Rationale: Diagnosis of latent tuberculosis infection (LTBI) is currently based on the tuberculin skin test. The enzyme-linked immunospot assay (ELISPOT) is a new blood test to diagnose LTBI.Objective: To compare the ELISPOT and the tuberculin skin test for detecting LTBI in contacts of patients with tuberculosis. Methods: Prospective study of 413 contacts of patients with tuberculosis.
Measurements and Main Results:Because there is no gold standard for LTBI, the sensitivity and specificity of the ELISPOT and tuberculin skin test cannot be directly measured. For each contact, we therefore estimated the likelihood of having LTBI by calculating a contact score that quantified exposure to and infectiousness of the index case. We analyzed the relationship of contact score to ELISPOT and tuberculin skin test results. The likelihood of a positive ELISPOT (p ϭ 0.0005) and a tuberculin skin test (p ϭ 0.01) increased significantly with rising contact scores. The contact score was more strongly related to the ELISPOT than to the tuberculin skin test results, although this difference was not statistically significant. Among U.S.
Keywords: blood test; contact investigation; diagnosisTuberculosis case rates continue to decline in most industrialized nations, but persons with latent tuberculosis infection (LTBI) constitute a vast pool of individuals who may develop tuberculosis, particularly when the immune response is suppressed. Diagnosis and treatment of LTBI are therefore increasingly important goals of tuberculosis control (1). Unfortunately, the standard method to diagnose LTBI is the tuberculin skin test, which has many shortcomings. Two visits are required, and skilled personnel are essential for proper placement and interpretation of the test. In addition, because purified protein derivative of tuberculin contains many antigens that are shared with other mycobacteria, the skin test does not reliably distinguish LTBI from prior immunization with Mycobacterium bovis bacille Calmette-Gué rin (BCG) or infection with environmental mycobacteria (2). This is a major problem in most developed countries because a growing proportion of those with LTBI are foreign-born persons from highincidence countries, most of whom received BCG vaccination during childhood (3, 4). A more accurate and convenient test to diagnose LTBI would greatly enhance tuberculosis control efforts (5).In persons with LTBI, memory T cells produce IFN-␥ in response to Mycobacterium tuberculosis antigens. A major scientific advance was the identification of the 6-kD M. tuberculosis early-secreted antigenic target protein (ESAT-6) and the 10-kD culture filtrate protein (CFP10), which are absent from BCG and most environmental mycobacteria (6, 7).Tests can now detect T cells that produce IFN-␥ in response to ESAT-6 and CFP10 using the ELISA to measure IFN-␥ concentrations in supernatants (QuantiFeron-TB Gold; Cellestis Ltd., St. Kilda, Australia) or the enzyme-linked immunospot assay (ELISPOT) to detect individual IFN-␥-producing T cells (T SPOT-TB; Oxford Im...