Discrepancy between the tuberculin skin test and the whole-blood interferon γ assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country

youngae kang, Won Lee Hye, Il Yoon Ho, Be Long Cho, Koo Han Sung, Young Soo Shim, Jae Joon Yim

Research output: Contribution to journalArticle

376 Citations (Scopus)

Abstract

Context. A recently developed whole-blood interferon γ (IFN-γ) assay based on stimulation with the Mycobacterium tuberculosis-specific antigens early secreted antigenic target 6 and culture filtrate protein 10 shows promise for the diagnosis of latent tuberculosis (TB) infection. Objective. To compare the tuberculin skin test (TST) and the whole-blood IFN-γ assay in the diagnosis of latent TB infection according to the intensity of exposure. Design and Setting. A prospective comparison between the whole-blood IFN-γ assay and the TST using a 2-TU dose of purified protein derivative RT23 in a population with intermediate TB burden was conducted sequentially between February 1, 2004, and February 28, 2005, in a Korean tertiary referral hospital. Participants. Of 273 participants, 220 (95.7%) had received BCG vaccine. Participants were grouped according to their risk of infection: group 1, no identifiable risk of M tuberculosis infection (n = 99); group 2, recent casual contacts (n = 72); group 3, recent close contacts (n = 48); group 4, bacteriologically or pathologically confirmed TB patients (n = 54). Main Outcome Measures. Levels of agreement between the TST and the IFN-γ assay and the likelihood of infection in the various groups. Results For the TST with a 10-mm induration cutoff, the positive response rate in group 1 was 51%; group 2, 60%; group 3, 71%, and group 4, 78%. For the IFN-γ assay, the positive response rate in group 1 was 4%; group 2, 10%; group 3, 44%; and group 4, 81%. The overall agreement between the TST and the IFN-γ assay in healthy volunteers was κ = 0.16. The odds of a positive test result per unit increase in exposure across the 4 groups increased by a factor of 5.31 (95% confidence interval [CI], 3.62-7.79) for the IFN-γ assay and by a factor of 1.52 (95% CI, 1.20-1.91) for the TST (P<.001). Using a 15-mm induration cutoff for the TST did not make a substantial difference to the test results. Conclusion. The IFN-γ assay is a better indicator of the risk of M tuberculosis infection than TST in a BCG-vaccinated population.

Original languageEnglish
Pages (from-to)2756-2761
Number of pages6
JournalJournal of the American Medical Association
Volume293
Issue number22
DOIs
Publication statusPublished - 2005 Jun 8

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Latent Tuberculosis
Tuberculin Test
Skin Tests
Interferons
Tuberculosis
Infection
Confidence Intervals
BCG Vaccine
Mycobacterium bovis
Tertiary Care Centers
Population
Healthy Volunteers
Proteins
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{433b1e1102cc4f628749347323f153a0,
title = "Discrepancy between the tuberculin skin test and the whole-blood interferon γ assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country",
abstract = "Context. A recently developed whole-blood interferon γ (IFN-γ) assay based on stimulation with the Mycobacterium tuberculosis-specific antigens early secreted antigenic target 6 and culture filtrate protein 10 shows promise for the diagnosis of latent tuberculosis (TB) infection. Objective. To compare the tuberculin skin test (TST) and the whole-blood IFN-γ assay in the diagnosis of latent TB infection according to the intensity of exposure. Design and Setting. A prospective comparison between the whole-blood IFN-γ assay and the TST using a 2-TU dose of purified protein derivative RT23 in a population with intermediate TB burden was conducted sequentially between February 1, 2004, and February 28, 2005, in a Korean tertiary referral hospital. Participants. Of 273 participants, 220 (95.7{\%}) had received BCG vaccine. Participants were grouped according to their risk of infection: group 1, no identifiable risk of M tuberculosis infection (n = 99); group 2, recent casual contacts (n = 72); group 3, recent close contacts (n = 48); group 4, bacteriologically or pathologically confirmed TB patients (n = 54). Main Outcome Measures. Levels of agreement between the TST and the IFN-γ assay and the likelihood of infection in the various groups. Results For the TST with a 10-mm induration cutoff, the positive response rate in group 1 was 51{\%}; group 2, 60{\%}; group 3, 71{\%}, and group 4, 78{\%}. For the IFN-γ assay, the positive response rate in group 1 was 4{\%}; group 2, 10{\%}; group 3, 44{\%}; and group 4, 81{\%}. The overall agreement between the TST and the IFN-γ assay in healthy volunteers was κ = 0.16. The odds of a positive test result per unit increase in exposure across the 4 groups increased by a factor of 5.31 (95{\%} confidence interval [CI], 3.62-7.79) for the IFN-γ assay and by a factor of 1.52 (95{\%} CI, 1.20-1.91) for the TST (P<.001). Using a 15-mm induration cutoff for the TST did not make a substantial difference to the test results. Conclusion. The IFN-γ assay is a better indicator of the risk of M tuberculosis infection than TST in a BCG-vaccinated population.",
author = "youngae kang and Hye, {Won Lee} and Ho, {Il Yoon} and Cho, {Be Long} and Sung, {Koo Han} and Shim, {Young Soo} and Yim, {Jae Joon}",
year = "2005",
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doi = "10.1001/jama.293.22.2756",
language = "English",
volume = "293",
pages = "2756--2761",
journal = "JAMA - Journal of the American Medical Association",
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Discrepancy between the tuberculin skin test and the whole-blood interferon γ assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. / kang, youngae; Hye, Won Lee; Ho, Il Yoon; Cho, Be Long; Sung, Koo Han; Shim, Young Soo; Yim, Jae Joon.

