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Comparison of QuantiFERON-TB Gold and the tuberculin skin test for detecting previous tuberculosis infection evaluated by chest CT findings in Japanese rheumatoid arthritis patients

Abstract

The aim of the study was to compare the usefulness of the QuantiFERON-TB Gold (QFT-2G) with that of the tuberculin skin test (TST) for detecting previous infection of tuberculosis (TB) in Japanese rheumatoid arthritis (RA) patients. Before receiving biologic therapy, 97 RA patients were divided into two groups based on their chest computed tomography (CT) findings: the TB past infection group (n = 48), with old inflammatory changes due to prior pulmonary TB; and the non-TB infection group (n = 49), without such findings. The QFT-2G was not affected by methotrexate or prednisolone. Indeterminate results with a positive control had a low incidence (5.2%). A positive QFT-2G for the TB past infection group at cutoffs of 0.35 and 0.1 IU/ml (intermediate range) was seen in 5.8% and 20.8%, respectively. A TST >20 mm was significantly higher in the non-TB infection group (31%) than in the TB past infection group (13%). The correlation between the QFT-2G and TST was poor among all patients. Disagreement between these tests in the non-TB infection group was caused by the false-positive TST induced by previous Bacillus Calmette-Guérin (BCG) vaccination. Only 12 (12.4%) of 97 patients had a positive QFT-2G (≥0.1 IU/ml) and a negative TST (<20 mm), but in this subgroup, a high incidence (10, 83.3%) was detected in the TB past infection group. QFT-2G may be a good alternative to the TST to evaluate previous TB infection when it is necessary to determine whether isoniazid (INH) prophylaxis is needed before biologic therapy is begun.

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References

  1. Yamada T, Nakajima A, Inoue E, Tanaka E, Hara M, Tomatsu T, et al. Increased risk of tuberculosis in patients with rheumatoid arthritis in Japan. Ann Rheum Dis. 2006;65:1661–3.

    PubMed  Article  CAS  Google Scholar 

  2. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. 2001;345:1098–104.

    PubMed  Article  CAS  Google Scholar 

  3. Tubach F, Salmon D, Ravaud P, Allanore Y, Goupille P, Breban M, et al. Risk of Tuberculosis is higher with anti-tumor necrosis factor antibody than with soluble tumor necrosis factor receptor therapy. The three-year prospective French research axed on tolerance of biotherapies registry. Arthritis Rheum. 2009;60:1884–94.

    PubMed  Article  CAS  Google Scholar 

  4. Takeuchi T, Tatsuki Y, Nogami Y, Ishiguro N, Tanaka Y, Yamanaka H, et al. Postmarketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis. Ann Rheum Dis. 2008;67:189–94.

    PubMed  Article  CAS  Google Scholar 

  5. Koike R, Takeuchi T, Eguchi K, Miyasaka N. Update on the Japanese guidelines for the use of infliximab and etanercept in rheumatoid arthritis. Mod Rheumatol. 2007;17:451–8.

    PubMed  Article  CAS  Google Scholar 

  6. Mori T, Sakatani M, Yamagishi F, Takashima T, Kawabe Y, Nagao K, et al. Specific detection of tuberculosis infection: an interferon-gamma-based assay using new antigens. Am J Respir Crit Care Med. 2004;170:59–64.

    PubMed  Article  Google Scholar 

  7. Mori T. Usefulness of interferon-gamma release assays for diagnosing TB infection and problems with these assays. J Infect Chemother. 2009;15:143–55.

    PubMed  Article  CAS  Google Scholar 

  8. Kobashi Y, Mouri K, Obase Y, Fukuda M, Miyashita N. Clinical evaluation of QuantiFERON TB-2G test for immunocompromised patients. Eur Respir J. 2007;30:945–50.

    PubMed  Article  CAS  Google Scholar 

  9. Kang YA, Lee HW, Yoon HI, Cho B, Shim Y-S, Yim J-J. 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. JAMA. 2005;293:2756–61.

    PubMed  Article  CAS  Google Scholar 

  10. Martin J, Walsh C, Gibbs A, McDonnell T, Fearon U, Keane J, et al. Comparison of interferon γ release assays and conventional screening tests before tumor necrosis factor α blockade in patients with inflammatory arthritis. Ann Rheum Dis. 2010;69:181–5.

