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Pediatr Infect Dis J. 2014 Sep;33(9):e226-31. doi: 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: a multicenter study of the Italian Society of Pediatric Infectious Diseases.

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From the *Department of Pediatrics, University of Turin, AOU Città della Salute e della Scienza, Regina Margherita Children's Hospital, Turin; †Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence; ‡Department of Pediatrics, University of Modena and Reggio Emilia, Modena; §Department of Pediatrics, University of Bologna, S. Orsola-Malpighi General Hospital, Bologna; ¶Unit of Microbiology, Department DIMES, University of Bologna, S. Orsola-Malpighi General Hospital, Bologna; ‖Pietro Barilla Children's Hospital, Parma; **Pediatrics and Infectious Diseases, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome; and ††Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.



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.


We performed a multicenter, retrospective study in children 0-24 months of age who were tested at least once with QuantiFERON-TB Gold-in-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice.


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.


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 QTF-IT 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.

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