Detection of latent tuberculosis, QuantiFERON-TB Gold test, possibilities and pitfalls of the method
Authors:
V. Vroblová; K. Jankovičová; M. Trojáčková-Kudlová; J. Krejsek
Authors place of work:
Přednosta: prof. RNDr. Jan Krejsek, CSc.
; Lékařská fakulta a Fakultní nemocnice v Hradci Králové
; ÚSTAV KLINICKÉ IMUNOLOGIE A ALERGOLOGIE
; Univerzita Karlova v Praze
Published in the journal:
Prakt. Lék. 2009; 89(4): 204-209
Category:
Diagnostis
Summary
Tuberculosis (TB) is an illness that is found throughout the world and affects both children and adolescents. TB can affect all organs but mainly involves the lungs. Based on individual genetic predisposition, individual immune reactivity, and the characteristics of the particular M. tuberculosis strain, mycobacterial infection is either eliminated or localized, or clinically manifest disease develops. M. tuberculosis, which is present in viable form in granuloma of patients suffering from latent TB infection, is able to survive for decades without any clinical signs of infection. This latent infection can be reactivated, leading to M. tuberculosis multiplying and spreading throughout the body, if the patient’s immune system fails for either natural reasons (e.g. acquired immunodeficiency – AIDS, cancer) or artificial reasons (immunosuppression, cancer therapy). The presence of latent M. tuberculosis infection has to be tested if there is a risk of the development of active TB. This may occur in individuals who are in close contact with active TB or individuals with an increased risk of latent TB reactivation due to immunosuppression. Until now, the Mantoux skin test (MT) was the only approach available to support the suspicion of latent TB but has many limitations.
A new generation of blood tests based on specific cell mediated immune response to M. tuberculosis antigens has now been launched. These tests do not suffer from poor MT test specificity and sensitivity.
The QuantiFERON-TB Gold test is based on ELISA determination of interferon *gamma by antigen specific T cells after in vitro stimulation by specific M. tuberculosis peptidic antigens. QuantiFERON-TB Gold test has been approved for the diagnosis of both latent and active infection by M. tuberculosis. Its application is without any harm for patients. The possible drawback of this test is its price. However, the cost effectiveness of this test is substantial if all the expenditures regarding other tests needed to diagnose latent TB and treatment of incorrectly diagnosed patients with prophylactic therapy are added together. The QuantiFERON-TB Gold test is recommended by NICE guidelines for elimination of active TB. This tests is used to confirm the presence of latent M. tuberculosis infection in patients at risk of TB development especially those undergoing so-called biological treatment by anti TNF-a monoclonals.
Key words:
latent tuberculosis, QuantiFERON-TB Gold test, Mantoux skin test.
Zdroje
1. Beglinger, Ch., Dudler, J., Mottet, Ch. et al. Screening for tuberculosis infection before initiation of anti-TNF‑α therapy. Swiss Med. Wkly. 2007, 137, p. 621-622.
2. Brock, I., Weldingh, K., Lillebaek, T. et al. Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts. Am. J. Respir. Crit. Care Med. 2004, 170, p. 65-69.
3. Detjen, A.K., Keil, T., Roll, S. et al. Interferon-γ release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis. Clin. Infect. Dis. 2007, 45, p. 322-328.
4. Diel, R., Nienhaus, A., Lange, C. et al. Tuberculosis contact investigation with a new, specific blood test in a low-incidence population containing a high proportion of BCG-vaccinated persons. Respir. Res. 2006, 7(77), p. 1-9.
5. Diel, R., Nienhaus, A. Loddenkemper, R. Cost-effectiveness of interferon-γ release assay screening for latent tuberculosis infection treatment in Germany. Chest 2007, 131(5), p. 1424-1434.
6. Ferrara, G., Losi, M., Meacci, M. et al. Routine hospital use of a new commercial whole blood interferon-γ assay for the diagnosis of tuberculosis infection. Am. J. Respir Crit. Care Med. 2005, 172, p. 631-635.
7. Jones, S., Gijsel, D., Wallach, F.R. et al. Utility of QuantiFERON-TB Gold in-tube testing for latent TB infection in HIV-infected individuals. Int. J. Tuberc. Lung Dis. 2007, 11, p. 1190-1195.
8. Kang, Y,A., Lee, H.W., Hwang, S.S. et al. Usefulness of whole-blood interferon-γ assay and interferon-γ enzyme-linked immunospot assay in the diagnosis of active pulmonary tuberculosis. Chest 2007, 132, p. 959-965.
9. Kang, Y.A., Lee, H.W., Yoon, H.I. Discrepancy between the tuberculin skin test and the whole-blood interferon-g assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005, 293, p. 2756-2761.
10. Kobashi, Y., Mouri, K., Obase, Y. et al. Clinical evaluation of QuantiFERON TB-2G test for immunocompromised patients. Eur. Respir. J. 2007, 30, p. 945-950.
11. Kobashi, Y., Obase, Y., Fukuda, M. et al. Usefulness of QuantiFERON TB-2G, a diagnostic method for latent tuberculosis infection, in a contact investigation of health care workers. Int. Med. 2007, 46(18), p. 1543-1549.
12. Krejsek, J. Kopecký, O. Klinická imunologie. 1. vyd. Hradec Králové: Nucleus 2004. s. 509-520.
13. Křepela, K. Diagnostika a léčba tuberkulózy dětí a mladistvých v ČR. Pediatrie pro praxi, 2007, 8(4), s. 208-210.
14. Lee, S.S., Liu, Y., Huang, T. et al. Comparison of the interferon- γ release assay and the tuberculin skin test for contact investigation of tuberculosis in BCG-vaccinated health care workers. Scand. J. Infect. Dis. 2007, 40(5), p. 1-8.
15. Mori, T., Sakatani, M., Yamagishi, F. et al. Specific detection of tuberculosis infection. Am. J. Respir. Crit. Care Med. 2004, 170, p. 59-64.
16. Okada, K., Mao, T.E., Mori, T. et al. Performance of an interferon-gamma release assay for diagnosing latent tuberculosis infection in children. Epidemiol. Infect. 2007, 136(9), p. 1-9.
17. Palomino, J.C., Lečo, S.C., Ritacco, V. Tuberculosis 2007. From basic science to patient care. [on line]. Dostupný na www.Tuberculosis Textbook.com.
18. Rangaka, M.X., Wilkinson, K.A., Seldon, R. Effect of HIV-1 infection on T-cell-based and skin test detection of tuberculosis infection. Am. J. Respir. Crit. Care Med. 2007, 175, p. 514-520.
19. Ravn, P., Munk, M.E., Andersen, A.B. et al. Prospective evaluation of whole-blood test using Mycobacterium tuberculosis-specific antigens ESAT-6 and CFP-10 for diagnosis of active tuberculosis. Clin. Diagn. Lab. Immunol. 2005, 12(4), p. 491-496.
20. Richeldi, L. An update on the diagnosis of tuberculosis infection. Am. J. Respir. Crit. Care Med. 2006, 174, p. 736-742.
21. Controlling Tuberculosis in the United States – Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR Recommendations and Reports 2005, 54, p. 1-81. Dostupné na http://www. cdc.gov/mmwr/preview/mmwrhtml/rr5412a1.htm.
22. Vincenti, D., Carrara, S., Butera, O. et al. Response to region of difference 1 (RD1) epitopes in human immunodeficiency virus (HIV)-infected individuals enrolled with suspected active tuberculosis: a pilot study. Clin. Exp. Immunol. 2007, 150(1), p. 91-98.
23. Wu, H.P., Hua, C.C., Liu, Y.C. et al. Comparison of interferon-γ response between tuberculosis and non-tubercular Pneumonia. Inflamm. Res. 2007, 56, p. 11-16.
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