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Molecular Diagnosis & Therapy

, Volume 19, Issue 1, pp 9–24 | Cite as

A Systematic Review on TST and IGRA Tests Used for Diagnosis of LTBI in Immigrants

  • Jonathon R. Campbell
  • Jane Krot
  • Kevin Elwood
  • Victoria Cook
  • Fawziah Marra
Systematic Review

Abstract

Background

High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants.

Objectives

We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin.

Methods

We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher’s exact test or χ 2 test, where appropriate.

Results

Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001).

Limitations

The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study.

Conclusion

Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.

Keywords

Tuberculin Skin Test Positive Tuberculin Skin Test Interferon Gamma Release Assay Tuberculin Skin Test Result LTBI Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Funding and conflicts of interest

The authors have no funding sources or conflicts of interest to declare.

Author contribution

Jonathon R. Campbell performed the literature search, extraction, and analysis; he wrote the initial and subsequent drafts and is the guarantor of the overall content. Jane Krot performed the literature search and extraction in tandem with JRC. Victoria Cook and Kevin Elwood provided expert opinion and were involved in the editing and review process. Fawziah Marra conceptualized the paper and its direction; she provided key interpretations of the data and was the main author involved in editing and reviewing the manuscript.

Supplementary material

40291_2014_125_MOESM1_ESM.docx (142 kb)
Supplementary material 1 (DOCX 141 kb)

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Jonathon R. Campbell
    • 1
  • Jane Krot
    • 1
  • Kevin Elwood
    • 2
  • Victoria Cook
    • 1
    • 2
  • Fawziah Marra
    • 1
  1. 1.University of British ColumbiaVancouverCanada
  2. 2.BC Centre for Disease ControlVancouverCanada

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