In: Journal of the American Medical Association, Vol. 293, No. 22, 08.06.2005, p. 2756-2761.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Discrepancy between the tuberculin skin test and the whole-blood interferon γ assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country

AU - kang, youngae

AU - Hye, Won Lee

AU - Ho, Il Yoon

AU - Cho, Be Long

AU - Sung, Koo Han

AU - Shim, Young Soo

AU - Yim, Jae Joon

PY - 2005/6/8

Y1 - 2005/6/8

N2 - Context. A recently developed whole-blood interferon γ (IFN-γ) assay based on stimulation with the Mycobacterium tuberculosis-specific antigens early secreted antigenic target 6 and culture filtrate protein 10 shows promise for the diagnosis of latent tuberculosis (TB) infection. Objective. To compare the tuberculin skin test (TST) and the whole-blood IFN-γ assay in the diagnosis of latent TB infection according to the intensity of exposure. Design and Setting. A prospective comparison between the whole-blood IFN-γ assay and the TST using a 2-TU dose of purified protein derivative RT23 in a population with intermediate TB burden was conducted sequentially between February 1, 2004, and February 28, 2005, in a Korean tertiary referral hospital. Participants. Of 273 participants, 220 (95.7%) had received BCG vaccine. Participants were grouped according to their risk of infection: group 1, no identifiable risk of M tuberculosis infection (n = 99); group 2, recent casual contacts (n = 72); group 3, recent close contacts (n = 48); group 4, bacteriologically or pathologically confirmed TB patients (n = 54). Main Outcome Measures. Levels of agreement between the TST and the IFN-γ assay and the likelihood of infection in the various groups. Results For the TST with a 10-mm induration cutoff, the positive response rate in group 1 was 51%; group 2, 60%; group 3, 71%, and group 4, 78%. For the IFN-γ assay, the positive response rate in group 1 was 4%; group 2, 10%; group 3, 44%; and group 4, 81%. The overall agreement between the TST and the IFN-γ assay in healthy volunteers was κ = 0.16. The odds of a positive test result per unit increase in exposure across the 4 groups increased by a factor of 5.31 (95% confidence interval [CI], 3.62-7.79) for the IFN-γ assay and by a factor of 1.52 (95% CI, 1.20-1.91) for the TST (P<.001). Using a 15-mm induration cutoff for the TST did not make a substantial difference to the test results. Conclusion. The IFN-γ assay is a better indicator of the risk of M tuberculosis infection than TST in a BCG-vaccinated population.

AB - Context. A recently developed whole-blood interferon γ (IFN-γ) assay based on stimulation with the Mycobacterium tuberculosis-specific antigens early secreted antigenic target 6 and culture filtrate protein 10 shows promise for the diagnosis of latent tuberculosis (TB) infection. Objective. To compare the tuberculin skin test (TST) and the whole-blood IFN-γ assay in the diagnosis of latent TB infection according to the intensity of exposure. Design and Setting. A prospective comparison between the whole-blood IFN-γ assay and the TST using a 2-TU dose of purified protein derivative RT23 in a population with intermediate TB burden was conducted sequentially between February 1, 2004, and February 28, 2005, in a Korean tertiary referral hospital. Participants. Of 273 participants, 220 (95.7%) had received BCG vaccine. Participants were grouped according to their risk of infection: group 1, no identifiable risk of M tuberculosis infection (n = 99); group 2, recent casual contacts (n = 72); group 3, recent close contacts (n = 48); group 4, bacteriologically or pathologically confirmed TB patients (n = 54). Main Outcome Measures. Levels of agreement between the TST and the IFN-γ assay and the likelihood of infection in the various groups. Results For the TST with a 10-mm induration cutoff, the positive response rate in group 1 was 51%; group 2, 60%; group 3, 71%, and group 4, 78%. For the IFN-γ assay, the positive response rate in group 1 was 4%; group 2, 10%; group 3, 44%; and group 4, 81%. The overall agreement between the TST and the IFN-γ assay in healthy volunteers was κ = 0.16. The odds of a positive test result per unit increase in exposure across the 4 groups increased by a factor of 5.31 (95% confidence interval [CI], 3.62-7.79) for the IFN-γ assay and by a factor of 1.52 (95% CI, 1.20-1.91) for the TST (P<.001). Using a 15-mm induration cutoff for the TST did not make a substantial difference to the test results. Conclusion. The IFN-γ assay is a better indicator of the risk of M tuberculosis infection than TST in a BCG-vaccinated population.

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JF - JAMA - Journal of the American Medical Association

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