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Influencial factors of the performance of interferon-γ release assays in the diagnosis of childhood tuberculosis.

Li T, Bao L, Diao N, Sun F, Gao Y, Wong KW, Xi X, Liu X, Wang S, Wu J, Hui M, Fan X, Zhang Y, Zhang W, Lu S - Clin. Exp. Med. (2014)

Bottom Line: There was no significant difference of the positive rate of both tests in children <5 years old compared with those ≥5 years old.Glucocorticoids had a significant negative influence on IGRAs if treated for >1 week.Age made no difference on the performance of these tests in children.

View Article: PubMed Central - PubMed

Affiliation: Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.

ABSTRACT
Diagnosis of active tuberculosis (TB) in children remains difficult. This study aimed at evaluating the ability of interferon-gamma release assays (IGRAs) in the detection of active TB in human immunodeficiency virus-negative children vaccinated with Bacille Calmette-Guérin and investigating the effect of prednisolone treatment on the IGRAs performance. Among the 162 children with suspected TB disease recruited in China, 60 were tested with QuantiFERON-TB Gold In Tube (QFT-GIT) and 102 were tested with T-SPOT.TB. QFT-GIT presented a sensitivity of 83.9 % (95 % CI 66.9-93.4 %) and a specificity of 88.5 % (95 % CI 70.2-96.8 %), while T-SPOT.TB had a sensitivity of 75.9 % (95 % CI 63.4-85.2 %) and a specificity of 94.7 % (95 % CI 81.8-99.5 %). The positive predictive value was high in both assays, 92.9 % for QFT-GIT and 95.7 % for T-SPOT.TB. In total of these two kinds of IGRAs, false negative rate was significantly higher in children receiving systemic prednisolone (1 mg/kg/day) therapy for >1 week (two tested with T-SPOT.TB and five tested with QFT-GIT) than in those with ≤1 week of prednisolone therapy and without prednisolone therapy (57.1 vs. 18.3 %, p = 0.035). There was no significant difference of the positive rate of both tests in children <5 years old compared with those ≥5 years old. Both types of IGRAs showed good diagnostic values in detecting childhood TB before microbiological evidence was available. Glucocorticoids had a significant negative influence on IGRAs if treated for >1 week. Age made no difference on the performance of these tests in children.

No MeSH data available.


Related in: MedlinePlus

Recruitment and diagnostic classification of all participants
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Related In: Results  -  Collection


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Fig1: Recruitment and diagnostic classification of all participants

Mentions: Of the 167 children enrolled in this study, five were excluded due to unsuccessful blood collection, 102 were tested with T-SPOT.TB and 60 with QFT-GIT. None of these children had been tested both with QFT-GIT and T-SPOT.TB. Among the 102 children tested with T-SPOT.TB, 27 were diagnosed with confirmed tuberculosis, 31 with highly probable tuberculosis, and 38 without tuberculosis. Among the 60 children with QFT-GIT test, 23 were classified as confirmed tuberculosis, eight with highly probable tuberculosis, and 26 without tuberculosis. Nine cases (six tested with T-SPOT.TB and three tested with QFT-GIT) were unable to get a definite diagnosis and were excluded from data analysis (Fig. 1). For children diagnosed with highly probable TB, hila or mediastinal lymphadenopathy was the most common symptoms. All children with confirmed and highly probable TB received anti-tuberculosis treatment. One child with confirmed TB was lost for follow-up. The remaining 88 children with confirmed TB or highly probable TB showed sustained clinical improvement after initiation of anti-tuberculosis therapy. All the 64 children who were not TB had no active tuberculosis during 12-month follow-up. Clinical samples for microbiological identification included gastric aspirates, induced sputum samples, bronchoscopy lavage fluid, samples from lymph node aspiration, samples from percutaneous biopsy of pulmonary under CT guidance, pericardial stripping organization, pleural fluid samples, ascites, bone marrow and cerebrospinal fluid (CSF). The main characteristics are listed in Table 2.Fig. 1


Influencial factors of the performance of interferon-γ release assays in the diagnosis of childhood tuberculosis.

