title: Quantiferon-TB Gold In-Tube Improves Tuberculosis Diagnosis in Children.
abstract: The diagnostic accuracy of Quantiferon-TB Gold In-Tube (QFT-IT) is uncertain in the pediatric population, while tuberculin skin test (TST) is still conventionally used despite its limitations. The aim of this study was to compare the performance of QFT-IT with TST in a large cohort of children screened for tuberculosis (TB) infection because of contact tracing, suspected TB, arrival from endemic country or immunosuppressive therapy.
  
  
  
  A retrospective analysis was conducted on 517 children 0-14 years of age evaluated at the pediatric unit of the S. Orsola-Malpighi University Hospital of Bologna, Italy; 366 of them were also tested with TST. Results were analyzed for Calmette-Guérin bacillus vaccination, country of origin, reason for testing, diagnosis and age.
  
  
  
  The overall agreement between the 2 tests was 89.9%, but it was highly affected by Calmette-Guérin bacillus vaccination (P < .0001). According to diagnosis and age, QFT-IT detected latent tuberculous infection cases better than TST in all age groups. Sensitivity for diagnosing active TB in symptomatic children was higher for QFT-IT than TST (93.3% vs. 86.5%), especially in children younger than 2 years, while specificity was high for both tests (99.3% and 98.8%, respectively). Low rate of indeterminate QFT-IT results (3.9%) was not differently distributed among age groups, but was associated with diagnosis of TB exclusion (P < 0.0001), mainly pneumonia (35%), and to Italian children (P = 0.0024).
  
  
  
  Despite the concern about the use of QFT-IT in children because of their immature immune system, our results suggest the preferential use of QFT-IT as a support tool for diagnosis and management of TB, even in infants.
authors.affiliation: From the *Department of Medical and Surgical Sciences, Unit of Pediatrics, S. Orsola-Malpighi University Hospital, Bologna, Italy; †Department of Medical and Surgical Sciences, Unit of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy; ‡Unit of Pediatric Emergency, S. Orsola-Malpighi University Hospital, Bologna, Italy; and §Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Petrucci
authors.forename: Giulia
authors.initials: G
authors.lastname: Lombardi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Corsini
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.forename: Francesca
authors.initials: F
authors.lastname: Visciotti
authors.forename: Filippo
authors.initials: F
authors.lastname: Bernardi
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Landini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cazzato
authors.forename: Paola
authors.initials: P
authors.lastname: Dal Monte
mesh_terms: D000293:Adolescent; D001431:Bacteriological Techniques / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059425:Interferon-gamma Release Tests / Q000379:methods*; D008297:Male; D009169:Mycobacterium tuberculosis / Q000276:immunology* / Q000302:isolation & purification; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000276:immunology