Cerrahpaşa Tıp Fakültesi Kliniklerinden İstemi Yapılan QuantiFERON-TB Gold Test Sayıları ve Sonuçları ile Paralel Olarak Klinik Kullanımdaki Yeri: 2 Yıllık Retrospektif Değerlendirme

Abstract

Amaç: Bu retrospektif çalışma Cerrahpaşa Tıp Fakültesi’nin farklı kliniklerinden spesifik amaçlara dönük istemi yapılan QuantiFERON-TB Gold (QFT) testinin kullanım sıklığının ve sonuçlarının belirlenmesi ile bu testin kliniğin amaçlarına dönük uygunluğunun olup olmamasının değerlendirilmesi amacıyla yapılmıştır. Gereç ve Yöntem: Ocak 2018-Aralık 2019 tarihleri arasında çeşitli kliniklerden gönderilen ve laboratuvarda tam kan örneğinden ticari kitin öngörüleri doğrultusunda in vitro çalışması yapılan QFT testinin istem yapan kliniklere göre sayısı ve sonuçları retrospektif olarak belirlenmiş ve değerlendirmeye alınmıştır. Bulgular: Çeşitli kliniklerden gönderilen 1.207 hastaya ait tam kan örneklerinin 151’inde (%12,5) pozitiflik saptanmıştır. Test isteminin en sık 297 (%24,6) olgu ile nöroloji kliniğinden yapıldığı, bunu sırasıyla 235 (%19,5) ve 142 (%11,8) olgu ile romatoloji ve enfeksiyon hastalıkları kliniklerinin takip ettiği tespit edilmiştir. Test istemi yapan birimler arasında en sık pozitif saptama oranının göz hastalıkları kliniğinden olduğu belirlenmiştir. Sonuç: Testin istem sıklığının özellikle göğüs hastalıkları ve enfeksiyon hastalıkları kliniklerinde fazla olması beklenirken onların yerine nöroloji ve romatoloji kliniklerinde daha fazla olması, buna karşın yüksek pozitifliğin göz hastalıkları kliniğinde görülmesi dikkat çekicidir. QFT testinin klinikler düzeyinde test istem sayısına ve buna bağlı pozitiflik sonuç ilişkisine bakıldığında amaca dönük istem sayısı ile alınan pozitiflik sonucu arasında bir uyumsuzluk olduğu belirlenmiştir. Hem ticari kitin maliyeti hem de alınan pozitiflik sonuçlarının klinisyenlere yol göstericiliği hususundaki etkinlik göz önüne alındığında kliniklere göre test isteminin ulusal algoritmalar düzeyinde tekrar gözden geçirilmesinin yararlı olacağı kanaatindeyiz.

Keywords

• Latent Tüberküloz Enfeksiyonu
• Mycobacterium tuberculosis
• Tanı
• Tüberküloz

The Frequency and Results of QuantiFERON-TB Gold Test in Parallel with the Place of the Clinical Usage in the Cerrahpaşa Medical Faculty Clinics: A 2-year Retrospective Evaluation

Abstract

Objectives: We aimed to evaluate the relevancy of QuantiFERON-TB Gold (QFT) test which was required for the specific aims from the various clinics of Cerrahpaşa Medical Faculty by determining the using frequency and results of the QFT test in this retrospective study. Materials and Methods: The in vitro studies of QFT test were performed from the whole blood samples according to the manufacturer’s recommendations between January 2018 and December 2019. The numbers and results of QFT test were retrospectively determined according to the required clinics and were taken into consideration. Results: The test positivity was detected in 151 (12.5%) from the whole blood samples of 1,207 patients from various clinics. It was determined that the test request was made most frequently from the neurology clinic with 297 (24.6%) cases, followed by the rheumatology and infectious diseases clinics with 235 (19.5%) and 142 (11.8%), respectively. It was also determined that the most common positivity detection rate among the clinics requesting the test was from the ophthalmology clinic. Conclusion: It is noteworthy that the frequency of the test request was expected to be higher in the chest diseases and infectious diseases clinics, but unexpectantly, test request frequency was rather higher in the neurology and rheumatology clinics, whereas the high positivity in the test request was observed in the ophthalmology clinic. When the QFT test was examined on the number of test requests in the clinics and the relation between positive results, it was determined that there was a discrepancy between the number of purposeful requests and the positive result obtained. Considering the effectiveness of both the cost of the commercial kit and the positive results obtained in guiding clinicians, we believe that it would be beneficial to review the test requests at the national algorithms level by clinics

