Prevalence of Latent Tuberculosis Infection Among Healthy Young Children and Adolescents and a Two-step Approach for the Diagnosis of Tuberculosis Infection in Chengdu, China

Jia, Jihang; Chen, Dapeng; Liu, Li; Siddiqui, Mohd Jaish; Yang, Fan; Zhu, Yu; Liao, Qiong; Luo, Shuanghong; Shu, Min; Yang, Wen; Gao, Li; Li, Xu; Long, Lilin; Peng, Xiaoshan; Li, Weiran; Liu, Yang; Xu, Wanting; Han, Qiang; Wu, Hui; Guo, Jiarong; Du, Xi; Guo, Qin; Wan, Chaomin

doi:10.1097/inf.0000000000003338

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…The TST can be used as the first line test because it is the easiest and cheapest test to apply at a large scale (with good sensitivity); then, considering TST results, the IGRA test can be used in second line for more specific results. [28][29][30] Economic evaluation of the cost-effectiveness of this diagnostic approach must be conducted to support the usefulness and the rational application of this strategy for public health purposes.…”

Section: Discussionmentioning

confidence: 99%

How useful is the tuberculin skin test for the detection of active tuberculosis: Assessing diagnostic accuracy metrics and selection of best cut-off value through a large Tunisian multicenter case-control study

Nouira,

Ben Rayana,

Ennigrou

2023

F1000Res

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Background and aim: During the past decade, the frequency of extrapulmonary forms of tuberculosis (TB) has increased. These forms are often miss-diagnosed. This statement of the TB epidemiological profile modification, conduct us to reflect about the utility of the Tuberculin Skin Test (TST) in active TB detection. This study aimed to evaluate the diagnostic accuracy performance of the TST for active tuberculosis detection. Methods: This was a case-control, multicenter study conducted in 11 anti-TB centers in Tunisia (June-November2014). The cases were adults aged between 18 and 55 years with newly diagnosed and confirmed tuberculosis. Controls were free from tuberculosis. A data collection sheet was filled out and a TST was performed for each participant. Diagnostic accuracy measures of TST were estimated using Receiver Operating Curve (ROC) curve and Area Under Curve (AUC) to estimate sensitivity and specificity of a determined cut-off point. Results: Overall, 1050 patients were enrolled, composed of 336 cases and 714 controls. The mean age was 38.3±11.8 years for cases and 33.6±11 years for controls. The mean diameter of the TST induration was significantly higher among cases than controls (13.7mm vs.6.2mm; p=10-6). AUC was 0.789 [95% CI: 0.758-0.819; p=0.01], corresponding to a moderate discriminating performance for this test. The most discriminative cut-off value of the TST, which was associated with the best sensitivity (73.7%) and specificity (76.6%) couple was ≥ 11 mm with a Youden index of 0.503. Positive and Negative predictive values were 3.11% and 99.52%, respectively. Conclusions: TST could be a useful tool used for active tuberculosis detection, with a moderate global performance and accepted sensitivity and specificity at the cut-off point of 11 mm. However, it cannot be considered as a gold standard test due to its multiple disadvantages.

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Section: Discussionmentioning

confidence: 99%

How useful is the tuberculin skin test for the detection of active tuberculosis: Assessing diagnostic accuracy metrics and selection of best cut-off value through a large Tunisian multicenter case-control study

Nouira,

Ben Rayana,

Ennigrou

2023

F1000Res

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“…Recently, a new two-step screening approach to individuals was recommended in some countries such as the United Kingdom, Canada, Italy, Spain, Saudi Arabia, and China, that is, using TST as the first line followed by IGRA as the second step if the TST results were positive ( Denkinger et al., 2011 ; Internal Clinical Guidelines Team (UK), 2016 ; Schaberg et al., 2017 ; Jia et al., 2022 ). Considering the complexity and high cost of IGRA, it is unlikely to be conducted across all student populations.…”

Section: Discussionmentioning

confidence: 99%

Selection of the cutoff value of the tuberculin skin test for diagnosing students who need preventive treatment: A school-based cross-sectional study

