title: Detection of tuberculosis in HIV-infected children using an enzyme-linked immunospot assay.
abstract: OBJECTIVE
  To evaluate an enzyme-linked immunospot assay (ELISPOT) for the diagnosis of tuberculosis (TB) in HIV-infected children with suspected TB and to compare the performance of ELISPOT with the tuberculin skin test (TST).
  
  
  METHODS
  Interferon-gamma responses to Mycobacterium tuberculosis-specific antigens were measured by ELISPOT in HIV-infected children with suspected TB. HIV-infected and HIV-uninfected children without TB were taken for comparison.
  
  
  RESULTS
  Results were available for 188 children, of whom 139 (74%) were HIV-infected. Of these, 22 were classified as having definite TB: 24 probable TB, 14 possible TB and 128 not having TB. The median (range) age of patients was 20 (10-54.1) months. Median interferon-gamma responses to early-secreted antigenic target-6 and culture filtrate protein-10 were higher in children with definite or probable TB compared with children without TB (P < 0.002). In HIV-infected children with an interpretable ELISPOT result, the ELISPOT was positive in 14/21 (66%) with definite TB. A significantly higher proportion of HIV-infected children with definite or probable TB had a positive ELISPOT compared with a positive TST [25/39 (64%) vs. 10/34 (29%), P = 0.005]. In contrast to TST, results from ELISPOT were not affected by young age or severe immunosuppression. In HIV-infected children without active TB disease, 27% had a positive ELISPOT, suggesting latent TB infection.
  
  
  CONCLUSIONS
  ELISPOT is more sensitive than TST for the detection of active TB in HIV-infected children. However, the sensitivity of current ELISPOT assays is not sufficiently high to be used as a rule out test for TB.
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.|School of Public Health and Family Medicine, University of Cape Town, South Africa.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.affiliation: Department of Paediatrics, University of Melbourne; Infectious Diseases Unit, Department of General Medicine; and Murdoch Children's Research Institute; Royal Children's Hospital Melbourne, Parkville, Australia.|Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa.
authors.forename: Tom
authors.initials: T
authors.lastname: Connell
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Christine
authors.initials: C
authors.lastname: Johannisen
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.|Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Wood
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Sandy
authors.initials: S
authors.lastname: Pienaar
authors.affiliation: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa.|National Institute for Medical Research, Mill Hill, London NW7 1AA, UK.
authors.forename: Katalin A
authors.initials: KA
authors.lastname: Wilkinson
authors.affiliation: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa.|National Institute for Medical Research, Mill Hill, London NW7 1AA, UK.|Division of Medicine, Imperial College London, W2 1PG, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Beatty
authors.affiliation: Department of Paediatrics, University of Melbourne; Infectious Diseases Unit, Department of General Medicine; and Murdoch Children's Research Institute; Royal Children's Hospital Melbourne, Parkville, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Curtis
authors.affiliation: Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.|Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Nicol
mesh_terms: D000367:Age Factors; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007223:Infant; D007371:Interferon-gamma / Q000097:blood; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D009752:Nutritional Status; D012680:Sensitivity and Specificity; D013019:South Africa; D014374:Tuberculin Test / Q000379:methods; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000276:immunology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C117940:CFP-10 protein, Mycobacterium tuberculosis; C525005:ESAT-6 antigen, Mycobacterium leprae; D007371:Interferon-gamma