Interferon-γ Release Assays and Tuberculin Skin Testing for Diagnosis of Latent Tuberculosis Infection in Healthcare Workers in the United States

Dorman, Susan E.; Belknap, Robert; Graviss, Edward A.; Reves, Randall; Schluger, Neil W.; Weinfurter, Paul; Wang, Yaping; Cronin, Wendy A.; Hirsch‐Moverman, Yael; Teeter, Larry D.; Parker, Matthew; Garrett, Denise O; Daley, Charles L.

doi:10.1164/rccm.201302-0365oc

Cited by 188 publications

(186 citation statements)

References 36 publications

Supporting

Mentioning

168

Contrasting

Unclassified

Order By: Relevance

“…A total of seven studies were included (6,(22)(23)(24)(25)(26)(27). Individual test data were available for five studies with a total of 739 subjects, with each subject providing two test results obtained in identical settings.…”

Section: Quantiferon Variability Under Identical Conditionsmentioning

confidence: 99%

“…QuantiFERON boosting after a negative skin test was assessed in six studies (6,(40)(41)(42)(43)(44). Individual test data were available from five studies on 219 subjects (6,(40)(41)(42)44).…”

Section: Quantiferon Boosting By Tuberculin Skin Testmentioning

confidence: 99%

“…Individual test data were available from five studies on 219 subjects (6,(40)(41)(42)44). Most baseline QuantiFERON results before skin test were negative (206), and on repeat testing after skin test only nine tests converted (4.4%).…”

Section: Quantiferon Boosting By Tuberculin Skin Testmentioning

confidence: 99%

“…A total of three studies used T-SPOT (6,22,30) and assessed variability under the same conditions (125 subjects) on repeat testing over time (270 subjects) and boosting by negative skin test (63 subjects). Percent of conversions and reversions are summarized in Table 4; variation of results on repeat testing were not reported if the baseline test was in the borderline range (4.1-7.9 spot-forming units).…”

Section: Variability Of T-spotmentioning

confidence: 99%

“…However, there is uncertainty about the interpretation of results when IGRAs are performed serially in subgroups with very low annual risk of tuberculosis infection, including in health-care workers. Conversions (change from negative to positive test results) and reversions (change from positive to negative test results) have been reported to occur more commonly for IGRAs than skin test (3)(4)(5)(6)(7)(8). Uncertainty in the interpretation of repeat results has also been reported for the skin test.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Reproducibility of Interferon Gamma (IFN-γ) Release Assays. A Systematic Review

Tagmouti¹,

Slater

Benedetti

et al. 2014

Annals ATS

View full text Add to dashboard Cite

Rationale: Interferon gamma (IFN-g) release assays for latent tuberculosis infection result in a larger-than-expected number of conversions and reversions in occupational screening programs, and reproducibility of test results is a concern.Objectives: Knowledge of the relative contribution and extent of the individual sources of variability (immunological, preanalytical, or analytical) could help optimize testing protocols. Methods:We performed a systematic review of studies published by October 2013 on all potential sources of variability of commercial IFN-g release assays (QuantiFERON-TB Gold In-Tube and T-SPOT.TB). The included studies assessed test variability under identical conditions and under different conditions (the latter both overall and stratified by individual sources of variability). Linear mixed effects models were used to estimate withinsubject SD. Measurements and Main Results:We identified a total of 26 articles, including 7 studies analyzing variability under the same conditions, 10 studies analyzing variability with repeat testing over time under different conditions, and 19 studies reporting individual sources of variability. Most data were on QuantiFERON (only three studies on T-SPOT.TB). A considerable number of conversions and reversions were seen around the manufacturer-recommended cut-point. The estimated range of variability of IFN-g response in QuantiFERON under identical conditions was 60.47 IU/ml (coefficient of variation, 13%) and 60.26 IU/ml (30%) for individuals with an initial IFN-g response in the borderline range (0.25-0.80 IU/ml). The estimated range of variability in noncontrolled settings was substantially larger (61.4 IU/ml; 60%). Blood volume inoculated into QuantiFERON tubes and preanalytic delay were identified as key sources of variability.Conclusions: This systematic review shows substantial variability with repeat IFN-g release assays testing even under identical conditions, suggesting that reversions and conversions around the existing cut-point should be interpreted with caution.

show abstract