Clinical Applications of Interferon-gamma Release Assays

Kwang-Sook Woo; Kyeong-Hee Kim

doi:10.3343/lmo.2016.6.1.8

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Woo and Kim: Clinical Applications of Interferon-gamma Release Assays

Review Article

Diagnostic Immunology

Laboratory Medicine Online 2016; 6(1): 8-11.

Published online: 1 January 2016

DOI: https://doi.org/10.3343/lmo.2016.6.1.8

Clinical Applications of Interferon-gamma Release Assays

Kwang-Sook Woo, M.D., Kyeong-Hee Kim, M.D.

Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea.

Corresponding author: Kyeong-Hee Kim. Department of Laboratory Medicine, Dong-A University College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan 49201, Korea. Tel: +82-51-240-2850, Fax: +82-51-255-9366, progreen@dau.ac.kr

Received 2 January 2015 Revised 30 April 2015 Accepted 11 June 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Mycobacterium tuberculosis infection remains an important problem in Korea and globally. Interferon-gamma release assays (IGRAs) are blood-based tests that measure the amount of interferon-gamma released by T lymphocytes after stimulation by antigens specific for M. tuberculosis. IGRAs are not recommended for diagnosis of active pulmonary tuberculosis because they cannot distinguish between latent tuberculosis infection (LTBI) and the active disease. For extrapulmonary tuberculosis, IGRAs are considered adjuvant diagnostic tools. The diagnostic performance of IGRAs differs according to infection site. The sensitivity of IGRAs in children is suboptimal in low- and middle-income countries. In Korea, for children who have received a M. bovis bacille Calmette-Guérin (BCG) vaccine after 1 yr of age or have been inoculated with the BCG vaccine twice or more, IGRA is recommended instead of the tuberculin skin test (TST). Diagnosis and treatment of LTBI before the initiation of anti-tumor necrosis factor (TNF) agents are recommended in patients with immune-mediated inflammatory diseases because anti-TNF therapy is associated with an increased risk of developing tuberculosis. A strategy using both TST and IGRA is used for immunocompromised adults in Korea; positive results obtained by either test confirm a diagnosis of LTBI. Negative results of only TST are not considered conclusively negative for LTBI. In addition to interferon-gamma, a biomarker to discriminate between active and latent tuberculosis is required, and IP-10 and IL-2 are currently being investigated in this regard. The use of IGRA would improve the diagnosis of extrapulmonary tuberculosis and LTBI.

Keywords: Interferon-gamma release assays, Latent tuberculosis, Sensitivity, Specificity

Notes

This article is available from http://www.labmedonline.org

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