    PubMed  Article  CAS  Google Scholar 

  11. Matulis G, Juni P, Villiger PM, Gadola SD. Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen-specific interferon γ assay. Ann Rheum Dis. 2008;67:84–90.

    PubMed  Article  CAS  Google Scholar 

  12. Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, Gutierrez C, Cucho M, Alfaro J, et al. Comparison of an interferon-γ assay with tuberculin skin test for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol. 2008;35 :1–5.

    Google Scholar 

  13. Inanc N, Aydin SZ, Karakurt S, Atagunduz P, Yavuz S, Direskeneli H. Agreement between Quantiferon-TB Gold test and tuberculin skin test in the identification of latent tuberculosis infection in patients with rheumatoid arthritis and ankylosing spondylitis. J Rheumatol. 2009;36:2675–81.

    PubMed  Article  Google Scholar 

  14. Maeda T, Banno S, Maeda S, Naiwa T, Hayami Y, Watanabe M, et al. Usefulness and limitations QuantiFERON-TB Gold in Japanese rheumatoid arthritis patients: proposal to decrease the lower cutoff for assessing latent tuberculosis infection. Mod Rheumatol. 2010;20:18–23.

    PubMed  Article  Google Scholar 

  15. Wu-Hsieh BA, Chen CK, Chang JH, Lai SY, Wu CH, Cheng WC, et al. Long-lived immune response to early secretary antigenic target 6 in individuals who had recovered from tuberculosis. Clin Infect Dis. 2001;33:1336–40.

    PubMed  Article  CAS  Google Scholar 

  16. Kobashi Y, Mouri K, Yagi S, Obase Y, Miyashita N, Oka M. Transitional changes in T-cell responses to Mycobacterium tuberculosis-specific antigens during treatment. J Infection. 2009;58:197–204.

    Article  Google Scholar 

  17. Ponce de Leon D, Acevedo-Vasquez E, Sanchez-Torres A, Cucho M, Alfaro J, Perich R, et al. Attenuated response to purified protein derivative in patients with rheumatoid arthritis: study in population with a high prevalence of tuberculosis. Ann Rheum Dis. 2005;64:1360–1.

    PubMed  Article  CAS  Google Scholar 

  18. Murakami S, Takeno M, Kirino Y, Kobayashi M, Watanabe R, Kudo M, et al. Screening of tuberculosis by interferon-γ assay before biologic therapy for rheumatoid arthritis. Tuberculosis. 2009;89:136–41.

    PubMed  Article  CAS  Google Scholar 

  19. Luetkemeye AF, Charlebois ED, Flores LL, Bangsberg DR, Deeks SG, Martin JN, et al. Comparison of an interferon-gamma release assay with tuberculin skin testing in HIV-infected individuals. Am J Respir Crit Care Med. 2007;175:737–42.

    Article  Google Scholar 

  20. Brock I, Ruhwald M, Lundgren B, Westh H, Mathiesen LR, Ravn P. Latent tuberculosis in HIV positive, diagnosed by the M. tuberculosis specific interferon-gamma test. Respir Res. 2006;7:56.

    PubMed  Article  Google Scholar 

  21. Shovman O, Anouk M, Vinnitsky U, Arad U, Paran D, Litinsky I, et al. QuantiFERON-TB Gold in the identification of latent tuberculosis infection in rheumatoid arthritis: a pilot study. Int J Tuberc Lung Dis. 2009;13:1427–32.

    PubMed  CAS  Google Scholar 

  22. Smolen JS, Aletaha D, Bijlsma JWJ, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631–7.

    PubMed  Article  Google Scholar 

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Correspondence to Shogo Banno.

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Maeda, T., Banno, S., Maeda, S. et al. Comparison of QuantiFERON-TB Gold and the tuberculin skin test for detecting previous tuberculosis infection evaluated by chest CT findings in Japanese rheumatoid arthritis patients. J Infect Chemother 17, 842–848 (2011). https://doi.org/10.1007/s10156-011-0250-1

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  • DOI: https://doi.org/10.1007/s10156-011-0250-1

Keywords

  • Tuberculosis
  • Interferon gamma
  • QuantiFERON
  • Tuberculin skin test
  • Rheumatoid arthritis