Questionable role of interferon-γ assays for smear-negative pulmonary TB in immunocompromised patients

Jung, Ji Ye; Lim, Ju Eun; Lee, Hye jeong; Kim, Young Mi; Cho, Sang Nae; Kim, Se Kyu; Chang, Joon; Kang, Young Ae

doi:10.1016/j.jinf.2011.09.008

Cited by 28 publications

(20 citation statements)

References 26 publications

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“…However, inconsistencies were observed according to different definitions of immunosuppression, and smaller patient number may have limited these findings. Malignancy was a risk factor for decreased QFT-GIT sensitivity, a finding that is consistent with previous studies [15, 16, 26]. …”

Section: Discussionsupporting

confidence: 92%

“…Immunosuppression can be a risk factor for negative IGRA results in patients with TB infections, and several studies have confirmed these findings in patients with active TB [15, 16, 21, 26, 27]. However, inconsistencies were observed according to different definitions of immunosuppression, and smaller patient number may have limited these findings.…”

Section: Discussionmentioning

confidence: 97%

“…The reported sensitivity of QFT-GIT in diabetic TB patients is variable. Although some studies reported high sensitivity of QFT-GIT in diabetic TB patients [15, 28, 29], a recent study demonstrated a decrease in sensitivity of QFT-GIT in diagnostic TB patients [30]. Some of the proposed causes of the high incidence of indeterminate results include delayed M .…”

Section: Discussionmentioning

confidence: 99%

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Factors that Predict Negative Results of QuantiFERON-TB Gold In-Tube Test in Patients with Culture-Confirmed Tuberculosis: A Multicenter Retrospective Cohort Study

et al. 2015

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BackgroundInterferon-γ release assays such as the QuantiFERON-TB Gold In-Tube Test (QFT-GIT) are designed to detect Mycobacterium tuberculosis infections, whether latent or manifesting as disease. However, a substantial number of persons with culture-confirmed tuberculosis (TB) have negative QFT-GITs. Information on host factors contributing to false-negative and indeterminate results are limited.MethodsA multicenter retrospective cohort study was performed with 1,264 culture-confirmed TB patients older than 18 years who were subjected to the QFT-GIT at one of the six hospitals between May 2007 and February 2014. Patients with human immunodeficiency virus infection were excluded. Clinical and laboratory data were collected in South Korea.ResultsOf all patients, 87.6% (1,107/1,264) were diagnosed with pulmonary TB and 12.4% (157/1,264) with extrapulmonary TB. The rate of negative results was 14.4% (182/1,264). The following factors were highly correlated with false-negative results in the QFT-GIT: advanced age (age ≥ 65 years, odds ratio [OR] 1.57, 95% confidence interval [CI] 1.03–2.39), bilateral disease as determined by chest radiography (OR 1.75, 95% CI 1.13–2.72), malignancy (OR 2.42, 95% CI 1.30–4.49), and lymphocytopenia (total lymphocyte count < 1.0 × 109/L, OR 1.86, 95% CI 1.21–2.87).ConclusionsConsequently, QFT-GIT results need to be interpreted with caution in patients with these host risk factors such as the elderly, bilateral disease on chest radiography, or malignancy, or lymphocytopenia.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Factors that Predict Negative Results of QuantiFERON-TB Gold In-Tube Test in Patients with Culture-Confirmed Tuberculosis: A Multicenter Retrospective Cohort Study

et al. 2015

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“…However, these findings require further analysis given that in the study by Rawat et al, the DM patients were older and multivariable analysis was not conducted and in the study by Faurholt-Jepsen et al, only the proportion of negative QFT-IT results (and not the positive results) was analyzed, without taking into account the significantly higher proportion of indeterminate results in the non-DM group. Two more studies found no differences in the performance of TST and/or IGRAs by DM status [58;59]. Finally, we found no difference in the performance of the T.Spot-TB, and higher sensitivity of the QFT-Gold in individuals with DM [25].…”

Section: Impact Of Dm On Other Aspects Of the Association Between supporting

confidence: 38%

Impact of diabetes on the natural history of tuberculosis

Restrepo¹,

Schlesinger²

2014

Diabetes Research and Clinical Practice

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Tuberculosis (TB) is the number one bacterial killer worldwide and the current increase in type 2 diabetes mellitus patients (DM), particularly in countries where TB is also endemic, has led to the re-emerging importance of DM2 as a risk factor for TB. There is an urgent need to implement strategies for TB prevention among the millions of DM patients exposed to Mycobacterium tuberculosis (Mtb) worldwide, but knowledge is limited on how and when DM2 alters the natural history of this infection. In this review we summarize the current epidemiological, clinical and immunologic studies on TB and DM and discuss the clinical and public health implications of these findings. Specifically, we evaluate the mechanisms by which DM patients have a higher risk of Mtb infection and TB development, present with signs and symptoms indicative of a more infectious TB infection, and are more likely to have adverse TB treatment outcomes, including death. Emphasis is placed on type 2 DM given its higher prevalence in contemporary times, but the underlying role of hyperglycemia and of type 1 DM is also discussed.

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“…Recent international studies suggest that even if the PPD test is normal, pulmonary tuberculosis should be diagnosed and treated in symptomatic elderly patients or when imaging studies are altered [22][23][24][25] . Diabetes mellitus is another well-known cause of active pulmonary tuberculosis with a negative PPD test [22][23][24][25] . The patient presented here was immunosuppressed with prednisone and azathioprine, was elderly, and had uncontrolled diabetes mellitus at the time of PPD testing.…”

Section: Discussionmentioning

confidence: 99%

Nodular scleritis and granulomatous polyangiitis (Wegener) mimicking tuberculosis

C¹,

Oliveira²,

Fidelix³

et al. 2015

Revista Brasileira De Oftalmologia

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Os autores declaram não haver conflitos de interesse RESUMO ABSTRACTGranulomatous polyangiitis is a systemic disease that may affect any organ, with a predilection for the upper respiratory tract, lungs and kidneys. This article aims to report a case of a patient with atypical nodular scleritis as the initial manifestation of granulomatous polyangiitis (Wegener), mimicking a case of tuberculosis. The patient presented ocular hyperemia and lower progressive visual acuity for 1.5 years, followed by eye pain for two months. The patient had subpleural nodules with soft tissue density, increased pulmonary lymph nodes and discrete bilateral pleural thickening, with negative alcohol-resistant acid bacilli (BAAR). The histological diagnosis revealed a granulomatous vasculitis suggestive of non-infectious vasculitis (granulomatous polyangiitis). Cyclophosphamide pulse therapy was initiated.

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Questionable role of interferon-γ assays for smear-negative pulmonary TB in immunocompromised patients

Cited by 28 publications

References 26 publications

Factors that Predict Negative Results of QuantiFERON-TB Gold In-Tube Test in Patients with Culture-Confirmed Tuberculosis: A Multicenter Retrospective Cohort Study

Factors that Predict Negative Results of QuantiFERON-TB Gold In-Tube Test in Patients with Culture-Confirmed Tuberculosis: A Multicenter Retrospective Cohort Study

Impact of diabetes on the natural history of tuberculosis

Nodular scleritis and granulomatous polyangiitis (Wegener) mimicking tuberculosis

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