Comparison of a Quantiferon-TB Gold In Tube Test With Tuberculin Skin Test in Patients With Active and Latent Tuberculosis Infection

Abstract

Objective: To compare the usefulness and the performance of Quanti FERON-TB Gold Test (QFT-G) assays and tuberculin skin test (TST) in patients with active and latent tuberculosis (TB) disease. Material and Method: Sixteen patients with active, 26 patients with latent TB ve 21 controls were included the study. Blood samples were taken for QFT-GIT before the treatment in patients with active TB and then TST was performed. Results: QFT-GIT tests were positive in 12 (75.0%) of active TB, in 15 (65.2%) of latent TB patients and in 3 (14.3%) controls. QFT-GIT test was found to be significantly higher in active TB patients and in latent TB patients compare to those of controls (respective p=0.003, p=0.005). Sensitivities of QFT-G were found to be as 75% and specificities 85.7% for active TB and 65.2% and 85.7% respectively for latent TB. When patients with active and latent TB were evaluated sensitivities of QFT-GIT were 75% and specificities 34.8%. The mean TST value was statistically higher in latent TB patients than active TB patients (p=0.001) and in active TB patients than controls (p=0.001). A positive correlation was detected between QFT-GIT test and TST. Conclusion: Even it was thought that QFT assays have the supplementary role for detection of active and latent TB, specificity of the test for the diagnostic discrimination between active TB and latent TB disease is low. The presence of positive correlation between QFT-GIT and TST and the high quality of QFN-GIT is taking into account in our.

Keywords

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Aktif ve Latent Tüberkülozlu Olguların Tanısında Tüberkülin Deri Testi ile Quantiferon-TB Gold In Tube Testinin Etkinliğinin Karşılaştırılması

Öz

Amaç: Aktif ve latent tüberkülozu (TB) olan hastalarda QuantiFERON-TB Gold In Tube (QFT-GIT) ve tüberkülin deri testinin (TDT) tanısal değerinin araştırılması ve bu iki testin etkinliğinin karşılaştırılması. Gereç ve Yöntem: Çalışmamıza 16 aktif akciğer, 26 latent TB'li olgu ve 21 sağlıklı kontrol olgu alındı. Aktif akciğer TB'li olgularda tedavi başlanmadan önce olmak üzere tüm olgularda önce QFT- GIT için kan alındı daha sonra TDT'leri uygulandı. Bulgular: QFT-GIT testi aktif TB hastalarının 12'sinde (%75.0), latent TB olgularının 15'inde (%65.2) pozitif iken, kontrol grubunda 3 (%14.3) olguda pozitif sonuç elde edildi. Ortalama QFT-GIT testi düzeyleri hem aktif hem de latent TB olgularında kontrol grubu ile karşılaştırıldığında istatistiksel olarak anlamlı düzeylerde yüksekti (sırasıyla p=0.003, p=0.005). QFT-GIT testinin duyarlılığı ve özgüllüğü aktif akciğer TB'nin saptanmasında %75 ile %85.7, latent TB'nin saptanmasında %65.2 ile %85.7 olarak saptandı. Aktif akciğer ve latent TB'li olgular değerlendirildiğinde ise testin duyarlılığı %75, özgüllüğü %34.8 olarak bulundu. Ortalama TDT endürasyon çapı latent TB'li olgularda aktif akciğer TB'ye göre (p=0.001) ve aktif akciğer TB'li olgularda kontrol grubuna göre (p=0.001) istatiksel olarak yüksek saptandı. QFT-GIT testi ile TDT arasında pozitif korelasyon saptandı. Sonuç: Latent TB infeksiyonu ve aktif TB'lu hastaların saptanmasında, TDT ile karşılaştırıldığında QFT-GIT'in tanıda katkısının olabileceği düşünülse de; testin aktif hastalık ve latent infeksiyon ayırımında özgüllüğü düşmektedir. QFT-GIT ile TDT arasında pozitif korelasyon saptanmış olması ve QFT-GIT'in maliyetinin yüksek olması ise ülkemiz şartlarında dikkate alınmalıdır.

