High Prevalence of Latent Tuberculosis Infection in Patients in End-Stage Renal Disease on Hemodialysis: Comparison of QuantiFERON-TB GOLD, ELISPOT, and Tuberculin Skin Test

Abstract

This pilot study is the first to compare QFT-G, ELISPOT, and TST in ESRD patients on hemodialysis and demonstrates a high prevalence of LTBI in this population. In our study, the QFT-G was the more accurate method for identifying those truly infected with Mycobacterium tuberculosis, even in BCG-vaccinated individuals.

Interferon- release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis

“…For these five studies, the pooled NPV for the QFT-G-IT was 99.8% (95% CI 99.4-100%; three individuals contracted tuberculosis among the 1,442 scored-negatives) and 97.8% (95% CI 94.5-99.4%) for the T-SPOT1.TB (four individuals contracted active tuberculosis among the 182 scorednegatives). Conversely, the NPV of the included study performed in Thailand [46], an intermediate-burden country, was 88% (95% CI 63.6-98.5%).…”

“…In the majority of the evaluated studies, it was not possible to compare the NPV estimates for IGRAs to that of the TST results [19,21,22,45,46]. In particular, in two studies performed on HIV-infected persons, TST-negative individuals were excluded from the follow-up [19,22].…”

Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease

“…Another recent small study gave sensitivity, specificity and positive and negative predictive values of the QuantiFERON test for active TB disease in 32 patients with CKD as 100%, 62.1%, 8.3% and 100%, respectively. 55 The limited evidence available to date, however, suggests that IGRA tests may be more useful as a screening tool for LTBI in this patient group than the TST. These must, however, be interpreted in the light of radiographic changes, previous history of TB, foreign travel, ethnic and environmental background, as indeterminate assays are more likely in this population and there is scant evidence on negative predictive values of these tests in this patient group.…”

Tuberculosis: an Old but Still Fascinating Disease

“…In this issue of Infection we are publishing five papers that deal with various aspects of tuberculosis [1][2][3][4][5]. The first two manuscripts are reviews on the topic of latent tuberculosis and its pathogenesis.…”

“…On a more practical level, the manuscript by Lee et al investigates the sensitivity, specificity and positive and negative predictive values of modern T-cell-based assays and the more traditional tuberculin skin test to diagnose latent tuberculosis infection in patients with end-stage renal disease on hemodialysis [3]. These papers are accompanied by a short report on interleukin-6 blood levels in patients with tuberculosis.…”