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PLoS One. 2014 Mar 21;9(3):e92308. doi: 10.1371/journal.pone.0092308. eCollection 2014.

Pregnancy differentially impacts performance of latent tuberculosis diagnostics in a high-burden setting.

Author information

1
Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America.
2
Department of Obstetrics and Gynaecology, Byramjee Jeejeebhoy Government Medical College- Sassoon General Hospital, Pune, Maharashtra, India.
3
Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India.
4
Byramjee Jeejeebhoy Government Medical College- Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
5
Department of Microbiology, Byramjee Jeejeebhoy Government Medical College- Sassoon General Hospital, Pune, Maharashtra, India.

Abstract

BACKGROUND:

Targeted screening for latent TB infection (LTBI) in vulnerable populations is a recommended TB control strategy. Pregnant women are at high risk for developing TB and likely to access healthcare, making pregnancy an important screening opportunity in developing countries. The sensitivity of the widely-used tuberculin skin test (TST), however, may be reduced during pregnancy.

METHODS:

We performed a cross-sectional study comparing the TST with the QuantiFERON Gold In-tube (QGIT) in 401 HIV-negative women presenting antepartum (n = 154), at delivery (n = 148), or postpartum (n = 99) to a government hospital in Pune, India. A subset of 60 women enrolled during pregnancy was followed longitudinally and received both tests at all three stages of pregnancy.

RESULTS:

The QGIT returned significantly more positive results than the TST. Of the 401 women in the cross-sectional study, 150 (37%) had a positive QGIT, compared to 59 (14%) for the TST (p<0.005). Forty-nine (12%) did not have their TST read. Of 356 who had both results available, 46 (13%) were concordant positive, 91 (25%) were discordant (12 (3%) TST+/QGIT-; 79 (22%) TST-/QGIT+), and 206 (57%) concordant negative. Comparison by stage of pregnancy revealed that QGIT percent positivity remained stable between antepartum and delivery, unlike TST results (QGIT 31-32% vs TST 11-17%). Median IFN-γ concentration was lower at delivery than in antepartum or postpartum (1.66 vs 2.65 vs 8.99 IU/mL, p = 0.001). During postpartum, both tests had significantly increased positives (QGIT 31% vs 32% vs 52%, p = 0.01; TST 17% vs 11% vs 25%, p<0.005). The same trends were observed in the longitudinal subset.

CONCLUSIONS:

Timing and choice of LTBI test during pregnancy impact results. QGIT was more stable and more closely approximated the LTBI prevalence in India. But pregnancy stage clearly affects both tests, raising important questions about how the complex immune changes brought on by pregnancy may impact LTBI screening.

PMID:
24658103
PMCID:
PMC3962385
DOI:
10.1371/journal.pone.0092308
[Indexed for MEDLINE]
Free PMC Article

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