Rapid diagnosis of Mycobacterium tuberculosis infection in children using interferon-gamma release assays (IGRAs)

Abstract

Diagnosis of tuberculosis (TB)

Is secretion of IFN‐gamma in response to Mycobacterium tuberculosis antigens in youngest children sufficient to play a role in TB diagnostics?

“…To our best knowledge, the majority of published so far studies is concordant with our findings . However, a few publications showed no association between phytohemagglutinin induced IFN‐ɣ production and age (Table ). The correlation between IFN‐ɣ concentration in positive control and age can cause a higher proportion of indeterminate results in the youngest patients.…”

“…To our best knowledge, the majority of published so far studies is concordant with our findings. [24][25][26][27][28][29] However, a few publications showed no association between phytohemagglutinin induced IFN-ɣ production and age 30,31 (Table 4).…”

Accuracy of QuantiFERON-TB Gold Test for Tuberculosis Diagnosis in Children

“…Although the TST has been widely used in clinical practice, it has known limitations, such as variable specificity, reproducibility, and cross-reactivity with non-tuberculous mycobacteria and BCG in those who have been vaccinated [ 11 ]. A major benefit of QuantiFERON-TB Gold-In-Tube (QFT-IT) (as well as other IGRAs) rests on its higher specificity in BCG-vaccinated subjects [ 12 ], preventing unnecessary and potentially toxic treatments [ 13 – 15 ]. However, the reliability of IGRAs in pediatric patients has been questioned.…”

Aktuelle Fragestellungen zum Tuberkulose-Screening mit Interferon-Gamma-Release Assays (IGRAs)

“…umgekehrt mit der Reversion eines zuvor positiven Tests (in den als Test-negativ bewerteten Bereich). Neben einer im Einzelfall möglichen Elimination der mykobakteriellen Belastung oder einer auch nur vorübergehenden individuellen Verminderung der T-Zell-Reaktivität gegenüber mykobakteriellen Antigenen [17] [29] in allen Altersgruppen (481 Kinder zwischen 6 Monaten und 18 Jahren) adäquat und insbesondere in den jüngsten Altersgruppen (0,5 -2 11/12 Jahre und 2 -4 11/12 Jahre) mit 5,9 IU/mL und 5,6 IU/mL sogar höher als in der Altersgruppe der 5 -9 11/12 Jahre alten Kinder. Prospektive Vergleichsstudien zur Performanz des THT und von IGRAs in größeren Kollektiven von Kindern mit aktiver TB sind dringend erforderlich, um eine ausreichende statistische Power zu gewährleisten und zu belastbaren Aussagen über mögliche Vor-oder Nachteile der IGRA-Testung zu kommen.…”