title: Reduced sensitivity of the QuantiFERON(®) test in diabetic patients with smear-negative tuberculosis.
abstract: METHODS
  Immunosuppressive conditions have been associated with low sensitivity of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for the diagnosis of tuberculosis (TB). However, no systematic analysis of patient and bacterial characteristics has been performed before.
  
  
  OBJECTIVE
  To determine the sensitivity and the risk factors for false-negative QuantiFERON(®)-TB (QFT) assay and TST in TB patients.
  
  
  METHODS
  We performed a retrospective analysis of data collected in a community-based study of TB in San Francisco, CA, USA. We included 300 TB patients who underwent QFT and TST.
  
  
  RESULTS
  The risk factors for false-negative QFT were human immunodeficiency virus infection and the use of QuantiFERON(®)-TB Gold. In patients with sputum smear-negative TB, diabetes mellitus (DM) was associated with false-negative QFT (OR 2.85, 95%CI 1.02-7.97, P = 0.045). TST sensitivity was higher than QFT sensitivity in DM patients (OR 9.46, 95%CI 2.53-35.3).
  
  
  CONCLUSIONS
  In San Francisco, QFT sensitivity was lower than that of TST, especially in patients with DM. Stratified analysis by sputum smear results showed that this association was specific to smear-negative TB. In contrast, TST was not affected by the presence of DM.
authors: Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California, USA; Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, South Korea.
authors: J C
authors: JC
authors: Choi
authors: Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California, USA.
authors: L G
authors: LG
authors: Jarlsberg
authors: Office of Equity and Quality Improvement, Population Health Division, San Francisco Department of Public Health, San Francisco, California, USA.
authors: J A
authors: JA
authors: Grinsdale
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
authors: D H
authors: DH
authors: Osmond
authors: Tuberculosis Control Program, San Francisco Department of Public Health, San Francisco, California, USA.
authors: J
authors: J
authors: Higashi
authors: Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California, USA.
authors: P C
authors: PC
authors: Hopewell
authors: Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California, USA.
authors: M
authors: M
authors: Kato-Maeda
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification* / Q000472:pathogenicity; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012495:San Francisco; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test / Q000379:methods*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology