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Open Access Highly Accessed Research article

Agreement between QuantiFERON®-TB Gold In-Tube and the tuberculin skin test and predictors of positive test results in Warao Amerindian pediatric tuberculosis contacts

Lilly M Verhagen12*, Mailis Maes13, Julian A Villalba14, Adriana d’Alessandro1, Lazaro Perez Rodriguez5, Mercedes F España6, Peter WM Hermans2 and Jacobus H de Waard1

Author Affiliations

1 Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela

2 Department of Pediatrics, Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands

3 Department of Medicine, University of Cambridge, Cambridge, UK

4 Lovelace Respiratory Research Institute, Albuquerque, USA

5 ASIC Elena Cotua Municipio Antonio Díaz Misión Medica Cubana Delta Amacuro Venezuela, Tucupita, Venezuela

6 Programa Nacional Integrado de Control de la Tuberculosis, Ministerio de Salud, Caracas, Venezuela

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BMC Infectious Diseases 2014, 14:383  doi:10.1186/1471-2334-14-383

Published: 11 July 2014

Abstract

Background

Interferon-gamma release assays have emerged as a more specific alternative to the tuberculin skin test (TST) for detection of tuberculosis (TB) infection, especially in Bacille Calmette-Guérin (BCG) vaccinated people. We determined the prevalence of Mycobacterium tuberculosis infection by TST and QuantiFERON®-TB Gold In-Tube (QFT-GIT) and assessed agreement between the two test methods and factors associated with positivity in either test in Warao Amerindian children in Venezuela. Furthermore, progression to active TB disease was evaluated for up to 12 months.

Methods

163 HIV-negative childhood household contacts under 16 years of age were enrolled for TST, QFT-GIT and chest X-ray (CXR). Follow-up was performed at six and 12 months. Factors associated with TST and QFT-GIT positivity were studied using generalized estimation equations logistic regression models.

Results

At baseline, the proportion of TST positive children was similar to the proportion of children with a positive QFT-GIT (47% vs. 42%, p = 0.12). Overall concordance between QFT-GIT and TST was substantial (kappa 0.76, 95% CI 0.46-1.06). Previous BCG vaccination was not associated with significantly increased positivity in either test (OR 0.68, 95% CI 0.32-1.5 for TST and OR 0.51, 95% CI 0.14-1.9 for QFT-GIT). Eleven children were diagnosed with active TB at baseline. QFT-GIT had a higher sensitivity for active TB (88%, 95% CI 47-98%) than TST (55%, 95% CI 24-83%) while specificities were similar (respectively 58% and 55%). Five initially asymptomatic childhood contacts progressed to active TB disease during follow-up.

Conclusion

Replacement of TST by the QFT-GIT for detection of M. tuberculosis infection is not recommended in this resource-constrained setting as test results showed substantial concordance and TST positivity was not affected by previous BCG vaccination. The QFT-GIT had a higher sensitivity than the TST for the detection of TB disease. However, the value of the QFT-GIT as an adjunct in diagnosing TB disease is limited by a high variability in QFT-GIT results over time.

Keywords:
Tuberculosis; Indigenous children; Diagnostics; Child tuberculosis contacts