Performance of Commercial Blood Tests for the Diagnosis of Latent Tuberculosis Infection in Children and Adolescents (original) (raw)
Articles| March 01 2009
cStatistics, University of Modena and Reggio Emilia, Modena, Italy
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dMicrobiology and Virology Laboratory, Policlinico Hospital of Modena, Modena, Italy
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dMicrobiology and Virology Laboratory, Policlinico Hospital of Modena, Modena, Italy
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dMicrobiology and Virology Laboratory, Policlinico Hospital of Modena, Modena, Italy
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Address correspondence to Luca Richeldi, MD, PhD, University of Modena and Reggio Emilia, Department of Respiratory Diseases, Policlinico Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy. E-mail [email protected]
Pediatrics (2009) 123 (3): e419–e424.
Citation
Barbara Maria Bergamini, Monica Losi, Francesca Vaienti, Roberto D'Amico, Barbara Meccugni, Marisa Meacci, Donatella De Giovanni, Fabio Rumpianesi, Leonardo M. Fabbri, Fiorella Balli, Luca Richeldi; Performance of Commercial Blood Tests for the Diagnosis of Latent Tuberculosis Infection in Children and Adolescents. _Pediatrics March 2009; 123 (3): e419–e424. 10.1542/peds.2008-1722
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BACKGROUND. The accurate diagnosis of latent tuberculosis infection reduces the risk of progression to severe disseminated disease. However, in young children, a major limitation of the standard tuberculin skin test is that false-negative results cannot be detected. The new interferon-γ release assays QuantiFERON-TB Gold (Cellestis Carnegie Victoria, Australia), QuantiFERON-TB In-Tube (Cellestis), and T-SPOT.TB (Oxford Immunotec, Abingdon, United Kingdom) show promise of greater accuracy, but they may also be affected by impaired cellular immunity, resulting in indeterminate results (ie, insufficient response in positive-control wells).
OBJECTIVE. To evaluate the impact of age on the performance of interferon-γ release assays when used in a routine hospital setting among children tested for suspected active or latent TB infection.
METHODS. We retrospectively studied 496 children 0 to 19 years of age who had been tested with the tuberculin skin test and at least 1 interferon-γ release assay: 181 with QuantiFERON-TB Gold and 315 with QuantiFERON-TB In-Tube. In 154 of the children, paired interferon-γ release assay testing was available: 87 with QuantiFERON-TB Gold/T-SPOT.TB and 67 with QuantiFERON-TB In-Tube/T-SPOT.TB.
RESULTS. Compared with T-SPOT.TB, the rates of indeterminate results were significantly higher for both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube. QuantiFERON-TB Gold and QuantiFERON-TB In-Tube also gave indeterminate results more frequently in children <4 years of age than in those ≥4 years of age. Indeterminate results were associated with younger age for both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube but not for T-SPOT.TB. Considering age as a binary variable (<4 and ≥4 years of age), a significantly higher concentration of phytohaemagglutinin-produced interferon-γ was observed in older children with both QuantiFERON-TB Gold and QuantiFERON-TB In-Tube.
CONCLUSIONS. Different blood tests for the diagnosis of latent tuberculosis infection in children seem to perform differently, because both QuantiFERON-TB tests were more likely than T-SPOT.TB to give indeterminate results in children <4 years of age.
Copyright © 2009 by the American Academy of Pediatrics
2009
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