Keywords

• Latent Tuberculosis Infection
• Mycobacterium tuberculosis
• Diagnosis
• Tuberculosis

References

1. 1. Kalender N, Sütçü Çiçek H. Eski Değil Eskimeyen Hastalık: Tüberküloz. Hacettepe Üniv Hemş Fak Derg. 2016;3:58-67.
2. 2. Kim YJ, Kang JY, Kim SI, et al. Predictors for false-negative QuantiFERONTB Gold assay results in patients with extrapulmonary tuberculosis. BMC Infect Dis. 2018;18:457. doi: 10.1186/s12879-018-3344-x
3. 3. Global tuberculosis report 2019. Geneva: World Health Organization; 2019. https://www.who.int/tb/publications/global_report/en/ (Accessed 01 July 2020).
4. 4. Bloom BR, Atun R, Cohen T, et al. Tuberculosis. In: Holmes KK, Bertozzi S, Bloom BR, et al, editors. Major Infectious Diseases. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2017. s. 235-334.
5. 5. Dunn JJ, Starke JR, Revell PA. Laboratory Diagnosis of Mycobacterium tuberculosis Infection and Disease in Children. J Clin Microbiol. 2016;54:1434-1441.
6. 6. Haas MK, Belknap RW. Diagnostic Tests for Latent Tuberculosis Infection. Clin Chest Med. 2019;40:829-837.
7. 7. Piccazzo R, Paparo F, Garlaschi G. Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: a systematic review. J Rheumatol Suppl. 2014;91:32-40.
8. 8. Bartalesi F, Vicidomini S, Goletti D, et al. QuantiFERON-TB Gold and the TST are both useful for latent tuberculosis infection screening in autoimmune diseases. Eur Respir J. 2009;33:586-593.

9. 9. Huebner RE, Schein MF, Bass JB. The tuberculin skin test. Clin Infect Dis. 1993;17:968-975.
10. 10. Hsia EC, Schluger N, Cush JJ, et al. Interferon-γ release assay versus tuberculin skin test prior to treatment with golimumab, a human anti-tumor necrosis factor antibody, in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis. Arthritis Rheum. 2012;64:2068-2077.
11. 11. Pouchot J, Grasland A, Collet C, et al. Reliability of tuberculin skin test measurement. Ann Intern Med. 1997;126:210-214.
12. 12. Doosti-Irani A, Ayubi E, Mostafavi E. Tuberculin and QuantiFERON-TB-Gold tests for latent tuberculosis: a meta-analysis. Occup Med. 2016;66:437-445.
13. 13. QuantiFERON®-TB Gold Plus (QFT®-Plus) Package Insert. http://www. quantiferon.com/wp-content/uploads/2017/10/QFT-Plus-ELISA-IFUL1095849-R02.pdf (Accessed 01 July 2020).
14. 14. Çağatay T. Latent Tüberküloz Tarama Testleri. Turk J Dermatol. 2012;6:62- 64.
15. 15. Demir S, Sadi Aykan F, Öztuna D. Ankara Numune Eğitim Araştırma Hastanesi Göğüs Hastalıkları Kliniğinde son 8 yılda (2006-2013) TNF-alfa blokeri kullanan hastalara verilen latent tüberküloz tedavisi sonuçları. Tuberk Toraks. 2014;62:286-290.
16. 16. Solovic I, Sester M, Gomez-Reino JJ, et al. The risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement. Eur Respir J. 2010;36:1185-1206.
17. 17. Askling J, Fored CM, Brandt L, et al. Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum. 2005;52:1986-1992.
18. 18. Tanrıverdi Çaycı Y, Korkmaz F, Birinci A. Tüberküloz laboratuvarımıza gönderilen T-Spot. TB test sonuçlarının retrospektif olarak değerlendirilmesi. Ortadogu Tıp Derg. 2017;9:24-27.
19. 19. Çavuşoğlu C, Durusoy R, Yaşar M, et al. Mycobacterium tuberculosis Enfeksiyonu Tanısında QuantiFERON®-TB Gold in Tube Testi ve Tüberkülin Deri Testinin Değerlendirilmesi. Mikrobiyol Bul. 2017;51:115-126.
20. 20. Maden E, Bekci TT, Kesli R, et al. Evaluation of performance of quantiferon assay and tuberculin skin test in end stage renal disease patients receiving hemodialysis. New Microbiol. 2011;34:351-356.
21. 21. Kuś J, Demkow U, Lewandowska K, et al. Prevalence of latent infection with Mycobacterium tuberculosis in Mazovia Region using interferon gamma release assay after stimulation with specific antigens ESAT-6 and CFP-10. Pneumonol Alergol Pol. 2011;79:407-418.
22. 22. Çiftçi F, Sezer O, Kaya H, et al. Akciğer Tüberkülozlu Genç Erişkin Erkek Hastalarda Tüberkülin Deri Testi ile Quantiferon-TB Gold Tüp Testinin Karşılaştırılması. Turkiye Klinikleri J Med Sci. 2011;31:534-540.
23. 23. Çağan Appak Y, Appak Ö, Anal Ö, et al. Çocuklarda Latent Tüberküloz Tanısında Tüberkülin Deri Testi ve İn Vitro İnterferon-Gama Salınım Testinin Karşılaştırılması. Turkiye Klinikleri J Med Sci. 2013;33:1402-1407.
24. 24. Sargın G, Şentürk T, Ceylan E, et al. TST, QuantiFERON-TB Gold test and T-SPOT.TB test for detecting latent tuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy. Tuberk Toraks. 2018;66:136- 143.
25. 25. Diel R, Loddenkemper R, Meywald-Walter K, et al. Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis. Am J Respir Crit Care Med. 2008;177:1164-1170.
26. 26. Balkhy HH, El Beltagy K, El-Saed A, et al. Comparison of QuantiFERONTB gold in tube test versus tuberculin skin test for screening of latent tuberculosis infection in Saudi Arabia: A population-based study. Ann Thorac Med. 2016;11:197-201.
27. 27. Ferrara G, Losi M, D’Amico R, et al. Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study. Lancet. 2006;367:1328-1334.
28. 28. Kobashi Y, Sugiu T, Mouri K, et al. Indeterminate results of QuantiFERON TB-2G test performed in routine clinical practice. Eur Respir J. 2009;33:812- 815.
29. 29. García-Gasalla M, Fernández-Baca V, Juan-Mas A, et al. Use of QuantiferonTB-Gold in Tube(®) test for detecting latent tuberculosis in patients considered as candidates for anti-TNF therapy in routine clinical practice. Enferm Infecc Microbiol Clin. 2013;31:76-81.
30. 30. Tsiouri G, Gaitanis G, Kiorpelidou D, et al. Tuberculin skin test overestimates tuberculosis hypersensitivity in adult patients with psoriasis. Dermatology. 2009;219:119-125.
31. 31. Ponce de León D, Acevedo-Vásquez E, Sánchez-Torres A, et al. Attenuated response to purified protein derivative in patients with rheumatoid arthritis: study in a population with a high prevalence of tuberculosis. Ann Rheum Dis. 2005;64:1360-1361.