title: Tuberculin skin test and ELISPOT/T. SPOT.TB in children and adolescents with juvenile idiopathic arthritis.
abstract: BACKGROUND
  There are controversies regarding the accuracy of the tuberculin skin test (TST) and methods based on the production of interferon gamma by sensitized T cells for the diagnosis of latent tuberculosis infection (LTBI) in pediatrics and immunosuppressed patients. Our objectives are to study TST and ELISPOT/T. SPOT.TB in the diagnosis of LTBI in children and adolescents with JIA undergoing methotrexate, the correlation between both and the sensitivity and specificity of T. SPOT.TB.
  
  
  METHODS
  This is an observational prospective longitudinal study in which children and adolescents with JIA undergoing methotrexate therapy were assessed for clinical and epidemiological data for LTBI, in addition to performing TST and T. SPOT.TB at baseline and after 3 and 12months.
  
  
  RESULTS
  There were 24 patients. The prevalence of LTBI at inclusion was 20.8%, the incidence after initiation of immunosuppressions 26.3% and the prevalence at the end of the study 41.6%. Epidemiological history positive for TB showed a relative risk of 2.0 for the development of LTBI. Only 2 patients had positive T. SPOT.TB but only in one it was useful for detecting early LTBI. T. SPOT.TB presented a sensitivity of 10%, specificity of 92.8%, and low correlation with TST. No patient developed TB disease at a mean follow-up of 47months.
  
  
  CONCLUSIONS
  We found a high prevalence of ILTB that doubled with immunosuppression and that epidemiological history was an important relative risk. T. SPOT.TB showed low sensitivity and high specificity, and no superiority over TST. There was low agreement and little influence of immunosuppression on the results of both tests.
authors.affiliation: Pediatric Rheumatology Division, Universidade Federal do Rio de Janeiro, Rua Bruno Lobo 50, Cidade Universitária, 21941-912 Rio de Janeiro, Brasil.
authors.forename: Flavio
authors.initials: F
authors.lastname: Sztajnbok
authors.affiliation: Pneumology Division, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, 21941-913 Rio de Janeiro, Brasil.
authors.forename: Neio L F
authors.initials: NL
authors.lastname: Boechat
authors.affiliation: Molecular Biology Division, Multidisciplinary Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, 21941-913 Rio de Janeiro, Brasil.
authors.forename: Samantha B
authors.initials: SB
authors.lastname: Ribeiro
authors.affiliation: Pediatric Rheumatology Division, Universidade Federal do Rio de Janeiro, Rua Bruno Lobo 50, Cidade Universitária, 21941-912 Rio de Janeiro, Brasil.
authors.forename: Sheila K F
authors.initials: SK
authors.lastname: Oliveira
authors.affiliation: Pediatric Infectious Diseases Division, Universidade do Estado do Rio de Janeiro, Avenida 28 de setembro 87, Vila Isabel, 20551-030 Rio de Janeiro, Brasil.
authors.forename: Denise C N
authors.initials: DC
authors.lastname: Sztajnbok
authors.affiliation: Pediatric Pneumology Division, Universidade Federal do Rio de Janeiro, Rua Bruno Lobo 50, Cidade Universitária, 21941-912 Rio de Janeiro, Brasil.
authors.forename: Clemax C
authors.initials: CC
authors.lastname: Sant'Anna
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D001938:Brazil / Q000453:epidemiology; D002648:Child; D058501:Enzyme-Linked Immunospot Assay / Q000379:methods*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000379:methods*
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate