Open Access Research article

Value of the tuberculin skin testing and of an interferon-gamma release assay in haemodialysis patients after exposure to M. tuberculosis

Luis Anibarro1*, Matilde Trigo2, Diana Feijoó3, Mónica Ríos4, Luisa Palomares3, Alberto Pena1, Marta Núñez4, Carlos Villaverde5 and África González-Fernández6

Author Affiliations

1 Unidade de tuberculose, Servizo de Medicina Interna, Complexo hospitalario de Pontevedra (CHOP). SERGAS, Mourente s/n, Pontevedra 36071, Spain

2 Servizo de Microbioloxía, Complexo hospitalario de Pontevedra (CHOP). SERGAS, Mourente s/n, Pontevedra 36071, Spain

3 Servizo de Nefroloxía, Complexo hospitalario de Pontevedra (CHOP). SERGAS, Mourente s/n, Pontevedra 36071, Spain

4 Servizo de Neumoloxía, Complexo hospitalario de Pontevedra (CHOP). SERGAS, Mourente s/n, Pontevedra 36071, Spain

5 Unidade de estatística. Universidade de Vigo, Campus de Lagoas, Marcosende, Vigo, Pontevedra 36310, Spain

6 Área de Inmunoloxia, Centro de Investigaciones Biomédicas (CINBIO), Universidade de Vigo, Campus Lagoas Marcosende, Vigo, Pontevedra 36310, Spain

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BMC Infectious Diseases 2012, 12:195  doi:10.1186/1471-2334-12-195

Published: 20 August 2012

Abstract

Background

Patients with end-stage renal disease (ESRD) and Mycobacterium tuberculosis infection pose a high risk of developing active TB disease. It is therefore important to detect latent TB infection (LTBI) to be able to offer treatment and prevent progression to TB disease. We assessed the value of the tuberculin skin test (TST) and of an interferon-gamma release assay (Quantiferon®-TB Gold in-Tube, QFT) for diagnosing LTBI in ESRD patients, after prolonged exposure to a highly contagious TB case in a haemodialysis unit. As a high number of patients presented erythema without induration in the TST response, this type of reaction was also analysed.

Method

The TST and QFT were simultaneously performed twelve weeks after the last possible exposure to a bacilliferous TB patient. If the first TST (TST-1) was negative, a second TST (TST-2) was performed 15 days later to detect a booster response. A comparison was made between the TST responses (including those cases with erythema without induration) and those for the QFT. The correlation with risk of infection and the concordance between tests were both analysed.

Results

A total of 52 patients fulfilled the inclusion criteria. Overall, 11 patients (21.2%) had a positive TST response: 3 for TST-1 and 8 for TST-2, and 18 patients (34.6%) showed a positive QFT response (p = 0.065). Erythema without induration was found in 3 patients at TST-1 and in a further 9 patients at TST-2. The three patients with erythema without induration in TST-1 had a positive TST-2 response. Concordance between TST and QFT was weak for TST-1 (κ = 0.21); it was moderate for overall TST (κ = 0.49); and it was strong if both induration and erythema (κ = 0.67) were considered.

Conclusions

In patients with ESRD, erythema without induration in the TST response could potentially be an indicator of M. tuberculosis infection. The QFT shows better accuracy for LTBI diagnosis than the TST.