Li T, Bao L, Diao N, Sun F, Gao Y, Wong KW, Xi X, Liu X, Wang S, Wu J, Hui M, Fan X, Zhang Y, Zhang W, Lu S - Clin. Exp. Med. (2014)

Recruitment and diagnostic classification of all participants
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4522271&req=5

Fig1: Recruitment and diagnostic classification of all participants
Mentions: Of the 167 children enrolled in this study, five were excluded due to unsuccessful blood collection, 102 were tested with T-SPOT.TB and 60 with QFT-GIT. None of these children had been tested both with QFT-GIT and T-SPOT.TB. Among the 102 children tested with T-SPOT.TB, 27 were diagnosed with confirmed tuberculosis, 31 with highly probable tuberculosis, and 38 without tuberculosis. Among the 60 children with QFT-GIT test, 23 were classified as confirmed tuberculosis, eight with highly probable tuberculosis, and 26 without tuberculosis. Nine cases (six tested with T-SPOT.TB and three tested with QFT-GIT) were unable to get a definite diagnosis and were excluded from data analysis (Fig. 1). For children diagnosed with highly probable TB, hila or mediastinal lymphadenopathy was the most common symptoms. All children with confirmed and highly probable TB received anti-tuberculosis treatment. One child with confirmed TB was lost for follow-up. The remaining 88 children with confirmed TB or highly probable TB showed sustained clinical improvement after initiation of anti-tuberculosis therapy. All the 64 children who were not TB had no active tuberculosis during 12-month follow-up. Clinical samples for microbiological identification included gastric aspirates, induced sputum samples, bronchoscopy lavage fluid, samples from lymph node aspiration, samples from percutaneous biopsy of pulmonary under CT guidance, pericardial stripping organization, pleural fluid samples, ascites, bone marrow and cerebrospinal fluid (CSF). The main characteristics are listed in Table 2.Fig. 1

Bottom Line: There was no significant difference of the positive rate of both tests in children <5 years old compared with those ≥5 years old.Glucocorticoids had a significant negative influence on IGRAs if treated for >1 week.Age made no difference on the performance of these tests in children.

View Article: PubMed Central - PubMed

Affiliation: Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.

ABSTRACT
Diagnosis of active tuberculosis (TB) in children remains difficult. This study aimed at evaluating the ability of interferon-gamma release assays (IGRAs) in the detection of active TB in human immunodeficiency virus-negative children vaccinated with Bacille Calmette-Guérin and investigating the effect of prednisolone treatment on the IGRAs performance. Among the 162 children with suspected TB disease recruited in China, 60 were tested with QuantiFERON-TB Gold In Tube (QFT-GIT) and 102 were tested with T-SPOT.TB. QFT-GIT presented a sensitivity of 83.9 % (95 % CI 66.9-93.4 %) and a specificity of 88.5 % (95 % CI 70.2-96.8 %), while T-SPOT.TB had a sensitivity of 75.9 % (95 % CI 63.4-85.2 %) and a specificity of 94.7 % (95 % CI 81.8-99.5 %). The positive predictive value was high in both assays, 92.9 % for QFT-GIT and 95.7 % for T-SPOT.TB. In total of these two kinds of IGRAs, false negative rate was significantly higher in children receiving systemic prednisolone (1 mg/kg/day) therapy for >1 week (two tested with T-SPOT.TB and five tested with QFT-GIT) than in those with ≤1 week of prednisolone therapy and without prednisolone therapy (57.1 vs. 18.3 %, p = 0.035). There was no significant difference of the positive rate of both tests in children <5 years old compared with those ≥5 years old. Both types of IGRAs showed good diagnostic values in detecting childhood TB before microbiological evidence was available. Glucocorticoids had a significant negative influence on IGRAs if treated for >1 week. Age made no difference on the performance of these tests in children.

No MeSH data available.


Related in: MedlinePlus