Performance of the tuberculin skin test and interferon-γ release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population

Eun Y. Kim, Ju E. Lim, Ji Y. Jung, Ji Y. Son, Kyung J. Lee, Yoe W. Yoon, Byung H. Park, Jin W. Moon, Moo S. Park, Young S. Kim, Se K. Kim, Joon Chang, youngae kang

Research output: Contribution to journalArticle

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Abstract

Background: Interferon-γ release assay (IGRA) may improve diagnostic accuracy for latent tuberculosis infection (LTBI). This study compared the performance of the tuberculin skin test (TST) with that of IGRA for the diagnosis of LTBI in immunocompromised patients in an intermediate TB burden country where BCG vaccination is mandatory. Methods: We conducted a retrospective observational study of patients given the TST and an IGRA, the QuantiFERON-TB Gold In-Tube (QFT-IT), at Severance Hospital, a tertiary hospital in South Korea, from December 2006 to May 2009. Results: Of 211 patients who underwent TST and QFT-IT testing, 117 (55%) were classified as immunocompromised. Significantly fewer immunocompromised than immunocompetent patients had positive TST results (10.3% vs. 27.7%, p 0.001), whereas the percentage of positive QFT-IT results was comparable for both groups (21.4% vs. 25.5%). However, indeterminate QFT-IT results were more frequent in immunocompromised than immunocompetent patients (21.4% vs. 9.6%, p 0.021). Agreement between the TST and QFT-IT was fair for the immunocompromised group (κ = 0.38), but moderate agreement was observed for the immunocompetent group (κ = 0.57). Indeterminate QFT-IT results were associated with anaemia, lymphocytopenia, hypoproteinemia, and hypoalbuminemia. Conclusion: In immunocompromised patients, the QFT-IT may be more sensitive than the TST for detection of LTBI, but it resulted in a considerable proportion of indeterminate results. Therefore, both tests may maximise the efficacy of screening for LTBI in immunocompromised patients.

Original languageEnglish
Article number207
JournalBMC Infectious Diseases
Volume9
DOIs
Publication statusPublished - 2009 Dec 15

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Tuberculin Test
Immunocompromised Host
Mycobacterium bovis
Skin Tests
Gold
Interferons
Tuberculosis
Latent Tuberculosis
Infection
Population
Hypoproteinemia
Hypoalbuminemia
Republic of Korea
Lymphopenia
Tertiary Care Centers
Observational Studies
Anemia
Vaccination
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

Cite this

Kim, Eun Y. ; Lim, Ju E. ; Jung, Ji Y. ; Son, Ji Y. ; Lee, Kyung J. ; Yoon, Yoe W. ; Park, Byung H. ; Moon, Jin W. ; Park, Moo S. ; Kim, Young S. ; Kim, Se K. ; Chang, Joon ; kang, youngae. / Performance of the tuberculin skin test and interferon-γ release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population. In: BMC Infectious Diseases. 2009 ; Vol. 9.
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title = "Performance of the tuberculin skin test and interferon-γ release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population",
abstract = "Background: Interferon-γ release assay (IGRA) may improve diagnostic accuracy for latent tuberculosis infection (LTBI). This study compared the performance of the tuberculin skin test (TST) with that of IGRA for the diagnosis of LTBI in immunocompromised patients in an intermediate TB burden country where BCG vaccination is mandatory. Methods: We conducted a retrospective observational study of patients given the TST and an IGRA, the QuantiFERON-TB Gold In-Tube (QFT-IT), at Severance Hospital, a tertiary hospital in South Korea, from December 2006 to May 2009. Results: Of 211 patients who underwent TST and QFT-IT testing, 117 (55{\%}) were classified as immunocompromised. Significantly fewer immunocompromised than immunocompetent patients had positive TST results (10.3{\%} vs. 27.7{\%}, p 0.001), whereas the percentage of positive QFT-IT results was comparable for both groups (21.4{\%} vs. 25.5{\%}). However, indeterminate QFT-IT results were more frequent in immunocompromised than immunocompetent patients (21.4{\%} vs. 9.6{\%}, p 0.021). Agreement between the TST and QFT-IT was fair for the immunocompromised group (κ = 0.38), but moderate agreement was observed for the immunocompetent group (κ = 0.57). Indeterminate QFT-IT results were associated with anaemia, lymphocytopenia, hypoproteinemia, and hypoalbuminemia. Conclusion: In immunocompromised patients, the QFT-IT may be more sensitive than the TST for detection of LTBI, but it resulted in a considerable proportion of indeterminate results. Therefore, both tests may maximise the efficacy of screening for LTBI in immunocompromised patients.",
author = "Kim, {Eun Y.} and Lim, {Ju E.} and Jung, {Ji Y.} and Son, {Ji Y.} and Lee, {Kyung J.} and Yoon, {Yoe W.} and Park, {Byung H.} and Moon, {Jin W.} and Park, {Moo S.} and Kim, {Young S.} and Kim, {Se K.} and Joon Chang and youngae kang",
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Performance of the tuberculin skin test and interferon-γ release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population. / Kim, Eun Y.; Lim, Ju E.; Jung, Ji Y.; Son, Ji Y.; Lee, Kyung J.; Yoon, Yoe W.; Park, Byung H.; Moon, Jin W.; Park, Moo S.; Kim, Young S.; Kim, Se K.; Chang, Joon; kang, youngae.

