Interferon-γ Release Assay for the Diagnosis of Latent Tuberculosis in Children Younger Than 5 Years of Age

Pavić, Ivan; Topić, Renata Zrinski; Raos, Miljenko; Aberle, Neda; Dodig, Slavica

doi:10.1097/inf.0b013e318220c52a

Cited by 50 publications

(51 citation statements)

References 18 publications

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“…Considerations regarding costs, availability for clinicians and other health workers, patient acceptability, ease of distribution and storage should also be taken into account in this kind of setting. To date, data in the paediatric population aged less than 5 years are limited, and a specific sub-analysis for this category of studies could not be performed as complete data were not evincible from the considered studies [19,28,30,42,59,60]. …”

Section: Discussionmentioning

confidence: 99%

“…Six studies, including 1733 children, included exclusively children aged ≤ 5 years [19,28,30,42,59,60]. In particular, Detjen and colleagues evaluated in 2007 the diagnostic accuracy of TST and 2 IGRAs in a cohort of 73 children (median age: 39 months); comparing 28 children with bacteriologically confirmed TB with children without TB (23 with bacteriologically confirmed non-tuberculous mycobacterial lymphadenitis and 22 with other non-mycobacterial respiratory tract infections) [19].…”

Section: Studies With Children Populations Aged ≤ 5 Yearsmentioning

confidence: 99%

“…In the study conducted by Moyo and colleagues including 397 South African children aged less than 3 years, QFT-G-IT and TST showed notable agreement (k=0.79), however, both tests had low sensitivity for TB disease (38% and 35%) [30]. On contrast, Pavic and colleagues found in 142 Croatian children aged <5 years significant discordance between QFT-G-IT and TST (k=0.59), concluding that both tests should be performed in high-risk children aged <5 years, considering the child infected if either or both tests are positive [59]. Nkurunungi and colleagues found in their cross-sectional study conducted on 907 children screened for LTBI in a high prevalence African setting that T-SPOT.TB results were unstable over a three-week follow-up interval, and that TST compares poorly with T-SPOT.TB, making the categorisation of children as TB-infected or TB-uninfected difficult [60].…”

Section: Studies With Children Populations Aged ≤ 5 Yearsmentioning

confidence: 99%

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Systematic review and meta-analysis on the utility of Interferon-gamma release assays for the diagnosis of Mycobacterium tuberculosis finfection in children: a 2013 update

et al. 2014

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BackgroundPrevious meta-analyses regarding the performance of interferon-gamma release assays (IGRAs) for tuberculosis diagnosis in children yielded contrasting results, probably due to different inclusion/exclusion criteria.MethodsWe systematically searched PubMed, EMBASE and Cochrane databases and calculated pooled estimates of sensitivities and specificities of QuantiFERON-TB Gold In Tube (QFT-G-IT), T-SPOT.TB, and tuberculin skin test (TST). Several sub-analysis were performed: stratification by background (low income vs. high income countries); including only microbiological confirmed TB cases; including only studies performing a simultaneous three-way comparison of the three tests, and including immunocompromised children.ResultsOverall, 31 studies (6183 children) for QFT-G-IT, 14 studies (2518 children) for T-SPOT.TB and 34 studies (6439 children) for TST were included in the analyses. In high income countries QFT-G-IT sensitivity was 0.79 (95%IC: 0.75-0.82) considering all the studies, 0.78 (95%CI:0.70-0.84) including only studies performing a simultaneous three-way comparison and 0.86 (95%IC 0.81-0.90) considering only microbiologically confirmed studies. In the same analyses T-SPOT.TB sensitivity was 0.67 (95%IC 0.62-0.73); 0.76 (95%CI: 0.68 to 0.83); and 0.79 (95%IC 0.69-0.87), respectively. In low income countries QFT-G-IT pooled sensitivity was significantly lower: 0.57 (95%IC:0.52-0.61), considering all the studies, and 0.66 (95%IC 0.55-0.76) considering only microbiologically confirmed cases; while T-SPOT.TB sensitivity was 0.61 (95%IC 0.57-0.65) overall, but reached 0.80 (95%IC 0.73-0.86) in microbiologically confirmed cases. In microbiologically confirmed cases TST sensitivity was similar: 0.86 (95%IC 0.79-0.91) in high income countries, and 0.74 (95%IC 0.68-0.80) in low income countries. Higher IGRAs specificity with respect to TST was observed in high income countries (97-98% vs. 92%) but not in low income countries (85-93% vs. 90%).ConclusionsBoth IGRAs showed no better performance than TST in low income countries.

