title: Relation between BCG vaccine scar and an interferon-gamma release assay in immigrant children with "positive" tuberculin skin test (≥10 mm).
abstract: BACKGROUND
  Immigrants from countries with high incidence of tuberculosis (TB) are usually offered screening when they arrive to low incidence countries. The tuberculin skin test (TST) is often used. The interferon gamma release assays (IGRAs) are more specific and not affected by BCG vaccination. The aims of this study were 1. To see if there if there is a correlation between a positive IGRA (QFT) and presence of a BCG scar in children with TST ≥10 mm, 2. To compare the TST diameter with QFT result, 3. To see if chest X-ray can be omitted in QFT negative children despite TST ≥10 mm.
  
  
  METHODS
  762 healthy children/adolescents (median age 14 years) arriving to Gothenburg and surroundings with TST ≥10 mm were tested with QFT.
  
  
  RESULTS
  A total of 163/492 (33 %) children with BCG scar had positive QFT, whereas 205/270 (76 %) without BCG scar had positive QFT (p < 0.0001). The median TST was 12 mm in QFT negative and 18 mm in QFT positive children (p < 0.0001) but with considerable overlap. Median TST was the same (12 mm) in QFT negative children with and without BCG scar. Among the QFT positive children 25/368 had chest X-ray changes compared to 2/393 among the QFT negative children (p < 0.0007).
  
  
  CONCLUSIONS
  Previous BCG vaccination had an effect on the TST diameter so an IGRA is recommended to diagnose latent TB. Using only TST for screening of latent TB would lead to overdiagnosis. The TST diameter was larger in QFT positive than in QFT negative children but could not predict QFT in the individual patient. Chest X ray contributes little to the diagnosis of TB in QFT negative children but can not be omitted because of late seroconversion of QFT in some patients.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. margret.johansson.gudjonsdottir@vgregion.se.|Department of Pediatrics, Neonatology, Sahlgrenska University Hospital, 41685, Gothenburg, Sweden. margret.johansson.gudjonsdottir@vgregion.se.
authors.forename: Margret Johansson
authors.initials: MJ
authors.lastname: Gudjónsdóttir
authors.affiliation: Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Karsten
authors.initials: K
authors.lastname: Kötz
authors.affiliation: Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Ruth Stangebye
authors.initials: RS
authors.lastname: Nielsen
authors.affiliation: Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Philip
authors.initials: P
authors.lastname: Wilmar
authors.affiliation: Department of Paediatrics, Angered Hospital, Gothenburg, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Olausson
authors.affiliation: Department of Child Health, South Älvsborg Hospital, Borås, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wallmyr
authors.affiliation: Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Birger
authors.initials: B
authors.lastname: Trollfors
mesh_terms: D000293:Adolescent; D001500:BCG Vaccine / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology / Q000473:pathology; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059425:Interferon-gamma Release Tests / Q000379:methods*; D055985:Latent Tuberculosis / Q000175:diagnosis; D008297:Male; D012189:Retrospective Studies; D013548:Sweden; D014374:Tuberculin Test / Q000379:methods; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology; D014611:Vaccination
chemical_list: D001500:BCG Vaccine
keywords: BCG scar; Quantiferon; Tuberculin skin test; Tuberculosis