Comparison of PPD and IGST Sensitivity in Latent Tuberculosis Assessment (Cross-sectional Study)

Yıl 2025, Cilt: 15 Sayı: 3, 249 - 256, 30.09.2025

Fuat Erel , Nurhan Sarıoğlu , Nilay Şahin , Mustafa Çolak , Kazım Batıhan Büyükzengin , Hikmet Çoban

https://doi.org/10.31832/smj.1647879

Öz

Objective: Purified Protein Derivative (PPD) and Interferon Gamma Release Assay (IGRA) were performed on patients with ankylosing spondylitis and rheumatoid arthritis who were planned to initiate immunosuppressive treatment. The aim was to determine which test would be more appropriate for diagnosing latent tuberculosis (TB) and to evaluate the sensitivity and specificity of PPD and IGRA tests in latent TB diagnosis.
Materials and Methods: Forty-seven patients with rheumatoid arthritis and 27 patients with ankylosing spondylitis were included in the study. All patients underwent both PPD and QuantiFERON-TB Gold Plus testing. Latent TB was defined as close contact with active tuberculosis infection and/or presence of suspicious fibrotic/calcified lesions on chest radiography without active tuberculosis infection.
Results: The QuantiFERON-TB Gold Plus test demonstrated a specificity of 96.6% and sensitivity of 73.3%, while the tuberculin skin test (TST) showed a specificity of 25.4% and sensitivity of 93.3%. A significant correlation was found between the QuantiFERON-TB Gold Plus test and latent tuberculosis criteria (p<0.001, r=0.562), whereas no statistically significant correlation existed between TST and latent tuberculosis criteria (p=0.309, r=0.120).
Conclusion: The IGRA test demonstrated higher specificity and sensitivity compared to TST. Given the lower specificity of TST observed in our study compared to other studies, the IGRA test may be recommended for patients planned to receive prophylactic treatment.

Anahtar Kelimeler

PPD , BCG , IGRA , Latent tuberculosis , Prophylaxis

Kaynakça

• Er AG, Gul A, Inan Suer A, Tipirdamaz Yurteri AS, Babalık A, Yıldırım A, ve ark. Anti-TNF kullanan hastalarda tüberküloz rehberi 2016. Ankara, Türkiye: Halk Sağlığı Kurumu; 2016.
• Latorre I, Carrascosa JM, Vilavella M, Díaz J, Prat C, Domínguez J, et al. Diagnosis of tuberculosis infection by interferon-gamma release assays in patients with psoriasis. J Infect. 2014;69:600-606.
• Patel R, Cafardi JM, Patel N, Sami N, Cafardi JA. Tumor necrosis factor biologics beyond psoriasis in dermatology. Expert Opin Biol Ther. 2011;11(10):1341-1359.
• Cantini F, Niccoli L, Goletti D. Adalimumab, etanercept, infliximab, and the risk of tuberculosis: Data from clinical trials, national registries, and postmarketing surveillance. J Rheumatol Suppl. 2014;91:47-55.
• Sadovici V, Nicorici LM, Salaru V, Rotaru T, Vetrila S, Cebanu M, et al. Do we need to screen for latent TB when initiating a methotrexate treatment? European Respiratory Journal. 2013;42:P2839.
• Mrozek N, Pereira B, Soubrier M, Gourdon F, Laurichesse H. Screening of tuberculosis before biologics. Med Mal Infect. 2012;42:1-4.
• Skjot RL, Oettinger T, Rosenkrands I, Ravn P, Brock I, Jacobsen S, et al. Comperetive evaluation of lowmolecular-mass proteins from Mycobacterium tuberculosis identifies members of the ESAT-6 family as immunodominant T-cell antigens, Infect Immun. 2000;68:214-220.
• Brosch R, Gordon SV, Marmiesse M, Brodin P, Buchrieser C, Eiglmeier K, et al. A new evolutionary scenario for the Mycobacterium tuberculosis complex. Proc Natl Acad Sci. 2002;99:3684-3689.
• Cattamanchi A, Smith R, Steingart KR, Metcalfe JZ, Date A, Coleman C, et al. Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: A systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2011;56:230-238.
• Laffitte E, Janssens JP, Roux-Lombard P, Thielen AM, Barde C, Marazza G, et al. Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: Comparison of an interferon-gamma release assay vs. tuberculin skin test. Br J Dermatol. 2009;161:797-800.
• Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis. 1993;17:968-975.
• Özkara Ş, Türkkanı MH, Musaonbaşıoğlu S. Tüberküloz tanı ve tedavi rehberi. Ankara: Türkiye: Sağlık Bakanlığı Yayın No: 862, 2011.
• Metin Timur Ö, Tanir G, Öz FN, Bayhan Gİ, Aydin Teke T, Tuygun N. Comparison of QuantiFERON-TB gold in-tube test with tuberculin skin test in children who had no contact with active tuberculosis case. Tuberk Toraks. 2014;62:116-121.
• Bray MG, Poulain C, Dougados M, Gossec L. Frequency and tolerance of antituberculosis treatment according to national guidelines for prevention of risk of tuberculosis due to tumor necrosis factor blocker treatment. Joint Bone Spine. 2010;77:135-141.
• Lewinsohn DA, Zalwango S, Stein CM, Mayanja-Kizza H, Okwera A, Boom WH, et al. Whole blood interferongamma responses to Mycobacterium tuberculosis antigens in young household contacts of persons with tuberculosis in Uganda. PLoS ONE. 2008;3:3407.
• Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, Gutierrez C, Cucho M, Alfaro J, et al. Comparison of an interferongamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol. 2008;35:776-781.
• Katial RK, Hershey J, Purohitt-Seth T, Belisle JT, Brennan PJ, Spencer JS, 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.
• Martin J, Walsh C, Gibbs A, McDonnell T, Fearon U, Keane J, et al. Comparison of interferon {gamma} release assays and conventional screening tests before tumour necrosis factor {alpha} blockade in patients with inflammatory arthritis. Ann Rheum Dis. 2010;69:181-185.
• Chang B, Park HY, Jeon K, Ahn JK, Cha HS, Koh EM, et al. Interferon-γ release assay in the diagnosis of latent tuberculosis infection in arthritis patients treated with tumor necrosis factor antagonists in Korea. Clin Rheumatol. 2011;30:1535-1541.
• Pyo J, Cho SK, Kim D, Sung YK. Systemic review: agreement between the latent tuberculosis screening tests among patients with rheumatic diseases. Korean J Intern Med. 2018;33:1241-1251.
• Streeton JA, Desem N, Jones SL. Sensitivity and Specificity of a gamma interferon blood test for tuberculosis infection. Int J Tuberc Lung Dis. 1998;2:443-450.
• Lee JY, Choi HJ, Park IN, Hong SB, Oh YM, Lim CM, et al. Comparison of two commercial interferon-gamma assays for diagnosing Mycobacterium tuberculosis infection. Eur Respir J. 2006;28:24-30.
• Sargın G, Şentürk T, Ceylan E, Telli M, Çildağ S, Doğan H. 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.
• Diel R, Goletti D, Ferrara G, Bothamley G, Cirillo D, Kampmann B, et al. Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: A systematic review and meta-analysis. Eur Respir J. 2011;37:88-99.
• Zellweger JP, Sotgiu G, Corradi M, Durando P. The diagnosis of latent tuberculosis infection (LTBI): Currently available tests, future developments, and perspectives to eliminate tuberculosis (TB). Med Lav. 2020;111:170-183.