Jong-Won Choi; Min-Sung Kim; Jong-Hyun Kim

doi:10.14776/kjpid.2013.20.1.17

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Original Article

Korean Journal of Pediatric Infectious Diseases

Korean Journal of Pediatric Infectious Diseases 2013; 20(1): 17-27.

Published online: 30 April 2013

DOI: https://doi.org/10.14776/kjpid.2013.20.1.17

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

Jong-Won Choi, M.D., Min-Sung Kim, M.D., Jong-Hyun Kim, M.D.

Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Corresponding author (jh00mn@catholic.ac.kr)

Received 20 October 2012 Revised 24 October 2012 Accepted 24 October 2012

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.

Keywords: Latent tuberculosis infection, Tuberculin skin test, Interferon-γ releasing assay, QuantiFERON-TB Gold In-Tube assay

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.

Table 1

Demographic Features and Results of Tuberculin Skin Test and QuantiFERON®-Gold In-Tube Assay in Study Groups

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

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

^*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

^*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

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

References

1. World Health Organization. Global tuberculosis control: WHO report 2011. 2011. Geneva: WHO;9–27.

2. Kim HJ. Current status of tuberculosis in Korea. Korean J Med. 2012. 82:257–262.

3. American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR Recomm Rep. 2000. 49(RR-6):1–51.

4. Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007. 146:340–354.

5. Pai M, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med. 2008. 149:177–184.

6. Mazurek GH, Jereb J, Lobue P, Iademarco MF, Metchock B, Vernon A. Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC). Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Morb Mortal Wkly Rep. 2005. 54:49–55.

7. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006. 10:1192–1204.

8. Lewinsohn DA, Lobato MN, Jereb JA. Interferon-γ release assays: new diagnostic tests for Mycobacterium tuberculosis infection, and their use in children. Curr Opin Pediatr. 2010. 22:71–76.

9. Canadian Tuberculosis Committee (CTC). Recommendations on interferon gamma release assays for the diagnostic latent tuberculosis infection-2010 update. Can Commun Dis Rep. 2010. 36(ACS-5):1–21.

10. Starke JR. New concepts in childhood tuberculosis. Curr Opin Pediatr. 2007. 19:306–313.

11. Denkinger CM, Dheda K, Pai M. Guidelines on interferon-γ release assays for tuberculosis infection: concordance, discordance or confusion? Clin Microbiol Infect. 2011. 17:806–814.

12. Ling DI, Zwerling AA, Steingart KR, Pai M. Immune-based diagnostics for TB in children: what is the evidence? Paediatr Respir Rev. 2011. 12:9–15.

13. 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.

14. Bouros D, Zeros G, Panaretos C, Vassilatos C, Siafakas N. Palpation vs pen method for the measurement of skin tuberculin reaction (Mantoux test). Chest. 1991. 99:416–419.

15. Cellestis. QuantiFERON®-TB Gold (in-tube method) package insert, document No. US05990301E, January 2009. Accessed 12 September 2012. Available at: http://www.cellestis.com.

16. National Collaborating Centre for Chronic Conditions. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. 2006. London: Royal College of Physicians;105–114.

17. Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, Starke JJ, et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004. 8:392–402.

18. Marais BJ, Donald PR. Schaar HS, Zulma AI, editors. The natural history of tuberculosis infection and disease in children. Tuberculosis: a comprehensive clinical reference. 2009. Philadelphia: Elsevier Inc.;133–145.

19. Lighter J, Rigaud M, Eduardo R, Peng C, Pollack H. Latent tuberculosis diagnosis in children by using the QuantiFERON-TB Gold In-Tube test. Pediatrics. 2009. 123:30–37.

20. O'Neal S, Hedberg K, Markum A, Schafer S. Discordant tuberculin skin and interferon-gamma tests during contact investigations: a dilemma for tuberculosis controllers. Int J Tuberc Lung Dis. 2009. 13:662–664.

21. Herrera V, Perry S, Parsonnet J, Banaei N. Clinical application and limitations of interferon-gamma release assays for the diagnosis of latent tuberculosis infection. Clin Infect Dis. 2011. 52:1031–1037.

22. Chun JK, Kim CK, Kim HS, Jung GY, Lee TJ, Kim KH, et al. The role of a whole blood interferon-assay for the detection of latent tuberculosis infection in Bacille Calmette-Guerin vaccinated children. Diagn Microbiol Infect Dis. 2008. 62:389–394.

23. 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. 15:50–57.

24. Chun JK, Kim CK, Kim HS, Jung GY, Linton JA, Kim KH, et al. Comparison of a whole blood Interferon-gamma assay and A tuberculin skin test for detecting latent tuberculosis infection in children. Korean J Pediatr. 2008. 51:971–976.

25. Kim YJ, Lee JS. Comparison of Interferon-gamma assays with the tuberculin skin test in children. Pediatr Allergy Respir Dis. 2010. 20:10–16.

26. Soon EG, Lim BK, Kim HM, Namgoong MK, Cha BH, Uh Y, et al. A tapping the usefulness of whole blood interferon-gamma assay for diagnosing tuberculosis infection in children. Tuberc Respir Dis. 2010. 68:280–285.

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

28. 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.

29. Park YM, Chung S, Yoo KH. Relationship between asthma and latent tuberculosis infection in children. Korean J Asthma Allergy Clin Immunol. 2012. 32:101–106.

TOOLS

Similar articles