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Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country

Cited 339 time in Web of Science Cited 382 time in Scopus
Authors
Kang, Young Ae; Lee, Hye Won; Yoon, Ho Il; Cho, BeLong; Han, Sung Koo; Shim, Young-Soo; Yim, Jae-Joon
Issue Date
2005-06-09
Publisher
American Medical Association
Citation
JAMA. 2005 Jun 8;293(22):2756-61.
Keywords
AdolescentAdultAgedAntigens, Bacterial/immunologyBCG VaccineBacterial Proteins/immunologyFemaleHumansInterferon-gamma/*immunologyKoreaMaleMiddle AgedMycobacterium tuberculosis/immunology/*isolation & purification/physiologyRisk*Tuberculin TestTuberculosis, Pulmonary/*diagnosis/immunologyVirus Latency
Abstract
CONTEXT: A recently developed whole-blood interferon gamma (IFN-gamma) assay based on stimulation with the Mycobacterium tuberculosis-specific antigens early secreted antigenic target 6 and culture filtrate protein 10 shows promise for the diagnosis of latent tuberculosis (TB) infection. OBJECTIVE: To compare the tuberculin skin test (TST) and the whole-blood IFN-gamma assay in the diagnosis of latent TB infection according to the intensity of exposure. DESIGN AND SETTING: A prospective comparison between the whole-blood IFN-gamma assay and the TST using a 2-TU dose of purified protein derivative RT23 in a population with intermediate TB burden was conducted sequentially between February 1, 2004, and February 28, 2005, in a Korean tertiary referral hospital. PARTICIPANTS: Of 273 participants, 220 (95.7%) had received BCG vaccine. Participants were grouped according to their risk of infection: group 1, no identifiable risk of M tuberculosis infection (n = 99); group 2, recent casual contacts (n = 72); group 3, recent close contacts (n = 48); group 4, bacteriologically or pathologically confirmed TB patients (n = 54). MAIN OUTCOME MEASURES: Levels of agreement between the TST and the IFN-gamma assay and the likelihood of infection in the various groups. RESULTS: For the TST with a 10-mm induration cutoff, the positive response rate in group 1 was 51%; group 2, 60%; group 3, 71%, and group 4, 78%. For the IFN-gamma assay, the positive response rate in group 1 was 4%; group 2, 10%; group 3, 44%; and group 4, 81%. The overall agreement between the TST and the IFN-gamma assay in healthy volunteers was kappa = 0.16. The odds of a positive test result per unit increase in exposure across the 4 groups increased by a factor of 5.31 (95% confidence interval [CI], 3.62-7.79) for the IFN-gamma assay and by a factor of 1.52 (95% CI, 1.20-1.91) for the TST (P<.001). Using a 15-mm induration cutoff for the TST did not make a substantial difference to the test results. CONCLUSION: The IFN-gamma assay is a better indicator of the risk of M tuberculosis infection than TST in a BCG-vaccinated population.
ISSN
1538-3598 (Electronic)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15941805

http://hdl.handle.net/10371/11598
DOI
https://doi.org/10.1001/jama.293.22.2756
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College of Medicine/School of Medicine (의과대학/대학원)Family Medicine (가정의학전공)Journal Papers (저널논문_가정의학전공)
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