Background: The diagnosis of latent or active tuberculosis in children is often challenging. Recently, interferon-γ release assays have been licensed, but their diagnostic accuracy in young children remains questionable as frequent false-negative or indeterminate results have been reported. Methods: We performed a multicenter, retrospective study in children aged 0–24 months who were tested at least once with QuantiFERON-TB Goldin-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice. Results: Eight-hundred and twenty-three children (449 males, median age 13.5 months) were enrolled. QTF-IT sensitivity and specificity for active tuberculosis were 92.4% and 98.6%, respectively. Indeterminate tests (4.2 %) were not related to age (P = 0.838) or gender (P = 0.223); 32 children (91.4 %) with an indeterminate QTF-IT ultimately resulted uninfected. In the 616 subjects with valid paired results of QTF-IT and TST, sensitivity and specificity were comparable (91.1% vs. 85.1% and 98.1% vs. 97.9%, respectively). Diagnostic concordance between tests was higher in Bacillus Calmétte-Guerin nonvaccinated children (κ = 0.802). A high rate of discordant tests was observed in latent infections. Conclusions: QTF-IT showed good sensitivity and specificity, and a low rate of indeterminate results in the first 2 years of life, supporting its use at this age. However, considering costs and the similar performance between QTFIT and TST, it is reasonable to suggest the latter as first-line testing in young children. The complementary use of TST and interferon-γ release assays may be considered in selected cases to improve the accuracy of testing.

Performance of interferon-γ Release Assay for the Diagnosis of Active or Latent Tuberculosis in Children in the First 2 Years of Age / Silvia, Garazzino; Luisa, Galli; Elena, Chiappini; Michele, Pinon; Bergamini, Barbara Maria; Salvatore, Cazzato; Paola Dal, Monte; Icilio, Dodi; Laura, Lancella; Susanna, Esposito; Iughetti, Lorenzo; Carlotta, Montagnani; Maurizio De, Martino; Pier Angelo, Tovo. - In: THE PEDIATRIC INFECTIOUS DISEASE JOURNAL. - ISSN 0891-3668. - ELETTRONICO. - 33:(2014), pp. 226-231. [10.1097/INF.0000000000000353]

Performance of interferon-γ Release Assay for the Diagnosis of Active or Latent Tuberculosis in Children in the First 2 Years of Age

BERGAMINI, Barbara Maria;IUGHETTI, Lorenzo;
2014

Abstract

Background: The diagnosis of latent or active tuberculosis in children is often challenging. Recently, interferon-γ release assays have been licensed, but their diagnostic accuracy in young children remains questionable as frequent false-negative or indeterminate results have been reported. Methods: We performed a multicenter, retrospective study in children aged 0–24 months who were tested at least once with QuantiFERON-TB Goldin-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice. Results: Eight-hundred and twenty-three children (449 males, median age 13.5 months) were enrolled. QTF-IT sensitivity and specificity for active tuberculosis were 92.4% and 98.6%, respectively. Indeterminate tests (4.2 %) were not related to age (P = 0.838) or gender (P = 0.223); 32 children (91.4 %) with an indeterminate QTF-IT ultimately resulted uninfected. In the 616 subjects with valid paired results of QTF-IT and TST, sensitivity and specificity were comparable (91.1% vs. 85.1% and 98.1% vs. 97.9%, respectively). Diagnostic concordance between tests was higher in Bacillus Calmétte-Guerin nonvaccinated children (κ = 0.802). A high rate of discordant tests was observed in latent infections. Conclusions: QTF-IT showed good sensitivity and specificity, and a low rate of indeterminate results in the first 2 years of life, supporting its use at this age. However, considering costs and the similar performance between QTFIT and TST, it is reasonable to suggest the latter as first-line testing in young children. The complementary use of TST and interferon-γ release assays may be considered in selected cases to improve the accuracy of testing.
33
226
231
Performance of interferon-γ Release Assay for the Diagnosis of Active or Latent Tuberculosis in Children in the First 2 Years of Age / Silvia, Garazzino; Luisa, Galli; Elena, Chiappini; Michele, Pinon; Bergamini, Barbara Maria; Salvatore, Cazzato; Paola Dal, Monte; Icilio, Dodi; Laura, Lancella; Susanna, Esposito; Iughetti, Lorenzo; Carlotta, Montagnani; Maurizio De, Martino; Pier Angelo, Tovo. - In: THE PEDIATRIC INFECTIOUS DISEASE JOURNAL. - ISSN 0891-3668. - ELETTRONICO. - 33:(2014), pp. 226-231. [10.1097/INF.0000000000000353]
Silvia, Garazzino; Luisa, Galli; Elena, Chiappini; Michele, Pinon; Bergamini, Barbara Maria; Salvatore, Cazzato; Paola Dal, Monte; Icilio, Dodi; Laura, Lancella; Susanna, Esposito; Iughetti, Lorenzo; Carlotta, Montagnani; Maurizio De, Martino; Pier Angelo, Tovo
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/1035714
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