Discordance between Tuberculin Skin Test and Interferon-gamma Release Assays for Diagnosis of Tuberculosis Infection in Korean Children

Reenar Yoo; Joon-Il Kim; Seohee Kim; Jina Lee

doi:10.14776/piv.2016.23.1.18

Journal List > Pediatr Infect Vaccine > v.23(1) > 1095945

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Yoo, Kim, Kim, and Lee: Discordance between Tuberculin Skin Test and Interferon-gamma Release Assays for Diagnosis of Tuberculosis Infection in Korean Children

Original Article

Pediatric Infection & Vaccine 2016; 23(1): 18-24.

Published online: 30 April 2016

DOI: https://doi.org/10.14776/piv.2016.23.1.18

Discordance between Tuberculin Skin Test and Interferon-gamma Release Assays for Diagnosis of Tuberculosis Infection in Korean Children

Reenar Yoo, Joon-Il Kim, Seohee Kim, Jina Lee

Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author (entier@amc.seoul.kr)

Received 11 August 2015 Revised 6 October 2015 Accepted 20 October 2015

Abstract

Purpose

There is a the great diagnostic challenge in pediatric tuberculosis especially in high burden setting. The purpose of this preliminary study is to evaluate the agreement between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) including T-SPOT®.TB and QuantiFERON®-TB Gold (QFT-G) in Korean children.

Method

This retrospective study included children and adolescents who visited to Asan Medical Center to evaluate tuberculosis infection using at least two assays of TST, T-SPOT.TB and QFT-G, from January 2014 to April 2015.

Results

A total of 20 patients were included, whose median age was 13.3 years (range, 3.8–18.1 years), and all of them had history of BCG vaccination. Eleven patients had underlying diseases including 7 patients with immunosuppressant medication. The concordance rate between T-SPOT.TB and QFT-G was 90%. However, the concordance rate between TST and T-SPOT.TB was 50%, and between TST and QFT-G was 42.9%. Specificity for the diagnosis of tuberculosis infection of T-SPOT.TB, QFT-G, and TST was 93.3%, 86.7%, and 58.3%, respectively.

Conclusions

Although there was a discrepancy between TST and IGRA to diagnose tuberculosis, agreement between T-SPOT.TB and QFT-G was relatively high. Further prospective study to validate the clinical usefulness of each assay for immunologic evidence of tuberculosis infection in Korean children will be mandatory.

Keywords: Tuberculosis, Latent tuberculosis infection, T-spot, Quantiferon test, Children

Figures and Tables

Table 1

Clinical Characteristics of Study Population

Abbreviations: TB, tuberculosis; LTBI, latent tuberculosis infection.

Table 2

Agreement between T-SPOT®.TB and QuantiFERON®-TB Gold Results

^*Concordance rate= 90 % (18/20).

Table 3

Agreement between TST and T-SPOT®.TB or QuantiFERON®-TB Gold

Abbreviation: TST, tuberculin skin test.

^*Concordance rate between TST and T-SPOT.TB, 50% (7/14).

^†Concordance rate between TST and QuantiFERON-TB Gold Result, 42.9% (6/14).

Table 4

Final Clinical Diagnosis According to the Immunologic Evidence of M. tuberculosis Infection by T-SPOT®.TB, QuantiFERON®-TB Gold and Tuberculin Skin Test

Abbreviations: LTBI, latent tuberculosis infection; TB, tuberculosis; TST, tuberculin skin test.

References

1. Nelson LJ, Wells CD. Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis. 2004; 8:636–647.

2. Korea Centers for Disease Control and Prevention. Assessed 6 October 2015. Available at: http://cdc.go.kr/CDC/health/CdcKrHealth0101.jsp?menuIds=HOME001-MNU1132-MNU1147-MNU0746-MNU0747&fid=751&cid=14191.

3. Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med. 2004; 350:2060–2067.

4. Joint Committee for the Development of Korean Guidelines for Tuberculosis. Korean guidelines for tuberculosis. 2nd ed. Seoul: Korea Centers for Disease Control and Prevention;2014. p. 158–167.

5. Lee HW, Park HY, Ahn YM, Sohn KC. Clinical significance of interferon-γ release assay for diagnosis of tuberculosis in children. Korean J Pediatr Infect Dis. 2010; 17:137–147.

6. Sung JY, Kim JH, Yang MA, Kim SH, Eun BW, Lee J, et al. Usefulness of interferon-γ measurement following stimulation of tuberculosis-specific antigens for diagnosis of latent tuberculosis infection in children exposed to pulmonary tuberculosis. Korean J Pediatr Infect Dis. 2008; 15:51–57.

7. Choi JW, Kim MS, Kim JH. Comparison of results between tuberculin skin test and QuantiFERON®-TB in-tube assay for diagnosis of latent tuberculosis infection in children and adolescents. Korean J Pediatr Infect Dis. 2013; 20:17–27.

8. Ferrara G, Losi M, D'Amico R, Roversi P, Piro R, Meacci M, et al. Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study. Lancet. 2006; 367:1328–1334.

9. Graham SM, Ahmed T, Amanullah F, Browning R, Cardenas V, Casenghi M, et al. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel. J Infect Dis. 2012; 205:S199–S208.

10. Spicer KB, Turner J, Wang SH, Koranyi K, Powell DA. Tuberculin skin testing and T-SPOT.TB in internationally adopted children. Pediatr Infect Dis J. 2015; 34:599–603.

11. Lee YJ, Chun P, We JH, Park SE. Accuracy of an interferon-gamma release assay to detect active tuberculosis in children: a pilot study. Korean J Pediatr Infect Dis. 2011; 18:48–53.

12. Machingaidze S, Wiysonge CS, Gonzalez-Angulo Y, Hatherill M, Moyo S, Hanekom W, et al. The utility of an interferon gamma release assay for diagnosis of latent tuberculosis infection and disease in children: a systematic review and meta-analysis. Pediatr Infect Dis J. 2011; 30:694–700.

13. Detjen AK, Keil T, Roll S, Hauer B, Mauch H, Wahn U, et al. Interferon-gamma release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis. Clin Infect Dis. 2007; 45:322–328.

14. Liebeschuetz S, Bamber S, Ewer K, Deeks J, Pathan AA, Lalvani A. Diagnosis of tuberculosis in South African children with a T-cell-based assay: a prospective cohort study. Lancet. 2004; 364:2196–2203.

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