Use of Quantiferon-TB-Gold in Tube^? test for detecting latent tuberculosis in patients considered as candidates for anti-TNF therapy in routine clinical practice

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• 作者：Mercedes Garcí ; a-Gasalla^a ; ^{mercedesggasalla@yahoo.es} ; Victoria Fern&#225 ; ndez-Baca^b ; Antonio Juan-Mas^c ; Antoni Payeras-Cifre^a ; Carmen Cifuentes-Luna^a ; Rosa Taberner-Ferrer^d ; Joan Riera-Oliver^e ; Immaculada Ros-Villamajó ; ^c ; Veró ; nica Navarro-Fern&#225 ; ndez^a ; Catalina Morey Torrandell^a ; Carmen Gallegos-Alvarez^b ; Isabel Mir-Villadrich^f
• 关键词：Latent tuberculosis infection ; Anti-TNF¦Á treatment ; Quantiferon-TB-Gold in Tube® ; Tuberculin-skin test ; Tuberculosis
• 刊名：Enfermedades Infecciosas y Microbiolog¨ªa Cl¨ªnica
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：31
• 期：2
• 页码：76-81
• 全文大小：205 K

文摘

Background/methods

Quantiferon-TB-Gold in Tube^? test (QFT-G-IT) may have advantages if combined with TST when screening for Latent Tuberculosis Infection (LTBI) prior to initiating anti-TNF therapy in an area of intermediate tuberculosis incidence such as Spain. In a small-scale prospective study, we evaluate the use of QFT-G-IT in combination with the screening recommended in Spain (Tuberculin-Skin Test, TST retest, clinical data, and Chest X-Ray (CXR)) for LTBI in patients considered as candidates for anti-TNF¦Á treatment.

Results

From June 2008 to October 2010, 123 patients from a 300-bed hospital in Palma de Mallorca (Spain) were included in the study. The majority of patients were under immunosuppressive therapy. A positive TST and TST booster were found in 22 and 17 patients, respectively. Thus 39 (31.7 % ) of the 123 patients had a positive TST. QFT-G-IT was positive in 16 patients (13.6 % ), indeterminate in 4 (3.2 % ), and negative in 103 (83.7 % ). One of the two tests was positive and LTBI was diagnosed in 34.1 % of patients. The agreement between TST and QFT-G-IT among vaccinated patients was low and not statistically significant (Kappa = 0.15) and was almost perfect among non-BCG vaccinated patients (K = 0.81). TST positive responses were significantly related to BCG-vaccination (p < 0.05) and QFT-G-IT positive response rates were related to older age (p < 0.05).

Conclusion

QFT-G-IT may have advantages when combined with TST in immunosuppressed patients especially in older patients with a negative TST; in BCG vaccinated patients with a positive TST, QFT-G-IT could avoid unnecessary treatments and toxicities related to a false-positive TST result.