to a new class of immune-diagnostic tests, termed interferon-γ (IFN-γ) release assays (IGRAs), which appear to obviate many of the problems encountered with the tuberculin skin test (TST). Worldwide, 2 IGRAs are currently commercially available. QuantiFERON-TB Gold In-Tube (Cellestis) is a third-generation product that uses an enzyme-linked immunosorbent assay to measure IFN-γ generated in whole blood stimulated with M. tuberculosis–specific antigens. T-Spot-TB (Oxford Immunotec) employs enzyme-linked immunosorbent spot technology to enumerate the number of purified lymphocytes that respond to M. tuberculosis–specific antigens by producing IFN-γ. These in vitro tests measure the host immune response to M. tuberculosis–specific antigens, which virtually eliminates false-positive cross reactions caused by bacillus Calmette-Guérin vaccination and/or exposure to environmental nontuberculous mycobacteria that plague the interpretation and accuracy of the tuberculin skin test (TST). The high specificity of IGRAs, together with sensitivity commensurate with or better than that of the TST, promises an accurate diagnosis and the ability to focus tuberculosis-control activities on those who are actually infected with M. tuberculosis. The Third Global Symposium was held over a 3-day period and was presented by the University of California, San Diego, Continuing Medical Education department; slides and sound recordings of each presentation are available at http://cme.ucsd.edu/igras/syllabus.html. A moderated discussion is also available at http://cme.ucsd.edu/igrasvideo. This document provides a summary of the key findings of the meeting, specifically focusing on the use of IGRAs in screening healthcare worker populations.

scholarly journals Influence of replacing tuberculin skin test with ex vivo interferon γ release assays on decision to administer prophylactic antituberculosis antibiotics before anti-TNF therapy

2012 ◽  
Vol 71 (11) ◽  
pp. 1783-1790 ◽  
Author(s):  
Xavier Mariette ◽  
Gabriel Baron ◽  
Florence Tubach ◽  
Frédéric Lioté ◽  
Bernard Combe ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Ex Vivo ◽  
Inflammatory Diseases ◽  
Tertiary Care ◽  
Latent Tuberculosis ◽  
Interferon Γ ◽  
Specificity And Sensitivity ◽  
Immune Mediated

BackgroundThe recommendations for detecting latent tuberculosis infection (LTBI) before antitumour necrosis factor (anti-TNF) therapy are based on the tuberculin skin test (TST), which lacks both specificity and sensitivity and can lead to unnecessary treatment with antibiotics. A study was undertaken to investigate the effect of replacing TST with interferon γ (IFNγ) release assays (IGRA) in screening for LTBI and deciding to begin prophylactic antituberculosis (TB) antibiotics before anti-TNF therapy in immune-mediated inflammatory diseases.MethodsIn 15 tertiary care hospitals, consecutive patients with rheumatoid arthritis, spondylarthropathies or Crohn's disease were screened for LTBI before anti-TNF therapy with TST, QuantiFERON TB Gold in tube (QTF-Gold IT) and T-SPOT.TB at the same time. The potential diagnosis of LTBI and the effect on the decision to begin antibiotic prophylaxis were assessed.ResultsAmong 429 patients, 392 had results for the three tests. The results for TST, T-SPOT.TB and QTF Gold IT were positive for 35.2%, 15.1% and 9.9% of patients, respectively (p<0.0001). Antibiotics were required for 177 patients (45.2%) if positive TST results were included in the LTBI definition, 107 patients (27.3%) if TST results were replaced with results from one of the IGRA tests and 84 patients (21.4%) if TST results were replaced with QTF-Gold IT results (p<0.0001). The decision on the use of antibiotic prophylaxis was changed for 113 patients (28.8%, 95% CI 24.4% to 33.6%) if TST results were replaced with QTF-Gold IT results.ConclusionsReplacing TST with IGRA for determining LTBI allowed the proportion of patients with immune-mediated inflammatory diseases needing prophylactic anti-TB antibiotics before beginning anti-TNF agents to be reduced by half.TrialRegNo: NCT00811343.

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