Serial interferon-gamma release assays for the diagnosis of latent tuberculosis infection in patients treated with immunosuppressive agents.
BACKGROUND
We assessed the efficacy of serial interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in patients receiving immunosuppressive agents for treatment of rheumatic diseases in Korea.


METHODS
Of 276 patients who underwent consecutive screening with one of two IGRAs [QuantiFERON-TB Gold or QuantiFERON-TB Gold In-Tube], 66 patients were evaluated by the serial IGRA for detection of LTBI during therapy with immunosuppressive agents. Information on clinical diagnosis, medication, previous TB, blood cell count, tuberculin skin test, and interferon-gamma (IFN-γ) level measured by IGRA was collected.


RESULTS
Of the 66 patients, the initial IGRA was positive in 24.2%, negative in 65.2%, and indeterminate in 10.6%. Forty-six patients (69.7%) showed consistent IGRA results during follow-up, and 13 patients (19.7%) had consistently positive results. IGRA conversion rate was 12.1% (8/66) and reversion rate was 4.5% (3/66). Conversion of IGRA results was only observed in ankylosing spondylitis patients, and the median interval between the two tests in patients with conversion was 8.5 months. The mean IFN-γ level in the group of patients with consistently positive IGRA results was higher than that in the group with inconsistently positive results, although this trend was not statistically significant (P=0.293). Indeterminate results were observed most frequently in patients with systemic lupus erythematosus.


CONCLUSIONS
In patients receiving immunosuppressive agents, both IGRA conversions and reversions were observed. Serial IGRA testing may not be needed in patients with a positive initial IGRA result showing high IFN-γ levels, because of high consistency in the test results.
Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea.
Kyeong-Hee
KH
Kim
Sung-Won
SW
Lee
Won-Tae
WT
Chung
Byoung-Gwon
BG
Kim
Kwang-Sook
KS
Woo
Jin-Yeong
JY
Han
Jeong-Man
JM
Kim
D000328:Adult; D001772:Blood Cell Count; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007371:Interferon-gamma / Q000032:analysis*; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D014374:Tuberculin Test
D007166:Immunosuppressive Agents; D007371:Interferon-gamma