title: Enzyme-linked immunospot and tuberculin skin testing to detect latent tuberculosis infection.
abstract: BACKGROUND
  Diagnosis of latent tuberculosis infection (LTBI) is currently based on the tuberculin skin test. The enzyme-linked immunospot assay (ELISPOT) is a new blood test to diagnose LTBI.
  
  
  OBJECTIVE
  To compare the ELISPOT and the tuberculin skin test for detecting LTBI in contacts of patients with tuberculosis.
  
  
  METHODS
  Prospective study of 413 contacts of patients with tuberculosis.
  
  
  RESULTS
  Because there is no gold standard for LTBI, the sensitivity and specificity of the ELISPOT and tuberculin skin test cannot be directly measured. For each contact, we therefore estimated the likelihood of having LTBI by calculating a contact score that quantified exposure to and infectiousness of the index case. We analyzed the relationship of contact score to ELISPOT and tuberculin skin test results. The likelihood of a positive ELISPOT (p = 0.0005) and a tuberculin skin test (p = 0.01) increased significantly with rising contact scores. The contact score was more strongly related to the ELISPOT than to the tuberculin skin test results, although this difference was not statistically significant. Among U.S.-born persons and those who were not vaccinated with bacille Calmette-Guérin, approximately 30% had positive ELISPOT or tuberculin skin test results. Foreign-born, bacille Calmette-Guérin-vaccinated persons were significantly more likely to have a positive tuberculin skin test than a positive ELISPOT result (p < 0.0001).
  
  
  CONCLUSIONS
  Compared with the tuberculin skin test, the ELISPOT appears to be at least as sensitive for diagnosis of LTBI in contacts of patients with tuberculosis.
authors.affiliation: CPIDC, University of Texas Health Center, 11937 U.S. Highway 271, Tyler, TX 75708-3154. peter.barnes@uthct.edu.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Shams
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Weis
authors.forename: Peter
authors.initials: P
authors.lastname: Klucar
authors.forename: Ajit
authors.initials: A
authors.lastname: Lalvani
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Moonan
authors.forename: Janice M
authors.initials: JM
authors.lastname: Pogoda
authors.forename: Katie
authors.initials: K
authors.lastname: Ewer
authors.forename: Peter F
authors.initials: PF
authors.lastname: Barnes
mesh_terms: D000293:Adolescent; D000328:Adult; D001500:BCG Vaccine; D002353:Carrier State / Q000175:diagnosis*; D002648:Child; D016358:Contact Tracing; D004641:Emigration and Immigration; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000635:transmission
chemical_list: D001500:BCG Vaccine