Lü

Ding²,

Sun³

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveTuberculosis outbreaks in schools are common in China. This study aimed to introduce and evaluate a new screening process to help control outbreaks.MethodsScreening information of students in three schools with tuberculosis outbreaks was collected. QuantiFERON-TB gold in-tube (QFT) results were used as the reference standard to determine the cutoff value of the tuberculin skin test (TST) for diagnosing students who need to have preventive medication.ResultsA total of 1,232 students and teachers from three different schools that all had more than three student patients with tuberculosis were included in this study. In total, 308 (25.0%) students had an induration diameter ≥10 mm; among students in a class different from the index case, the infection rate was 24.4% (264/1,084), which was lower than the rate among students in the same class (29.7%) (P = 0.157). Students in the same class as the index tuberculosis case had a much higher QFT positivity compared to those in a different class (58.1% vs. 7.7%, P < 0.0001). Diagnostic agreement between TST ≥10 mm and QFT was 36.6%. The diagnostic value reached the highest when the induration diameter of TST was ≥9 mm, with a sensitivity and specificity of 94.1% (95% CI: 89.4%–97.1%) and 27.6% (95% CI: 24.9%–30.4%), respectively. The area under the curve (AUC) was 0.664 (95% CI: 0.637–0.690, P < 0.0001).ConclusionIn tuberculosis outbreaks in schools, if there are three or more cases of students with tuberculosis in a class or if the moderate or strong TST positivity rate is much higher than the normal range in the region, attention should be paid to those with moderately positive TST results. Interferon-gamma release assays (IGRAs) are recommended to be conducted following TST on the day of reading the results, especially among students sharing the same class with the index case. In resource-poor areas lacking IGRAs, the induration diameter of TST can be appropriately reduced from 15 to 9 mm to enhance the sensitivity of TST.

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“…Latent tuberculosis infection (LTBI) is a condition characterized by a persistent immune response to Mycobacterium tuberculosis (MTB) antigens, without any clinical symptoms of active tuberculosis (TB) [2].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Interferon-Gamma Release Assay Testing and Tuberculin Skin Test for Early Diagnosis of Tuberculosis in Children and Adolescents

Sorguç,

Yılmaz,

Ayhan

et al. 2024

OJPed

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Background: This study aimed to evaluate the diagnostic value of interferon-γ release assay (IGRA), a sensitive microbiological diagnostic method, in children and adolescents with suspected tuberculosis in a country with a high burden of tuberculosis. Method: This study included 581 children and adolescents aged 4 -19 years who were suspected of having tuberculosis, were latently infected with Mycobacterium tuberculosis, and had received at least one dose of BCG vaccine between April 17, 2019, and February 24, 2021. The study evaluated the TST results of 106 patients who had a positive Quantiferon test and were suspected of having tuberculosis. Results: The study included 581 patients aged between 4 and 19 years. Of these, 106 patients tested positive for the Quantiferon test, while 19 were indeterminate and 456 were negative. The Quantiferon test positivity rate was 18.24%. Among the 106 QFT-Plus-positive cases, 23 patients also tested positive for TST. The difference in distribution was found to be statistically significant. Conclusion: The QFT-Plus test is considered an alternative to TST and other microbiological diagnostic methods for early tuberculosis diagnosis, particularly in children and adolescents.

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Prevalence of Latent Tuberculosis Infection Among Healthy Young Children and Adolescents and a Two-step Approach for the Diagnosis of Tuberculosis Infection in Chengdu, China

Cited by 6 publications

References 29 publications

How useful is the tuberculin skin test for the detection of active tuberculosis: Assessing diagnostic accuracy metrics and selection of best cut-off value through a large Tunisian multicenter case-control study

How useful is the tuberculin skin test for the detection of active tuberculosis: Assessing diagnostic accuracy metrics and selection of best cut-off value through a large Tunisian multicenter case-control study

Selection of the cutoff value of the tuberculin skin test for diagnosing students who need preventive treatment: A school-based cross-sectional study

Evaluation of Interferon-Gamma Release Assay Testing and Tuberculin Skin Test for Early Diagnosis of Tuberculosis in Children and Adolescents

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