Comparison of QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold-Plus in the Diagnosis of
            <i>Mycobacterium tuberculosis</i>
            Infections in Immunocompromised Patients: a Real-World Study

Xu, Yuzhen; Yang, Qin; Zhou, Jingyu; Zhou, Feiran; Hezhang, Yufan; Gao, Yan; Shao, Lingyun; Shi, Jichan; Ruan, Qingwei; Zhang, Wenhong

doi:10.1128/spectrum.01870-21

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…However, Xu YZ found that IGRA may detect more LTBI in immunocompromised patients. 20 IGRA cannot distinguish between active TB and LTBI because it cannot measure the infection itself, which have important limitations and poor predictive value for active TB in CKD patients. Therefore, selecting a test with better performance may help early detection and better treatment of TB in patients with a high risk of developing active TB.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Xiao¹,

Ge²,

Zhang³

et al. 2022

IJGM

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Background The diverse manifestations of tuberculosis (TB) in chronic kidney disease (CKD) patients can cause difficulty in diagnosis, delayed treatment, even death. Therefore, this study investigated the clinical characteristics and the risk factors for mortality in CKD patients with TB. Methods This retrospective study included 167 patients diagnosed with active TB at two tertiary medical centers in Chongqing within six years. Clinical characteristics and outcomes of anti-TB treatment in patients with and without CKD were collected, and the predictive mortality values of variables were analyzed. Results Of the 167 patients, 66.7% (44/66) hemodialysis (HD), 41.1% (21/51) pre-HD, and 32.0% (16/50) non-CKD patients had extrapulmonary TB. The pleura and lymph node were the common sites in CKD patients. Clinical presentations of cough and hemoptysis in CKD patients were less common than those in non-CKD patients, 13.7% (16/117) of CKD patients even not having any clinical symptoms. The positive rates of tuberculin skin test, TB-polymerase chain reaction and acid-fast bacilli in sputum in HD patients were lower than those in pre-HD and non-CKD patients ( p <0.05). CKD patients were more prone to gastrointestinal and neurological side effects during anti-TB treatment. The mortality rates of non-CKD, pre-HD and HD patients was 6.1%, 31.9% and 37.3%, respectively. Multivariate Cox analysis revealed that age≥40 years (HR: 5.871; p =0.019), hypoalbuminemia (HR:2.879; p =0.004), CKD stage 4–5 (HR:4.719; p =0.018) and HD (HR:6.13; p =0.005) were associated with mortality. Discussion CKD patients with TB have atypical clinical manifestations and high mortality. Age, hypoalbuminemia, CKD stage 4–5, and HD were independent predictors of mortality.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Xiao¹,

Ge²,

Zhang³

et al. 2022

IJGM

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“…The rate of indeterminate results in immunocompromised patients is higher than that observed in immunocompetent individuals [62]. In addition, the indeterminate results determined by QFT-GIT were higher compared with QFT-Plus [62]. Since our samples were transported within the specified time interval and the proper procedure was followed during the specimens' storage and processing, the possibility of a wrong technical practice is potentially excluded.…”

Section: Discussionmentioning

confidence: 88%

“…An indeterminate result may be related to immunosuppression associated with older age and underlying diseases or due to some technical errors [61]. The rate of indeterminate results in immunocompromised patients is higher than that observed in immunocompetent individuals [62]. In addition, the indeterminate results determined by QFT-GIT were higher compared with QFT-Plus [62].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Latent Tuberculosis Infection among Patients Undergoing Regular Hemodialysis in Disenfranchised Communities: A Multicenter Study during COVID-19 Pandemic

et al. 2023

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Background and Objectives: Due to their weakened immune response, hemodialysis (HD) patients with latent tuberculosis infection (LTBI) are at higher risk for active tuberculosis (TB) disease and are more subject to patient-to-patient transmission within dialysis units. Consequently, current guidelines advocate screening these patients for LTBI. To our knowledge, the epidemiology of LTBI in HD patients has never been examined before in Lebanon. In this context, this study aimed to determine LTBI prevalence among patients undergoing regular HD in Northern Lebanon and to identify potential factors associated with this infection. Notably, the study was conducted during the COVID-19 pandemic, which is likely to have catastrophic effects on TB and increase the risk of mortality and hospitalization in HD patients. Materials and Methods: A multicenter cross-sectional study was carried out in three hospital dialysis units in Tripoli, North Lebanon. Blood samples and sociodemographic and clinical data were collected from 93 HD patients. To screen for LTBI, all patient samples underwent the fourth-generation QuantiFERON-TB Gold Plus assay (QFT-Plus). Multivariable logistic regression analysis was used to identify the predictors of LTBI status in HD patients. Results: Overall, 51 men and 42 women were enrolled. The mean age of the study population was 58.3 ± 12.4 years. Nine HD patients had indeterminate QFT-Plus results and were therefore excluded from subsequent statistical analysis. Among the remaining 84 participants with valid results, QFT-Plus was positive in 16 patients, showing a positivity prevalence of 19% (95% interval for p: 11.3%, 29.1%). Multivariable logistic regression analysis showed that LTBI was significantly associated with age [OR = 1.06; 95% CI = 1.01 to 1.13; p = 0.03] and a low-income level [OR = 9.29; 95% CI = 1.62 to 178; p = 0.04]. Conclusion: LTBI was found to be prevalent in one in five HD patients examined in our study. Therefore, effective TB control measures need to be implemented in this vulnerable population, with special attention to elderly patients with low socioeconomic status.

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“…HIV impacts the QuantiFERON-TB Gold In-Tube test (QFT-GIT) less than it does the ELISPOT (T SPOT-TB) 24 25. The QFT Gold Plus (QFT-Plus) and its forerunner, the QFT-GIT, have concordant performance 26 27. This paper presents the results of a study that sought to estimate TB infection prevalence among PLHIV using the QFT-Plus assay in a high TB burden context.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

et al. 2023

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BackgroundTuberculosis (TB) disease is the leading cause of mortality among people living with HIV (PLHIV). Interferon-gamma release assays (IGRAs) are approved for TB infection ascertainment. However, current IGRA data on the prevalence of TB infection in the context of near-universal access to antiretroviral therapy (ART) and TB preventive therapy (TPT) are lacking. We estimated the prevalence and determinants of TB infection among PLHIV within a high TB and HIV burden context.MethodsThis cross-sectional study included data from adult PLHIV age ≥18 years in whom QuantiFERON-TB Gold Plus (QFT-Plus) assay, an IGRA, was performed. TB infection was defined as a positive or indeterminate QFT-Plus test. Participants with TB and those who had previously used TPT were excluded. Regression analysis was performed to identify independent predictors of TB infection.ResultsOf 121 PLHIV with QFT-Plus test results, females were 74.4% (90/121), and the mean age was 38.4 (SD 10.8) years. Overall, 47.9% (58/121) were classified as TB infection (QFT-Plus test positive and indeterminate results were 39.7% (48/121) and 8.3% (10/121), respectively). Being obese/overweight (body mass index ≥25 kg/m2; p=0.013, adjusted OR (aOR) 2.90, 95% CI 1.25 to 6.74) and ART usage for >3 years (p=0.013, aOR 3.99, 95% CI 1.55 to 10.28) were independently associated with TB infection.ConclusionThere was a high TB infection prevalence among PLHIV. A longer period of ART and obesity were independently associated with TB infection. The relationship between obesity/overweight and TB infection may be related to ART use and immune reconstitution and requires further investigation. Given the known benefit of test-directed TPT among PLHIV never exposed to TPT, its clinical and cost implications for low and middle-income countries should be explored further.

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Comparison of QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold-Plus in the Diagnosis of Mycobacterium tuberculosis Infections in Immunocompromised Patients: a Real-World Study

Cited by 9 publications

References 32 publications

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Prevalence of Latent Tuberculosis Infection among Patients Undergoing Regular Hemodialysis in Disenfranchised Communities: A Multicenter Study during COVID-19 Pandemic

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

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