title: Interferon gamma release assays and the NICE 2011 guidelines on the diagnosis of latent tuberculosis.
abstract: In this clinical audit, we assessed retrospectively the current practice of respiratory physicians with respect to interferon gamma (IFNγ) release assay (IGRA) testing for tuberculosis (TB), as recommended by the 2011 National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis and management of TB. All IGRAs requested by respiratory physicians over a 3-year period were identified retrospectively, and both results and clinical indications analysed. Of the total number of IGRAs carried out, 90% formed part of investigations of suspected active TB. However, 89% of the patients had not had a documented Mantoux test and human immunodeficiency virus (HIV) status was unclear in the 35.2% of patients treated for active TB. Of patients with chest X-rays suggestive of TB, 92.3% were treated for active TB. Of the patients under the age of 35 with reactive IGRAs, 84.6% were treated for active or latent TB and 15.4% had justifiable reasons for not receiving chemoprophylaxis. Based on the results of our audit, IGRAs are commonly being utilised for the investigation of active TB, which is contrary to current guidance.
authors.affiliation: Centre for Translational Inflammation Research, Queen Elizabeth Hospital Birmingham, UK.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Mujakperuo
authors.forename: Richard D
authors.initials: RD
authors.lastname: Thompson
authors.forename: David R
authors.initials: DR
authors.lastname: Thickett
mesh_terms: D000328:Adult; D000942:Antigens, Bacterial / Q000276:immunology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis* / Q000096:biosynthesis / Q000276:immunology; D059425:Interferon-gamma Release Tests / Q000592:standards*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism; D008297:Male; D009169:Mycobacterium tuberculosis / Q000276:immunology; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000378:metabolism*; D006113:United Kingdom
chemical_list: D000942:Antigens, Bacterial; D007371:Interferon-gamma
keywords: Interferon gamma release assays; chemoprophylaxis; tuberculosis; tuberculous antigens
references.citation: Eur Respir J. 2008 Dec;32(6):1428-30
references.pmid: 19043006
references.citation: BMJ. 1995 Jul 15;311(6998):156-8
references.pmid: 7613426
references.citation: Eur Respir J. 2009 Jun;33(6):1250-3
references.pmid: 19483044
references.citation: Ann Intern Med. 2007 Mar 6;146(5):340-54
references.pmid: 17339619
references.citation: Joint Bone Spine. 2011 Jul;78(4):352-7
references.pmid: 21251863
references.citation: Chest. 2010 Apr;137(4):952-68
references.pmid: 20022968
references.citation: Chest. 1999 Jul;116(1):104-6
references.pmid: 10424511
references.citation: Cleve Clin J Med. 2010 Sep;77(9):606-11
references.pmid: 20810871
references.citation: Chest. 2007 Jun;131(6):1898-906
references.pmid: 17565023
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Mar 23;61(11):181-5
references.pmid: 22437911