In: BMC Infectious Diseases, Vol. 9, 207, 15.12.2009.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Performance of the tuberculin skin test and interferon-γ release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population

AU - Kim, Eun Y.

AU - Lim, Ju E.

AU - Jung, Ji Y.

AU - Son, Ji Y.

AU - Lee, Kyung J.

AU - Yoon, Yoe W.

AU - Park, Byung H.

AU - Moon, Jin W.

AU - Park, Moo S.

AU - Kim, Young S.

AU - Kim, Se K.

AU - Chang, Joon

AU - kang, youngae

PY - 2009/12/15

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N2 - Background: Interferon-γ release assay (IGRA) may improve diagnostic accuracy for latent tuberculosis infection (LTBI). This study compared the performance of the tuberculin skin test (TST) with that of IGRA for the diagnosis of LTBI in immunocompromised patients in an intermediate TB burden country where BCG vaccination is mandatory. Methods: We conducted a retrospective observational study of patients given the TST and an IGRA, the QuantiFERON-TB Gold In-Tube (QFT-IT), at Severance Hospital, a tertiary hospital in South Korea, from December 2006 to May 2009. Results: Of 211 patients who underwent TST and QFT-IT testing, 117 (55%) were classified as immunocompromised. Significantly fewer immunocompromised than immunocompetent patients had positive TST results (10.3% vs. 27.7%, p 0.001), whereas the percentage of positive QFT-IT results was comparable for both groups (21.4% vs. 25.5%). However, indeterminate QFT-IT results were more frequent in immunocompromised than immunocompetent patients (21.4% vs. 9.6%, p 0.021). Agreement between the TST and QFT-IT was fair for the immunocompromised group (κ = 0.38), but moderate agreement was observed for the immunocompetent group (κ = 0.57). Indeterminate QFT-IT results were associated with anaemia, lymphocytopenia, hypoproteinemia, and hypoalbuminemia. Conclusion: In immunocompromised patients, the QFT-IT may be more sensitive than the TST for detection of LTBI, but it resulted in a considerable proportion of indeterminate results. Therefore, both tests may maximise the efficacy of screening for LTBI in immunocompromised patients.

AB - Background: Interferon-γ release assay (IGRA) may improve diagnostic accuracy for latent tuberculosis infection (LTBI). This study compared the performance of the tuberculin skin test (TST) with that of IGRA for the diagnosis of LTBI in immunocompromised patients in an intermediate TB burden country where BCG vaccination is mandatory. Methods: We conducted a retrospective observational study of patients given the TST and an IGRA, the QuantiFERON-TB Gold In-Tube (QFT-IT), at Severance Hospital, a tertiary hospital in South Korea, from December 2006 to May 2009. Results: Of 211 patients who underwent TST and QFT-IT testing, 117 (55%) were classified as immunocompromised. Significantly fewer immunocompromised than immunocompetent patients had positive TST results (10.3% vs. 27.7%, p 0.001), whereas the percentage of positive QFT-IT results was comparable for both groups (21.4% vs. 25.5%). However, indeterminate QFT-IT results were more frequent in immunocompromised than immunocompetent patients (21.4% vs. 9.6%, p 0.021). Agreement between the TST and QFT-IT was fair for the immunocompromised group (κ = 0.38), but moderate agreement was observed for the immunocompetent group (κ = 0.57). Indeterminate QFT-IT results were associated with anaemia, lymphocytopenia, hypoproteinemia, and hypoalbuminemia. Conclusion: In immunocompromised patients, the QFT-IT may be more sensitive than the TST for detection of LTBI, but it resulted in a considerable proportion of indeterminate results. Therefore, both tests may maximise the efficacy of screening for LTBI in immunocompromised patients.

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