Diagnosing TB infection in children: analysis of discordances using in vitro tests and the tuberculin skin test.
The aim of the present study was to compare the performance of the interferon (IFN)-γ tests (QuantiFERON®-TB Gold In-Tube (QFT-G-IT) and T-SPOT®.TB) with the tuberculin skin test (TST) in diagnosing tuberculosis (TB) infection in children, and to analyse discordant results. This was a prospective study including 98 children from contact-tracing studies and 68 children with TST indurations ≥ 5 mm recruited during public health screenings. Positive IFN-γ tests results were associated with risk of exposure (p<0.0001). T-SPOT.TB was positive in 11 (78.6%) out of 14 cases with active TB and QFT-G-IT in nine (64.3%) out of 14 cases. Sensitised T-cells against Mycobacterium avium were detected in six out of 12 children not vaccinated with bacille Calmette-Guérin (BCG), a TST induration 5-9 mm in diameter and both IFN-γ tests negative. In concordant IFN-γ tests results, a positive correlation was found (p = 0.0001) between the number of responding cells and the amount of IFN-γ released. However, in discordant IFN-γ tests results this correlation was negative (p = 0.371): an increase in the number of spot-forming cells correlated with a decrease in the amount of IFN-γ released. The use of IFN-γ tests is helpful for the diagnosis of TB infection, avoiding cross-reactions with BCG immunisation and nontuberculous mycobacterial infections. The analysis of highly discordant results requires further investigation to elucidate possible clinical implications.
Altet-Gómez
N
N
Unitat Clínica de Prevenció i Control de la Tuberculosi de Barcelona, CAP Drassanes, Barcelona, Spain. naltet.bcn.ics@gencat.cat
De Souza-Galvao
M
M
Latorre
I
I
Milà
C
C
Jiménez
M A
MA
Solsona
J
J
Cantos
A
A
Zamora
J J
JJ
Ruiz-Manzano
J
J
Ausina
V
V
Domínguez
J
J
D000293:Adolescent; D001500:BCG Vaccine / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism*; D008297:Male; D008403:Mass Screening; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013601:T-Lymphocytes / Q000276:immunology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control
D001500:BCG Vaccine; D007371:Interferon-gamma