Relation between BCG vaccine scar and an interferon-gamma release assay in immigrant children with “positive” tuberculin skin test (≥10 mm)

Abstract

BackgroundImmigrants from countries with high incidence of tuberculosis (TB) are usually offered screening when they arrive to low incidence countries. The tuberculin skin test (TST) is often used. The interferon gamma release assays (IGRAs) are more specific and not affected by BCG vaccination. The aims of this study were 1. To see if there if there is a correlation between a positive IGRA (QFT) and presence of a BCG scar in children with TST ≥10 mm, 2. To compare the TST diameter with QFT result, 3. To see if chest X-ray can be omitted in QFT negative children despite TST ≥10 mm.Methods762 healthy children/adolescents (median age 14 years) arriving to Gothenburg and surroundings with TST ≥10 mm were tested with QFT.ResultsA total of 163/492 (33 %) children with BCG scar had positive QFT, whereas 205/270 (76 %) without BCG scar had positive QFT (p < 0.0001). The median TST was 12 mm in QFT negative and 18 mm in QFT positive children (p < 0.0001) but with considerable overlap. Median TST was the same (12 mm) in QFT negative children with and without BCG scar. Among the QFT positive children 25/368 had chest X-ray changes compared to 2/393 among the QFT negative children (p < 0.0007).ConclusionsPrevious BCG vaccination had an effect on the TST diameter so an IGRA is recommended to diagnose latent TB. Using only TST for screening of latent TB would lead to overdiagnosis. The TST diameter was larger in QFT positive than in QFT negative children but could not predict QFT in the individual patient. Chest X ray contributes little to the diagnosis of TB in QFT negative children but can not be omitted because of late seroconversion of QFT in some patients.Trial registrationNot applicable.

Combination of prealbumin and tuberculosis‐specific antigen/phytohemagglutinin ratio for discriminating active tuberculosis from latent tuberculosis infection

“…The tuberculin skin test (TST) is currently most widely used test for the detection of MTB infection. However, Bacille‐Calmette‐Guérin (BCG) vaccination would mislead the interpretation of the results 11,12 . Although interferon‐gamma release assays including T‐SPOT.TB (T‐SPOT) and QuantiFERON‐TB Gold In‐Tube (QFT‐GIT) are the most important and widely used immunodiagnostic for MTB infection, 13,14 they could not successfully differentiate ATB from LTBI 15,16 .…”

“…However, Bacille-Calmette-Guérin (BCG) vaccination would mislead the interpretation of the results. 11,12 Although interferon-gamma release assays including T-SPOT.TB (T-SPOT) and QuantiFERON-TB Gold In-Tube (QFT-GIT) are the most important and widely used immunodiagnostic for MTB infection, 13,14 they could not successfully differentiate ATB from LTBI. 15,16 The limitations of conventional approaches highlight the need to identify new attractive tools.…”