Journal List > Korean J Pediatr Infect Dis > v.20(1) > 1096046

Choi, Kim, and Kim: Comparison of Results between Tuberculin Skin Test and QuantiFERON®-TB In-Tube Assay for Diagnosis of Latent Tuberculosis Infection in Children and Adolescents

Abstract

Purpose

Recently, two tests are commercially available for the identification of latent tuberculosis infection (LTBI): tuberculin skin test (TST) and interferon-γ release assay (IGRA). Due to its false positiveness, TST tends to be preferred by IGRA until now. In our study, we simultaneously performed both TST and QuantiFERON®-TB Gold In-Tube (QFT-GIT) and compared their results.

Methods

TST and QFT-GIT were done for the diagnosis of LTBI among children who visited pediatric out-patient clinic at St. Vincent's Hospital, The Catholic University of Korea from February of 2007 to May of 2008. The study group was stratified into two groups in terms of whether there was intrafamilial contact or not.

Results

Out of total 35 children, 29 were tuberculosis (TB)-exposed cases and the remainders were diagnosed as clinical pulmonary TB. Among these 29 children, TST was positive 38.9% (7/18) for the intrafamilial and 45.5% (5/11) for the non-intrafamilial, and at the same time, the result for QFT-GIT was positive 5.6% (1/18) and 9.1% (1/11), respectively which implies that TST was more sensitive than QFT-GIT. Among 29 TB-exposed cases, 26 initially went through TST and QFT-GIT together on their first visit to out-patient clinic, and 15 continued the follow-up tests. Out of total 41 cases collected, the agreement (known as kappa value) was 0.063 which was relatively low. Including 6 cases with pulmonary TB who were all positive for TST and only 5 being positive for QFT-GIT, the final kappa value was 0.334.

Conclusion

In our study, the agreement for TST and QFT-GIT was low, and the majorities were almost the cases of positive TST. In current situation with lacking a gold standard test and limited data on children to adolescents, this result is quite alarming that the recent trend tends to replace TST by QFT-GIT when diagnosing LTBI.

Figures and Tables

Fig. 1
Relationship between the size of tuberculin skin test and the value of "TB antigen-Nil" in QuantiFERON®-TB Gold In-Tube assay.
kjpid-20-17-g001
Table 1
Demographic Features and Results of Tuberculin Skin Test and QuantiFERON®-Gold In-Tube Assay in Study Groups
kjpid-20-17-i001

Data are expressed as number or mean±SD (standard deviation)

Abbreviations : ESR, erythrocyte sedimentation rate; TB, tuberculosis; WBC, white blood cell

Table 2
Demographic Features of Index Cases in Tuberculosis Exposed Groups
kjpid-20-17-i002

Others: father in law (n=2), uncle (n=1), father's friend (n=2)

Abbreviations : AFB, acid fast bacilli; TB, tuberculosis

Table 3
The Status of Results for Repeated Tuberculin Skin Test and QuantiFERON®-TB Gold In-Tubes in Study Groups
kjpid-20-17-i003

*Interval between 1st and 2nd tests

Abbreviations : F, female; ID, indeterminate; M, male; m. months; ND, not determined; QFT, QuantiFERON-TB Gold In-Tube; TST, tuberculin skin test; yr, years; +, positive; -, negative

Table 4
Agreement for the Results of Tuberculin Skin Test and QuantiFERON®-TB Gold In-Tube Assay in Study Groups
kjpid-20-17-i004

*Caculated Kappa, overall agreement

Abbreviations : ID, indeterminate; neg, negative; pos, positive; QFT, QuantiFERON®-TB Gold In-Tube; TB, tuberculosis; TST, tuberculin skin test

Table 5
Agreement for the Results of Tuberculin Skin Test and QuantiFERON®-TB Gold In-Tube Assay in TB Exposed Cases Classified with Age
kjpid-20-17-i005

Abbreviations : ID, indeterminate; neg, negative; pos, positive; QFT, QuantiFERON®-TB Gold In-Tube; TB, tuberculosis; TST, tuberculin skin test

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