Comparative performance of tuberculin skin test, QuantiFERON-TB-Gold In Tube assay, and T-Spot.TB test in contact investigations for tuberculosis.
BACKGROUND
Mycobacterium tuberculosis (MTB)-specific interferon-gamma release assays (IGRAs) are an alternative or adjunct to the tuberculin skin test (TST) in identifying recent contacts with latent tuberculosis infection (LTBI), but there are scarce data directly comparing performance of the tests.


OBJECTIVE
To evaluate the agreement between both IGRAs and to determine which contacts were most likely to represent LTBI, the QuantiFERON-TB-Gold In Tube assay (QFT) and the T-Spot.TB test (T-Spot) were compared in TST-positive persons recently exposed to pulmonary tuberculosis cases.


METHODS
Prospectively enrolled close contacts (n = 812) of 123 culture-confirmed tuberculosis source cases underwent IGRA testing using standardized collected data. Factors independently influencing the risk of MTB infection and their interactions with each other were evaluated by multivariate analysis.


RESULTS
Five variables were found to significantly predict a positive IGRA test result (age, source case acid-fast bacilli positive and/or coughing, cumulative exposure time, foreign origin). There was excellent agreement between the two IGRAs (93.9%, kappa = 0.85), with QFT finding 30.2% of contacts positive and T-Spot finding 28.7%. Assuming positivity to both IGRAs as true infection, sensitivity of the TST at > 10 mm was 72% and at > 15 mm was 39.7%. The use of either IGRA as a replacement for the TST would decrease the number of LTBI suspects to be investigated by approximately 70%.


CONCLUSIONS
IGRAs are a more accurate indicator of the presence of LTBI than the TST. Both QFT and T-Spot appear to be valuable public health tools, showing excellent agreement with each other.
Diel
Roland
R
School of Public Health, Heinrich Heine University of Düsseldorf, Düsseldorf. Electronic address: Roland.Diel@uni-duesseldorf.de.
Loddenkemper
Robert
R
German Central Committee Against Tuberculosis, Lungenklinik Heckeshorn, HELIOS, Klinikum Emil von Behring, Berlin.
Meywald-Walter
Karen
K
Public Health Department Hamburg-Central, Hamburg, Germany.
Gottschalk
Rene
R
Institute of Medical Virology, University Hospital, Johann Wolfgang Goethe University, Frankfurt am Main.
Nienhaus
Albert
A
Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany.
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007371:Interferon-gamma / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic / Q000592:standards; D012680:Sensitivity and Specificity; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis*
D011933:Reagent Kits, Diagnostic; D007371:Interferon-gamma