title: Comparison of T-SPOT.TB assay and tuberculin skin test for the evaluation of young children at high risk for tuberculosis in a community setting.
abstract: OBJECTIVE
  We wished to compare the sensitivity of an enzyme-linked immunospot assay (T-SPOT.TB; Oxford Immunotec, Oxford, United Kingdom) and the tuberculin skin test for the detection of tuberculosis infection in very young children being evaluated for active tuberculosis in a rural community setting.
  
  
  METHODS
  Children with a history of exposure to tuberculosis and children presenting to a local clinic or hospital with symptoms suggesting tuberculosis were admitted to a dedicated case verification ward. T-SPOT.TB testing was performed, and children were evaluated with a clinical examination, a tuberculin skin test, chest radiographs, and cultures of induced sputum and gastric lavage specimens. The diagnosis was determined by using a clinical algorithm.
  
  
  RESULTS
  A total of 243 children (median age: 18 months) were recruited, of whom 214 (88%) had interpretable T-SPOT.TB results. Children > or =12 months of age were more likely than younger children to have positive T-SPOT.TB results, whereas tuberculin skin test results were unaffected by age. The sensitivity of the T-SPOT.TB was no better than that of the tuberculin skin test for culture-confirmed tuberculosis (50% and 80%, respectively) and was poorer for the combined group of culture-confirmed and clinically probable tuberculosis (40% and 52%, respectively). For the 50 children clinically categorized as not having tuberculosis, the specificity of both the T-SPOT.TB and the tuberculin skin test was 84%.
  
  
  CONCLUSIONS
  For young children presenting in a community setting after exposure to tuberculosis or with symptoms suggesting tuberculosis, T-SPOT.TB cannot be used to exclude active disease. The sensitivity of this assay may be impaired for very young children.
authors.affiliation: School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. mark.nicol@uct.ac.za
authors.forename: Mark P
authors.initials: MP
authors.lastname: Nicol
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Kathryn
authors.initials: K
authors.lastname: Wood
authors.forename: Mark
authors.initials: M
authors.lastname: Hatherill
authors.forename: Lesley
authors.initials: L
authors.lastname: Workman
authors.forename: Anthony
authors.initials: A
authors.lastname: Hawkridge
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.forename: Katalin A
authors.initials: KA
authors.lastname: Wilkinson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
authors.forename: Willem A
authors.initials: WA
authors.lastname: Hanekom
authors.forename: David
authors.initials: D
authors.lastname: Beatty
authors.forename: Gregory
authors.initials: G
authors.lastname: Hussey
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods / Q000592:standards*; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012111:Residence Characteristics; D012307:Risk Factors; D014374:Tuberculin Test / Q000379:methods / Q000592:standards*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism*