title: The 'either test positive' strategy for latent tuberculous infection before anti-tumour necrosis factor treatment.
abstract: METHODS
  A ttertiary referral centre in South Korea.
  
  
  OBJECTIVE
  The 'either test positive' strategy, incorporating both the tuberculin skin test (TST) and the T-SPOT(®).TB(T-SPOT) assay, was evaluated as a novel method for diagnosing latent tuberculous infection (LTBI) before treatment with anti-tumour necrosis factor (TNF) in patients with immune-mediated inflammatory diseases.
  
  
  METHODS
  From June 2008 to April 2012, 430 patients received anti-TNF treatment at our institution. TST and T-SPOT were performed simultaneously at baseline. LTBI was defined as a positive TST or a positive T-SPOT result.
  
  
  RESULTS
  The positivity rates for the TST and T-SPOT assays were respectively 19.1% (82/430) and 44.2% (190/430), yielding an LTBI-positive rate of 48.6% (209/430). LTBI treatment was initiated in 46.0% (198/430) of patients and was completed by 89.4% (177/198). During follow-up (median 884 days), 0.9% (4/430) of the patients developed active tuberculosis (TB). All four TB patients were TST-negative at baseline, although two received LTBI treatment based on the baseline positive T-SPOT assay results.
  
  
  CONCLUSIONS
  The either test positive strategy is a valid method for diagnosing LTBI before anti-TNF treatment, although it is not clear whether it is superior to other strategies.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Jung
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungju Hospital, School of Medicine, Konkuk University, Seoul, South Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: K-W
authors.initials: KW
authors.lastname: Jo
authors.affiliation: Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: B
authors.initials: B
authors.lastname: Yoo
authors.affiliation: Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: C-K
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Y-G
authors.initials: YG
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: S-K
authors.initials: SK
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: J-S
authors.initials: JS
authors.lastname: Byeon
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: K-J
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: B D
authors.initials: BD
authors.lastname: Ye
authors.affiliation: Okjeong Middle School, Seoul, South Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: S-D
authors.initials: SD
authors.lastname: Lee
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: W S
authors.initials: WS
authors.lastname: Kim
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: D S
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: T S
authors.initials: TS
authors.lastname: Shim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D062606:Tertiary Care Centers; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha