-
Colombia Medica (Cali, Colombia) 2022Tuberculin skin test (TST) has played an essential in the diagnosis of latent tuberculosis infection (LTBI) for nearly a century.
BACKGROUND
Tuberculin skin test (TST) has played an essential in the diagnosis of latent tuberculosis infection (LTBI) for nearly a century.
OBJECTIVE
This study aimed to investigate the general characteristics of patients tested with TST in a tertiary hospital within two years.
METHODS
All patients who were evaluated to screen for tuberculosis and received a TST were included. The Mantoux method was used for TST administration.
RESULTS
A total of 661 patients, 345 (52.2%) men and 316 (47.8%) women, with a mean age of 43.0 ±15.9 years, were included in the study. Accordingly, TST was performed prior to anti-TNF biological agent therapy for 50% (331) of the participants, for LTBI screening before solid organ and/or hematological stem cell transplantation for 20.4% (135), for screening following contact with tuberculosis for 25.1% (166), for screening of healthcare professionals for 1.1% (7), and medical report for 3.3% (22). 2.7% of the patients who took TST were diagnosed with active tuberculosis (14 with pulmonary tuberculosis and 4 with extrapulmonary tuberculosis). QuantiFERON-TB Gold (QFT) test was performed in 332 (50.2%) patients with anergic TST results. According to TST and QFT test results, 28.3% (187) of the patients were started on tuberculosis prophylaxis.
CONCLUSION
While TST is most performed for LTBI screening prior to biological agent therapy, almost one-fourth of patients taking TST require tuberculosis prophylaxis. On the other hand, about half of the patients require an additional QFT test.
Topics: Male; Humans; Female; Adult; Middle Aged; Tuberculin; Tumor Necrosis Factor Inhibitors; Tuberculosis; Tuberculin Test; Latent Tuberculosis
PubMed: 37152521
DOI: 10.25100/cm.v53i3.5055 -
Le Infezioni in Medicina Jun 2021Interferon-γ releasing assays (IGRAs) are currently widely employed in the initial work up of Mycobacterium tuberculosis infection, as well as in suspected tuberculosis...
Interferon-γ releasing assays (IGRAs) are currently widely employed in the initial work up of Mycobacterium tuberculosis infection, as well as in suspected tuberculosis (TB). These assays are commonly utilized over the Tuberculin Skin Test (TST) in high resource and low TB burden settings, despite the unclear benefits shown in such contexts. The debate on the use of TST and IGRAs is of current interest also in Italy due to the increasing presence of immigrants from countries with a high incidence of TB and the rising attention of health care institutions to economic costs. The aim of this study was to compare QuantiFERON-TB (QFT) and TST results in active TB. We evaluated QFT results and TST reactions from 245 consecutive patients having both tests, registered among 411 patients admitted for TB at the Infectious Disease Clinic, Department of Medicine of the University of Perugia (Italy). We compared the rates of positive QFT and TST tests and noted no statistically significant differences overall or in relation to age, gender, HIV status and TB localization. Among foreign-born patients with confirmed TB, we observed a lower rate of positive TST results. The results of our study indicated that both QFT and TST can be used in the work up of TB having special attention when evaluating foreign-born patients.
Topics: Emigrants and Immigrants; Humans; Incidence; Italy; Latent Tuberculosis; Mycobacterium tuberculosis; Tuberculin Test
PubMed: 34061788
DOI: No ID Found -
BMC Health Services Research Sep 2011Interferon-γ release assays (IGRAs) for TB have the potential to replace the tuberculin skin test (TST) in screening for latent tuberculosis infection (LTBI). The... (Comparative Study)
Comparative Study Review
BACKGROUND
Interferon-γ release assays (IGRAs) for TB have the potential to replace the tuberculin skin test (TST) in screening for latent tuberculosis infection (LTBI). The higher per-test cost of IGRAs may be compensated for by lower post-screening costs (medical attention, chest x-rays and chemoprevention), given the higher specificity of the new tests as compared to that of the conventional TST. We conducted a systematic review of all publications that have addressed the cost or cost-effectiveness of IGRAs. The objective of this report was to undertake a structured review and critical appraisal of the methods used for the model-based cost-effectiveness analysis of TB screening programmes.
METHODS
Using Medline and Embase, 75 publications that contained the terms "IGRA", "tuberculosis" and "cost" were identified. Of these, 13 were original studies on the costs or cost-effectiveness of IGRAs.
RESULTS
The 13 relevant studies come from five low-to-medium TB-incidence countries. Five studies took only the costs of screening into consideration, while eight studies analysed the cost-effectiveness of different screening strategies. Screening was performed in high-risk groups: close contacts, immigrants from high-incidence countries and healthcare workers. Two studies used the T-SPOT.TB as an IGRA and the other studies used the QuantiFERON-TB Gold and/or Gold In-Tube test. All 13 studies observed a decrease in costs when the IGRAs were used. Six studies compared the use of an IGRA as a test to confirm a positive TST (TST/IGRA strategy) to the use of an IGRA-only strategy. In four of these studies, the two-step strategy and in two the IGRA-only strategy was more cost-effective. Assumptions about TST specificity and progression risk after a positive test had the greatest influence on determining which IGRA strategy was more cost-effective.
CONCLUSION
The available studies on cost-effectiveness provide strong evidence in support of the use of IGRAs in screening risk groups such as HCWs, immigrants from high-incidence countries and close contacts. So far, only two studies provide evidence that the IGRA-only screening strategy is more cost-effective.
Topics: Contact Tracing; Cost-Benefit Analysis; Female; Germany; Health Care Costs; Humans; Interferon-gamma Release Tests; Male; Mass Screening; Tuberculin Test; Tuberculosis, Pulmonary
PubMed: 21961888
DOI: 10.1186/1472-6963-11-247 -
Clinical and Vaccine Immunology : CVI Aug 2015Tuberculosis (TB) is an ancient disease that has infected humans for thousands of years. However, despite diagnostic tests that detect the disease and effective therapy,... (Comparative Study)
Comparative Study Review
Tuberculosis (TB) is an ancient disease that has infected humans for thousands of years. However, despite diagnostic tests that detect the disease and effective therapy, there are still millions of people worldwide who are infected with TB. The first TB test used to detect infected patients was a skin test that identifies individuals actively infected with TB. This test used a mix of proteins from culture filtrates of the bacteria Mycobacterium tuberculosis. Recently, two new diagnostic tests have been introduced; these two new tests can detect TB infection in patients by challenging peripheral blood cells with specific TB proteins. These assays measure the cellular immune response to these proteins. This minireview evaluates the new assays and compares them to the use of the TB skin test. The use of these new assays may have some advantages in detecting individuals with active tuberculosis. However, there is still a role for the use of the skin test, especially in young patients.
Topics: Diagnostic Tests, Routine; Humans; Interferon-gamma Release Tests; Mycobacterium tuberculosis; Tuberculin Test; Tuberculosis
PubMed: 26018533
DOI: 10.1128/CVI.00199-15 -
FEMS Immunology and Medical Microbiology Dec 2012The tuberculin skin test, which involves monitoring the immune reaction to an injection of purified protein derivative (PPD), has been the most widely used method for... (Review)
Review
The tuberculin skin test, which involves monitoring the immune reaction to an injection of purified protein derivative (PPD), has been the most widely used method for detecting infection with Mycobacterium tuberculosis since its development in 1930s. Until recently, the molecular composition of PPD was unknown. This thwarted the discovery of improved skin testing reagents and drastically hindered efforts to define the mechanism of action. Proteomic evaluation of PPD combined with a detailed analysis in the guinea pig model of tuberculosis led to further definition of the molecular composition of PPD. This communication reviews the history and current status of PPD, in addition to describing candidate next-generation PPD reagents, based on the use of an individual protein or protein cocktails.
Topics: Animals; Guinea Pigs; History, 20th Century; History, 21st Century; Humans; Tuberculin; Tuberculin Test; Tuberculosis; Tuberculosis Vaccines
PubMed: 22762692
DOI: 10.1111/j.1574-695X.2012.01002.x -
The Pan African Medical Journal 2022Tuberculin reactivity following tuberculin skin test which is the most common measure of the effect of the Bacille Calmette Guerin (BCG) vaccination has remained...
Tuberculin reactivity following tuberculin skin test which is the most common measure of the effect of the Bacille Calmette Guerin (BCG) vaccination has remained complex. This protocol is aimed to assess the effect of BCG vaccine on tuberculin skin test in Africa as a guide to better understanding or resolving this complexity. A search strategy is developed using MeSH, key words, text words, and entry terms. Five databases will be searched, including PubMed, African Journals Online (AJOL), Google Scholar, Research Gate, and Cochrane Library. Only observational studies conducted in Sub-Saharan Africa and retrievable in English language will be included. The primary measurable outcome of this study is pooled prevalence of positive tuberculin skin tests. Secondary outcomes are factors that influence Tuberculin Skin Test (TST) positivity such as BCG type, the dose of BCG, age at BCG vaccinates, time/interval between BCG vaccination and TST, and type of tuberculin unit used for TST. Identified studies will be screened and selected based on inclusion criteria. Data will be extracted into Zotero, Microsoft Excel and CMA software. Both quality scores and the risk of bias for individual studies will be reported. Studies will be assessed for methodological, clinical, and statistical heterogeneity. Funnel Plots will be used for assessing publication bias. The results will be presented in tabular format in addition to a narrative synthesis. The pooled prevalence of effect of BCG vaccine on TST in Africa will be examined in relation to factors that influence TST positivity.
Topics: Africa; BCG Vaccine; Humans; Meta-Analysis as Topic; Systematic Reviews as Topic; Tuberculin; Tuberculin Test; Tuberculosis; Vaccination
PubMed: 35291362
DOI: 10.11604/pamj.2022.41.12.30535 -
Pulmonary Medicine 2020Immunocompromised patients are at a higher risk of having latent tuberculosis infection (LTBI). QuantiFERON-TB Gold Plus (QFT-Plus) has been proven to perform... (Comparative Study)
Comparative Study
Comparison between the Interferon Release Assay-QuantiFERON Gold Plus (QFT-Plus)-and Tuberculin Skin Test (TST) in the Detection of Tuberculosis Infection in Immunocompromised Children.
BACKGROUND
Immunocompromised patients are at a higher risk of having latent tuberculosis infection (LTBI). QuantiFERON-TB Gold Plus (QFT-Plus) has been proven to perform effectively in LTBI detection among immunocompromised adults and can overcome the limitations of the tuberculin skin test (TST). However, the role of QFT-Plus in detecting LTBI in immunocompromised paediatric patients has not been well established. Therefore, the aim of this study was to assess the test agreement between QFT-Plus and the TST in LTBI detection among immunocompromised children.
METHOD
In this cross-sectional study, we enrolled immunocompromised paediatric patients, aged between 5 and 18 years, who were treated with corticosteroids and/or chemotherapy from June to November 2019. We categorized them into three groups based on the following diseases: hematologic malignancies and nephrological and immunological diseases. We recorded the patient characteristics and QFT-Plus and TST results, in which the positive result of the TST was induration ≥ 5 mm. Within the same group, comparisons between the two tests were performed using the McNemar test, and results were statistically significant for values of <0.05. The kappa index was used to assess the agreement between the two test results.
RESULTS
Among 71 patients (median age: 11.8 years) who underwent TST and QFT-Plus testing, 52% were females, and 69% had a normal nutritional status. Chemotherapy was the most common treatment modality for hematologic malignancy compared to other immunosuppressive treatments. The total number of patients with positive QFT-Plus and TST results was 11/71 (15.5%) and 4/71 (5.6%), respectively, among whom 3/11 patients had positive results in both tests, and one patient with positive TST results exhibited a discrepancy, as this was not followed by positive QFT-Plus results. QFT-Plus generated more positive results than the TST in immunocompromised children (McNemar, = 0.039 ( < 0.05)). The diagnostic agreement between the tests was fair ( = 0.345, 95% CI: 0.05-0.745).
CONCLUSION
QFT-Plus detected LTBI more effectively than the TST in immunocompromised children.
Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Immunocompromised Host; Interferon-gamma Release Tests; Male; Reproducibility of Results; Sensitivity and Specificity; Tuberculin Test; Tuberculosis
PubMed: 32455014
DOI: 10.1155/2020/7159485 -
The International Journal of... Jun 2017To describe tuberculin skin test (TST) and interferon-gamma release assay (IGRA) (i.e., QuantiFERON®-TB [QFT] and T-SPOT®.TB [T-SPOT]) use among privately insured...
OBJECTIVE
To describe tuberculin skin test (TST) and interferon-gamma release assay (IGRA) (i.e., QuantiFERON®-TB [QFT] and T-SPOT®.TB [T-SPOT]) use among privately insured persons in the United States over a 15-year period.
METHODS
We used current procedural terminology (CPT) codes for the TST and IGRAs to extract out-patient claims (2000-2014) and determined usage (claims/100 000). The χ2 test for trend in proportions was used to describe usage trends for select periods.
RESULTS
The TST was the dominant (>80%) test in each year. Publication of guidelines preceded the assignment of QFT and T-SPOT CPT codes by 1 year (2006 for QFT; 2011 for T-SPOT). QFT usage was higher (P < 0.01) than T-SPOT in each year. The average annual increase in the use of QFT was higher than that of T-SPOT (35 vs. 3.8/100 000), and more so when the analytic period was 2011-2014 (65 vs. 38/100 000). However, during that 4-year period (2011-2014), TST use trended downward, with an average annual decrease of 28/100 000. The annual proportion of enrollees tested ranged from 1.1% to 1.5%.
CONCLUSIONS
These results suggest a gradual shift from the use of the TST to the newer IGRAs. Future studies can assess the extent, if any, to which the shift from the use of the TST to IGRAs evolved over time.
Topics: Current Procedural Terminology; Databases, Factual; Humans; Insurance, Health; Interferon-gamma Release Tests; Outpatients; Practice Guidelines as Topic; Retrospective Studies; Tuberculin Test; Tuberculosis; United States
PubMed: 28351463
DOI: 10.5588/ijtld.16.0617 -
International Journal of Environmental... Oct 2022A tuberculin skin test (TST) or interferon-gamma release assay (IGRA) can be used to screen for latent tuberculosis infection (LTBI). Due to its low cost, TST has been... (Review)
Review
A tuberculin skin test (TST) or interferon-gamma release assay (IGRA) can be used to screen for latent tuberculosis infection (LTBI). Due to its low cost, TST has been used particularly in underdeveloped countries. The limitations of TST were poor specificity in populations with a high prevalence of Bacille Calmette-Guérin (BCG) vaccination and variability of test readers. IGRA is used as an alternative to TST in settings where higher costs can be supported. The lack of studies conducted in high TB incidence countries since previous review, and using relevant assessment tools of the quality appraisal make the need for updated studies and a more comprehensive systematic review. This study aimed to conduct a systematic review of published economic evaluations of screening strategies for LTBI in contacts of TB patients, assess the quality of these studies, and compare the assessment results related to a country's income level in order to provide information to other countries. The databases were searched in January 2022 including MEDLINE and Scopus. Two independent reviewers evaluated the included studies based on eligibility criteria, data extraction, and quality assessment. Eleven economic evaluations of LTBI diagnostic tests in TB contacts were included. Most studies were conducted in high-income countries (91%) and used cost-effectiveness analysis methods (73%). The quality assessment of reporting and data sources was appropriate, ranging from 71% to 89%. Interventions varied from study to study. The outcomes were cost per life years gained (27%), cost per quality-adjusted life year gained (27%), cost per TB case prevented (36%), and cost per close contact case (10%). In high-income countries which were not countries with high TB burden, the use of IGRA alone for screening TB contacts was cost-effective, whereas TST was cost-effective in only two studies. In comparison to TST, IGRA could reduce false-positive results, resulting in fewer patients undergoing TB treatment and preventive treatment.
Topics: Humans; Latent Tuberculosis; Cost-Benefit Analysis; BCG Vaccine; Tuberculin Test; Mass Screening; Tuberculosis
PubMed: 36294107
DOI: 10.3390/ijerph192013529 -
PloS One 2014Interferon-gamma (IFN-γ) release assays (IGRAs) such as the Quantiferon Gold In-tube test are in vitro assays that measure IFN-γ release from T cells in response to M....
Interferon-gamma (IFN-γ) release assays (IGRAs) such as the Quantiferon Gold In-tube test are in vitro assays that measure IFN-γ release from T cells in response to M. tuberculosis (Mtb)-specific antigens. Unlike the tuberculin skin test (TST), IGRA is specific and able to distinguish Mtb-infection from BCG vaccination. In this study we evaluated the concordance between TST and IGRA and the efficacy of IGRA in diagnosing new Mtb infection in household contacts (HHC) of pulmonary tuberculosis (PTB) cases. A total of 357 HHC of TB cases in Vitória, Brazil were studied. A TST was performed within 2 weeks following enrollment of the HHC and if negative a second TST was performed at 8-12 weeks. HHC were categorized as initially TST positive (TST+), persistently TST negative (TST-), or TST converters (TSTc), the latter representative of new infection. IGRA was performed at 8-12 weeks following enrollment and the test results were positive in 82% of TST+, 48% of TSTc, and 12% of TST-, indicating poor concordance between the two test results among HHC in each category. Evaluating CXCL10 levels in a subset of IGRA supernatants or lowering the IGRA cutoff value to define a positive test increased agreement between TST and IGRA test results. However, ROC curves demonstrated that this resulted in a trade-off between sensitivity and specificity of IGRA with respect to TST. Together, the findings suggest that until the basis for the discordance between TST and IGRA is fully understood, it may be necessary to utilize both tests to diagnose new Mtb infection in recently exposed HHC. Operationally, in IGRA negative HHC, it may be useful to employ a lower cutoff value for IGRA to allow closer monitoring for potential conversion.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brazil; Female; Humans; Interferon-gamma Release Tests; Male; Middle Aged; Sensitivity and Specificity; Tuberculin Test; Tuberculosis, Pulmonary; Young Adult
PubMed: 24819060
DOI: 10.1371/journal.pone.0096564