Format

Send to

Choose Destination
Pediatr Infect Dis J. 2018 Dec;37(12):1235-1241. doi: 10.1097/INF.0000000000002015.

Performance of Tuberculin Skin Tests and Interferon-γ Release Assays in Children Younger Than 5 Years.

Author information

1
From the Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.
2
Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.
3
Institut Català de la Salut, Unitat de Tuberculosi Hospital Universitari Vall d'Hebrón-Drassanes, Barcelona, Spain.
4
Institut d'Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, Barcelona, Spain.
5
CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
6
Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain.
7
Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain.
8
Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine & Global Health Research Institute, University of Southampton, Southampton, United Kingdom.
9
Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
10
Great Ormond Street Hospital Institute of Child Health, University College London, London, United Kingdom.
11
Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.

Abstract

BACKGROUND:

Available data to assess the optimal diagnostic approach in infants and preschool children at risk of tuberculosis (TB) are limited.

METHODS:

We conducted a prospective observational study in children younger than 5 years undergoing assessment with both tuberculin skin tests (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) assays at 2 tertiary TB units in Barcelona, Spain.

RESULTS:

A total of 383 children were included. One of 304 participants considered uninfected developed active TB during follow-up {median [interquartile range (IQR)]: 47 [30; 48] months}, compared with none of 40 participants with latent TB infection [follow-up since completion of anti-TB treatment: 42 (32; 45) months]. Overall test agreement between TST and QFT-GIT was moderate (κ = 0.551), but very good in children screened after TB contact (κ = 0.801) and in Bacillus Calmette-Guérin (BCG)-unvaccinated children (κ = 0.816). Discordant results (16.8%, all TST+/QFT-GIT-) were mainly observed in new-entrant screening and in BCG-vaccinated children. Children with indeterminate QFT-GIT results were on average younger than those with determinate results (median age: 12 vs. 30 months; P < 0.001). The sensitivity of TSTs and QFT-GIT assays in children with confirmed active TB was 100% (95% confidence interval: 79.4%-100%) and 93.7% (95% confidence interval: 69.8%-99.8%), respectively. In patients with latent TB infection or active TB, there was no correlation between age and antigen-stimulated interferon-γ responses (r = -0.044; P = 0.714).

CONCLUSIONS:

In young BCG-unvaccinated children with recent TB contact, a dual testing strategy using TST and QFT-GIT in parallel may not be necessary. However, TST+/QFT-GIT- discordance is common, and it remains uncertain if this constellation indicates TB infection or not. In active TB, QFT-GIT assays do not perform better than TSTs.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center