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Lee and Shim: Diagnosis of Mycobacterium tuberculosis Infection using Ex-vivo interferon-gamma Assay
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Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(5): 497-509.

Published online: 31 May 2006

DOI: https://doi.org/10.4046/trd.2006.60.5.497

Diagnosis of Mycobacterium tuberculosis Infection using Ex-vivo interferon-gamma Assay

Jung Yeon Lee, M.D.1, Tae Sun Shim, M.D.2

1Division of Pulmonary Medicine, Department of Internal Medicine, Konkuk University Medical Center, Chungju Hospital, Korea.

2Division of Pulmonary & Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Korea.

Address for correspondence: Tae Sun Shim, M.D. Address: Division of Pulmonary & Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-Ku, Seoul, 138-736, South Korea. Phone: 02-3010-3892, Fax: 02-3010-6968, shimts@amc.seoul.kr

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Until recently, the tuberculin skin test (TST) has been the only tool available for diagnosing a latent TB infection. However, the development of new diagnostic tools, using the Mycobacterium tuberculosis (MTB)-specific early secreted antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) antigens, should improve the control of tuberculosis (TB) by allowing a more accurate identification of a latent TB infection (LTBI). Antigen-specific interferon-gamma (IFN-γ) assays have greater specificity in BCG-vaccinated individuals, and as less biased by nontuberculous mycobacterial infections. Many comparative studies have suggested that those assays have a higher specificity than the TST, and the sensitivity of these assays are expected to remarkably improved if more MTB-specific antigens can become available. Nevertheless, the major obstacle to the widespread use of these tests is the limited financial resources. Similar to other diagnostic tests, the predictive value of IFN-γ assays depends on the prevalence of a MTB infection in the population being tested. Therefore, prospective studies will be meeded to establish the applicability of these new assays at multiple geographic locations among patients of different ethnicities, and to determine if the IFN-γ responses can indicate those with a high risk of progressing to active TB.

Keywords: Interferon-gamma assay, Tuberculin test, Tuberculosis, Latent tuberculosis infection

Figures and Tables

Figure 1
Dot plot of individual responses to CFP-10* and ESAT-6† for 118 culture-positive patients with TB (a) and 213 subjects with a low risk for TB‡ exposure (b) using QFT-G§ kit. The dashed line represents the cutoff of 0.35 IU/ml for IFN-γ. The specificity of the test for the low-risk group was 98.1% and the sensitivity for patients with M. tuberculosis infection was 89.0%17. Adopted from reference 17.
*early secretory antigenic target 6, †culture filtrate protein 10, ‡tuberculosis, §QuantiFERON-TB Gold
trd-60-497-g001
Figure 2
Representative positive (A) and negative (B) results of T SPOT-TB analysis. The positive result (A) shows many spots in the ESAT-6* or CFP-10† stimulated wells, whereas the negative result (B) shows less than 5 spots in the ESAT-6 or CFP-10 stimulated wells.
*early secretory antigenic target 6, †culture filtrate protein 10
trd-60-497-g002
Table 1
Comparison between QuantiFERON-TB Gold and T SPOT-TB tests.
trd-60-497-i001

*early secretory antigenic target 6, †culture filtrate protein 10, ‡tuberculosis, §enzyme-linked immunosorbent assay, ∥enzyme-linked immunospot assay

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