title: Frequent detection of latent tuberculosis infection among aged underground hard coal miners in the absence of recent tuberculosis exposure.
abstract: BACKGROUND
  Miners are at particular risk for tuberculosis (TB) infection due to exposure to silica dust and silicosis. The objectives of the present observational cohort study were to determine the prevalence of latent TB infection (LTBI) among aged German underground hard coal miners with silicosis or chronic obstructive pulmonary disease (COPD) using two commercial interferon-gamma release assays (IGRAs) and to compare their performance with respect to predictors of test positivity.
  
  
  METHODS
  Between October 2008 and June 2010, miners were consecutively recruited when routinely attending pneumoconiosis clinics for an expert opinion. Both IGRAs, the QuantiFERON®-TB Gold In-Tube (QFT) and the T-SPOT®.TB (T-SPOT), were performed at baseline. A standardized clinical interview was conducted at baseline and at follow-up. The cohort was prospectively followed regarding the development of active TB for at least two years after inclusion of the last study subject. Independent predictors of IGRA positivity were calculated using logistic regression.
  
  
  RESULTS
  Among 118 subjects (mean age 75 years), none reported recent exposure to TB. Overall, the QFT and the T-SPOT yielded similarly high rates of positive results (QFT: 46.6%; 95% confidence interval 37.6-55.6%; T-SPOT: 61.0%; 95% confidence interval 52.2-69.8%). Positive results were independently predicted by age ≥80 years and foreign country of birth for both IGRAs. In addition, radiological evidence of prior healed TB increased the chance of a positive QFT result fivefold. While 28 subjects were lost to follow-up, no cases of active TB occurred among 90 subjects during an average follow-up of >2 years.
  
  
  CONCLUSIONS
  Considering the high prevalence of LTBI, the absence of recent TB exposure, and the currently low TB incidence in Germany, our study provides evidence for the persistence of specific interferon-gamma responses even decades after putative exposure. However, the clinical value of current IGRAs among our study population, although probably limited, remains uncertain.
authors: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors: Felix C
authors: FC
authors: Ringshausen
authors: Albert
authors: A
authors: Nienhaus
authors: Anja
authors: A
authors: Schablon
authors: José
authors: J
authors: Torres Costa
authors: Heiko
authors: H
authors: Knoop
authors: Frank
authors: F
authors: Hoffmeyer
authors: Jürgen
authors: J
authors: Bünger
authors: Rolf
authors: R
authors: Merget
authors: Volker
authors: V
authors: Harth
authors: Gerhard
authors: G
authors: Schultze-Werninghaus
authors: Gernot
authors: G
authors: Rohde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003031:Coal; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008906:Mining; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D011379:Prognosis
chemical_list: D003031:Coal