title: Tuberculin Skin Test and Quantiferon in BCG Vaccinated, Immunosuppressed Patients with Moderate-to-Severe Inflammatory Bowel Disease.
abstract: OBJECTIVE
  There are few data available on the effect of immunomodulator/biological therapy on the accuracy of the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) in BCG-vaccinated immunosuppressed patients with inflammatory bowel disease (IBD). Our aim was to define the accuracy, predictors and agreement of TST and IGRA in a BCG-vaccinated immunosuppressed referral IBD cohort.
  
  
  METHODS
  166 consecutive moderate-to-severe IBD patients (122 Crohn's disease, CD and 44 ulcerative colitis, UC) were enrolled in a prospective study from three centers. Patients were treated with immunosuppressives and/or biologicals. IGRA and TST were performed on the same day. Both in- and outpatient records were collected and comprehensively reviewed.
  
  
  RESULTS
  TST positivity rate was 23.5%, 21.1%,14.5% and 13.9% when cut-off values of 5, 10, 15 and 20mm were used. IGRA positivity rate was 8.4% with indeterminate result in 0.6%. Chest X-ray was suggestive of latent tuberculosis in 2 patients. Correlation between TST and IGRA was moderate (kappa: 0.39-0.41, p<0.001). In addition, a cut-off of 14 and 17mm for TST was defined to identify IGRA positivity in a ROC analysis (AUC: 0.76, p=0.03). TST and/or IGRA positivity was not influenced by medical therapy or disease phenotype. Importantly, smoking was identified as a risk factor for TST but not IGRA positivity (OR: 2.70-5.02, p<0.01, for TSTcut-offs=5-20mm).
  
  
  CONCLUSIONS
  TST and IGRA tests are partly complimentary methods, and additional testing by TST (with a cut-off of >15mm) should be considered to identify patients at risk for latent TB. Accuracy is satisfactory in BCG-vaccinated, immunosuppressed IBD patients. Smoking is a risk factor for TST positivity.
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kurti
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Barbara Dorottya
authors.initials: BD
authors.lastname: Lovasz
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Krisztina Barbara
authors.initials: KB
authors.lastname: Gecse
authors.affiliation: 1st Department of Medicine, Szeged University, Szeged, Hungary.
authors.forename: Anita
authors.initials: A
authors.lastname: Balint
authors.affiliation: 1st Department of Medicine, Szeged University, Szeged, Hungary.
authors.forename: Klaudia
authors.initials: K
authors.lastname: Farkas
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Agnes
authors.initials: A
authors.lastname: Morocza-Szabo
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Andras
authors.initials: A
authors.lastname: Gyurcsanyi
authors.affiliation: Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary.
authors.forename: Katalin
authors.initials: K
authors.lastname: Kristof
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest;Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Vegh
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Lorant
authors.initials: L
authors.lastname: Gonczi
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Lajos Sandor
authors.initials: LS
authors.lastname: Kiss
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Petra Anna
authors.initials: PA
authors.lastname: Golovics
authors.affiliation: Department of Medicine, Csolnoky F. Province Hospital, Veszprem, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Lakatos
authors.affiliation: 1st Department of Medicine, Szeged University, Szeged, Hungary.
authors.forename: Tamas
authors.initials: T
authors.lastname: Molnar
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary. lakatos.peter_laszlo@ med.semmelweis-univ.hu.
authors.forename: Peter Laszlo
authors.initials: PL
authors.lastname: Lakatos
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001500:BCG Vaccine / Q000276:immunology*; D001688:Biological Products / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D054884:Host-Pathogen Interactions; D006801:Humans; D006814:Hungary; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000276:immunology; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D014374:Tuberculin Test; D055815:Young Adult
chemical_list: D001500:BCG Vaccine; D001688:Biological Products; D007166:Immunosuppressive Agents