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Section: Discussionmentioning

confidence: 99%

Section: Studies With Children Populations Aged ≤ 5 Yearsmentioning

confidence: 99%

Section: Studies With Children Populations Aged ≤ 5 Yearsmentioning

confidence: 99%

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Systematic review and meta-analysis on the utility of Interferon-gamma release assays for the diagnosis of Mycobacterium tuberculosis finfection in children: a 2013 update

et al. 2014

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“…In most negative reactions, nine (36%) are in the group aged 0-3 years. Valid correlation between age and reaction to T-SPOT TB is statistically found, likelihood ratio-21,089 df6-P-0.002 [7,8] ( Fig. 1).…”

Section: Comparison Of T-spot Tb and Tuberculin Skin Test In Childrenmentioning

confidence: 78%

Comparison of T-SPOT TB and Tuberculin Skin Test in Children with Tuberculosis of Intrathoracic Lymph Nodes

Velizarova¹

2014

UCMS

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TB (Tuberculosis) of intrathoracic lymph nodes is the most common form of tuberculosis disease in childhood. In Bulgaria, about 67%-70% of all newly diagnosed children patients are with this diagnosis. The purpose of this study was to determine the diagnostic capabilities of the T-SPOT TB in this form of TB disease. In a period of one year, 50 children aged 0-12 years treated in our hospital with tuberculosis of lung lymph nodes were examined. The diagnosis was set based on history, clinical, microbiological and radiological check. T-SPOT TB (ELISPOT TB test) and the TST (tuberculin skin test) were performed simultaneously on the studied children. The relationship between immunological samples TST and T-SPOT TB (presence of BCG vaccination and contact with adult TB patient). One child had TST negative samples, 32% had normergic reactions to 15mm. 66% had hyperergic above 15mm. In a study with T-SPOT TB, 28% showed negative results and 72% showed positive.

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“…Although the IGRAs have low sensitivity for detecting TB disease in young children whose immune responses may be blunted by malnutrition and TB itself, it is not clear whether they have a higher sensitivity for detecting TB infection in otherwise healthy children. Pavi c et al 63 In summary, if an IGRA is performed in an infant or young child, a positive result likely indicates infection with M tuberculosis, but a negative result does not rule it out. The rates of indeterminate/ invalid results seem to be higher in infants and toddlers than in older children.…”

Section: Effect Of Age On Test Resultsmentioning

confidence: 99%

Interferon-γ Release Assays for Diagnosis of Tuberculosis Infection and Disease in Children

Starke¹,

Byington²,

Barnett³

et al. 2014

Pediatrics

142

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Tuberculosis (TB) remains an important problem among children in the United States and throughout the world. Although diagnosis and treatment of infection with Mycobacterium tuberculosis (also referred to as latent tuberculosis infection [LTBI] or TB infection) remain the lynchpins of TB prevention, there is no diagnostic reference standard for LTBI. The tuberculin skin test (TST) has many limitations, including difficulty in administration and interpretation, the need for a return visit by the patient, and false-positive results caused by significant cross-reaction with Mycobacterium bovis-bacille CalmetteGuérin (BCG) vaccines and many nontuberculous mycobacteria. Interferon-γ release assays (IGRAs) are blood tests that measure ex vivo T-lymphocyte release of interferon-γ after stimulation by antigens specific for M tuberculosis. Because these antigens are not found on M bovis-BCG or most nontuberculous mycobacteria, IGRAs are more specific tests than the TST, yielding fewer false-positive results. However, IGRAs have little advantage over the TST in sensitivity, and both methods have reduced sensitivity in immunocompromised children, including children with severe TB disease. Both methods have a higher positive predictive value when applied to children with risk factors for LTBI. Unfortunately, neither method distinguishes between TB infection and TB disease. The objective of this technical report is to review what IGRAs are most useful for: (1) increasing test specificity in children who have received a BCG vaccine and may have a falsepositive TST result; (2) using with the TST to increase sensitivity for finding LTBI in patients at high risk of developing progression from LTBI to disease; and (3) helping to diagnose TB disease. Pediatrics

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Interferon-γ Release Assay for the Diagnosis of Latent Tuberculosis in Children Younger Than 5 Years of Age

Cited by 50 publications

References 18 publications

Systematic review and meta-analysis on the utility of Interferon-gamma release assays for the diagnosis of Mycobacterium tuberculosis finfection in children: a 2013 update

Systematic review and meta-analysis on the utility of Interferon-gamma release assays for the diagnosis of Mycobacterium tuberculosis finfection in children: a 2013 update

Comparison of T-SPOT TB and Tuberculin Skin Test in Children with Tuberculosis of Intrathoracic Lymph Nodes

Interferon-γ Release Assays for Diagnosis of Tuberculosis Infection and Disease in Children

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