High prevalence of latent tuberculosis infection in dialysis patients using the interferon-gamma release assay and tuberculin skin test.
OBJECTIVE
Patients in ESRD on hemodialysis with latent tuberculosis (TB) infection have 10 to 25 times the risk of reactivation into active disease compared with healthy adults. This study investigates the prevalence of latent TB infection in dialysis patients from a country with an intermediate burden of TB and its associated risk factors using the QuantiFERON-TB Gold in-tube test (QGIT) and the tuberculin skin test (TST).


METHODS
This was a prospective, cross-sectional study performed at a medical center in Taiwan on dialysis patients. Each patient underwent QGIT, two-step TST using 2 tuberculin units (TU) of PPD RT-23, a chest x-ray to exclude active TB, and an interview to determine TB risk factors.


RESULTS
Ninety-three of 190 eligible patients were enrolled: 35 men and 58 women. 64.8% were vaccinated with the Bacille-Calmette-Guérin (BCG) vaccination. Overall, 34.4% were positive by QGIT and 10.8% were indeterminate. Using a 10-mm TST cutoff, 53.9% were positive. There was poor correlation between TST and QGIT at any TST cutoff criteria. There was a significant increasing trend of QGIT positivity with age in those younger than 70 years, and, conversely, a decreasing trend of TST reactivity with age. Significant risk factors for QGIT positivity included age and past TB disease.


CONCLUSIONS
This study shows a high prevalence of latent TB infection in dialysis patients in a country with an intermediate burden of TB. QGIT in dialysis patients correlated better than TST with the risk of TB infection and past TB disease.
Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Susan Shin-Jung
SS
Lee
Kang-Ju
KJ
Chou
Horng-Yunn
HY
Dou
Tsi-Shu
TS
Huang
Yen-Yun
YY
Ni
Hua-Chang
HC
Fang
Hung-Chin
HC
Tsai
Cheng-Len
CL
Sy
Jui-Kuang
JK
Chen
Kuang-Sheng
KS
Wu
Yung-Hsin
YH
Wang
Hsi-Hsun
HH
Lin
Yao-Shen
YS
Chen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014374:Tuberculin Test; D055815:Young Adult
D001500:BCG Vaccine; D007371:Interferon-gamma