Anahtar Kelimeler

• Aktif akciğer tüberkülozu, latent tüberküloz infeksiyonu, QuantiFERON-TB Gold IT, tüberkülin deri testi

Kaynakça

1. 1. Türkiye’de Tüberkülozun Kontrolü için Başvuru Kitabı. T.C Sağlık Bakanlığı Verem Savaşı Daire Başkanlığı, 1. Baskı, Ankara: Rekmay Ltd. Şti, 2003: 1-122.
2. 2. American Thoracic Society and Centers for Disease Control and Prevention. Diagnostic standarts and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000; 161: 1376-1395.
3. 3. Shinnich MT, Good RC. Diagnostic mycobacteriology laboratory practices. Clin Infect Dis 1995; 2: 291-299.
4. 4. Katial RK, Hershey J, Purohit-Seth T, et al. Cell-mediated immune response to tuberculosis antigens: comparison of skin testing and measurement of in vitro gamma interferon production in whole-blood culture. Clin Diagn Lab Immunol 2001; 8: 339-345.
5. 5. Mazurek GH, Villarino ME. Recommendation and reports. MMWR 2003; 52: 15-18.
6. 6. Elsie L, SH. Robert Evolution and Current Use of the Tuberculin Test. Clinical Infect Dis 2002; 34: 365-370.
7. 7. Kwamanga DO, Swai OB, Agwanda R, Githui W. Effect of non-tuberculous Mycobacteria infection on tuberculin results among primary school children in Kenya. East Afr Med J 1995; 72: 222–227.
8. 8. Snider DE Jr. Bacille Calmette-Guerin vaccination and tuberculin skin tests. JAMA 1985; 253: 3438-3439.

9. 9. Brock I, Weldingh K, Lillebaek T. Comprasion of Tuberculin Skin Test and New Spesific Blood Test in Tuberculosis Contacts. Am J Respir Crit Care Med 2004; 170: 65-69.
10. 10. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K. IGRA Expert Committee; Centers for Disease Control and Prevention (CDC). Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep 2010; 59 (RR-5): 1-25.
11. 11. Adetifa IM, Lugos MD, Hammond A, et al. Comparison of two interferon gamma release assays in the diagnosis of Mycobacterium tuberculosis infection and disease in The Gambia. BMC Infect Dis 2007; 7: 122.
12. 12. Mori T, Sakatani M, Yamagishi F, et al. Specific detection of tuberculosis infection: An interferon gamma-based assay using new antigens. Am J Respir Crit Care Med 2004; 170: 59-64.
13. 13. Kunimoto D, Der E, Beckon A. Use of the Quanti FERON-TB Gold test to confirm latent tuberculosis infection in a Canadian tuberculosis clinic. Int J Tuberc Lung Dis 2009; 13: 726-730.
14. 14. Streeton JA, Desem N, Jones SL. Sensitivity and Specificity of a gamma interferon blood test for tuberculosis infection. Int J Tuberc Lung Dis 1998; 26: 443-450.
15. 15. Saracino A, Scotto G, Fornabaio C, et al. QuantiFERON-TB Gold In-Tube test (QFT-GIT) for the screening of latent tuberculosis in recent immigrants to Italy. New Microbiol 2009; 32: 369-76.
16. 16. Çicek C, Çok G, Özhan M, Yaygın YE, Bilgiç A. Latent ve aktif tüberkülozu olan hastalarda tüberkülin deri testi ile quantiferon tb testinin karşılaştırılması. İnfeksiyon Dergisi 2006; 20: 15-18.
17. 17. Codecasa LR, Ferrarese M, Penati V, et al. Comparison of tuberculin skin test and Quantiferon immunological assay for latent tuberculosis infection. Monaldi Arch Chest Dis 2005; 63: 158-162.
18. 18. Ferrara G, Losi M, Meacci M, et al. Routine hospital use of a new commercial whole blood interferon-gamma assay for the diagnosis of tuberculosis infection. Am J Respir Crit Care Med 2005; 172: 631-635.
19. 19. Mazurek GH, LoBue PA, Daley CL. Comparison of a WholeBlood Interferon gamma assay with Tuberculin Skin Testing for Detecting Latent Mycobacterium Tuberculosis Infection. JAMA 2001; 286: 1740-1747.
20. 20. Johnson PD, Stuart RL, Grayson ML, et al. Tuberculinpurified protein derivative, MPT-64-, and ESAT-6-stimulated gamma interferon responses in medical students before and after Mycobacterium bovis BCG vaccination and in patients with tuberculosis. Clin Diagn Lab Immunol 1999; 6: 934-937.
21. 21. Buddle BM, De Lisle GW, Pfeffer A, Aldwell FE. Immunological responses and protection against Mycobacterium bovis in calves vaccinated with a low dose of BCG. Vaccine 1995; 13: 1123-1130.
22. 22. Converse PJ, Jones SL, Astemborski J, Vlahov D, Graham NM. Comparison of a tuberculin interferon- assay with the tuberculin skin test in high-risk adults: effect of human immunodeficiency virus infection. J Infect Dis 1997; 176: 144-150.
23. 23. Dockrell HM, Weir RE. Whole blood cytokine assays-a new generation of diagnostic tests for tuberculosis Int J Tuberc Lung Dis 1998; 2: 441-442