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Abstract
Background
The clinical manifestation of M. tuberculosis infection ranges from asymptomatic latent infection, to focal forms with minimal symptoms and low bacterial burdens, and finally to advanced tuberculosis (TB) with severe symptoms and high bacillary loads. We investigated the diagnostic sensitivity of the whole-blood interferon-γ release assay according to the wide spectrum of clinical phenotypes.
Methods
In patients diagnosed with active TB that underwent QuantiFERON® (QFT) testing, the QFT results were compared with patients known to be infected with pulmonary tuberculosis (P-TB) and extra-pulmonary TB (EP-TB). In addition, the results of the QFT test were further analyzed according to the radiographic extent of disease in patients with P-TB and the location of disease in patients with EP-TB.
Results
There were no statistical differences in the overall distribution of QFT results between 177 patients with P-TB and 84 patients with EP-TB; the positive results of QFT test in patients with P-TB and EP-TB were 70.1% and 64.3%, respectively. Among patients with P-TB, patients with mild extents of disease showed higher frequency of positive results of QFT test than that of patients with severe form (75.2% vs. 57.1%, respectively; p=0.043) mainly due to an increase of indeterminate results in severe P-TB. Patients with TB pleurisy showed lower sensitivity by the QFT test than those with tuberculous lymphadenitis (48.8% vs. 78.8%, respectively; p=0.019).
Figures and Tables
Figure 1
Results of interferon-gamma release assay according to the radiographic extent of disease in patients with pulmonary tuberculosis. There is significant difference in the distribution of interferon-gamma release assay results between patients with mild and severe extent of disease (p=0.043). Mild: extension within one-third of the unilateral lung field; Moderate: within the unilateral lung field; Severe: beyond the unilateral lung field.
Figure 2
Results of interferon-gamma release assay according to the location of disease in patients with extra-pulmonary tuberculosis. There is significant difference in the distribution of interferon-gamma release assay results between patients with pleural and lymphnode tuberculosis (p=0.019). *Including spine (n=2), breast (n=1), maxillary sinus (n=1), peritoneum (n=1), rectum (n=1), fallopian tube (n=1), and parotid gland (n=1) tuberculosis.
Table 1
Baseline characteristics of study subjects
Data are presented as mean±standard deviation or number (%).
*Including spine (n=2), breast (n=1), maxillary sinus (n=1), peritoneum (n=1), rectum (n=1), fallopian tube (n=1), and parotid gland (n=1) tuberculosis, †Some patients have two or more conditions, ‡Patients receiving systemic steroids (>10 mg/day of prednisone for ≥ 1 mo) (n=2) or cancer chemotherapy (n=3), §p<0.05 when compared with total extra-pulmonary TB, ∥p<0.05 when compared with mild pulmonary TB, ¶p<0.05 when compared with severe pulmonary TB, **p<0.01 when compared with LN TB.
TB: tuberculosis; LN: lymphnode; QFT-G: QuantiFERON®-TB Gold test; QFT-GIT: QuantiFERON®-TB Gold In-Tube test.
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