Abstract
Background
Interferon-gamma release assays (IGRAs) have high specificity and sensitivity for the diagnosis of tuberculosis (TB) infection. However, their role as a screening tool in children with immunodeficiency disorders is still unclear. In the present study, we performed a contact investigation using serial IGRAs on children with immunodeficiency conditions exposed to a contagious TB patient.
Methods
Children who were exposed to a contagious TB case underwent serial QuantiFERON® TB Gold In-Tube (QFT-GIT) and T-SPOT®.TB (T-SPOT) testing.
Results
Eighteen children were tested. At the first testing, only two children (11 %) were positive to T-SPOT. Indeterminate results were more frequent with QFT-GIT (35 %) than with T-SPOT (12 %). In the multivariable analysis, a statistically significant association of lymphocyte count <500 cells/mm3 (p < 0.00005) and low age (p = 0.03) with indeterminate results for the QFT-GIT test but not for T-SPOT (p = 0.10 and p = 0.88, respectively) was found. At the end of October 2012, 15 of the 18 children were alive and none developed active TB disease.
Conclusion
T-SPOT provided more determinate results and was less influenced by low age and lymphocytopenia than QFT-GIT in this population of immunodeficient children. These findings suggest that T-SPOT is a more accurate test for the identification of TB infection in young children with lymphocytopenia and should be preferred to QFT-GIT under such specific conditions.
This is a preview of subscription content, log in via an institution to check access.
References
Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med. 2009;68:2240–6.
Ferrara G, Murray M, Winthrop K, et al. Risk factors associated with pulmonary tuberculosis: smoking, diabetes and anti-TNFα drugs. Curr Opin Pulm Med. 2012;18:233–40.
Zumla A, Raviglione M, Hafner R, von Reyn CF. Tuberculosis. N Engl J Med. 2013;68:745–55.
National Institute for Health and Clinical Excellence (NICE). Tuberculosis. Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. 2011. http://www.nice.org.uk/nicemedia/live/13422/53642/53642.pdf. Accessed 5 March 2013.
Haustein T, Ridout DA, Hartley JC, et al. The likelihood of an indeterminate test result from a whole-blood interferon-gamma release assay for the diagnosis of Mycobacterium tuberculosis infection in children correlates with age and immune status. Pediatr Infect Dis J. 2009;28:669–73.
Bergamini BM, Losi M, Vaienti F, et al. Performance of commercial blood tests for the diagnosis of latent tuberculosis infection in children and adolescents. Pediatrics. 2009;123:e419–24.
Bruzzese E, Bocchino M, Assante LR, et al. Gamma interferon release assays for diagnosis of tuberculosis infection in immune-compromised children in a country in which the prevalence of tuberculosis is low. J Clin Microbiol. 2009;47:2355–7.
Stefan DC, Dippenaar A, Detjen AK, et al. Interferon-gamma release assays for the detection of Mycobacterium tuberculosis infection in children with cancer. Int J Tuberc Lung Dis. 2010;14:689–94.
Banfield S, Pascoe E, Thambiran A, Siafarikas A, Burgner D. Factors associated with the performance of a blood-based interferon-γ release assay in diagnosing tuberculosis. PLoS One. 2012;7:e38556.
Venables WN, Ripley BD. Modern applied statistics with S. 4th ed. New York: Springer; 2002.
Lewinsohn DA, Gennaro ML, Scholvinck L, Lewinsohn DM. Tuberculosis immunology in children: diagnostic and therapeutic challenges and opportunities. Int J Tuberc Lung Dis. 2004;8:658–74.
Taylor S, Bryson YJ. Impaired production of gamma-interferon by newborn cells in vitro is due to a functionally immature macrophage. J Immunol. 1985;134:1493–7.
Wilson CB, Westall J, Johnston L, Lewis DB, Dower SK, Alpert AR. Decreased production of interferon-gamma by human neonatal cells. Intrinsic and regulatory deficiencies. J Clin Invest. 1986;77:860–7.
Ferrara G, Losi M, D’Amico R, et al. Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study. Lancet. 2006;367:1328–34.
Herrmann JL, Belloy M, Porcher R, et al. Temporal dynamics of interferon gamma responses in children evaluated for tuberculosis. PLoS One. 2009;4:e4130.
Pai M, Joshi R, Dogra S, et al. T-cell assay conversions and reversions among household contacts of tuberculosis patients in rural India. Int J Tuberc Lung Dis. 2009;13:84–92.
Lee SW, Lee SH, Yim JJ. Serial interferon-gamma release assays after chemoprophylaxis in a tuberculosis outbreak cohort. Infection. 2012;40:431–5.
Connell TG, Davies MA, Johannisen C, et al. Reversion and conversion of Mycobacterium tuberculosis IFN-gamma ELISpot results during anti-tuberculous treatment in HIV-infected children. BMC Infect Dis. 2010;10:138.
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Carvalho, A.C.C., Schumacher, R.F., Bigoni, S. et al. Contact investigation based on serial interferon-gamma release assays (IGRA) in children from the hematology-oncology ward after exposure to a patient with pulmonary tuberculosis . Infection 41, 827–831 (2013). https://doi.org/10.1007/s15010-013-0450-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-013-0450-y