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Int J Infect Dis. 2019 Mar;80S:S20-S22. doi: 10.1016/j.ijid.2019.01.048. Epub 2019 Feb 6.

Tuberculin skin test - Outdated or still useful for Latent TB infection screening?

Author information

1
National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: gina.gualano@inmi.it.
2
National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: paola.mencarini@inmi.it.
3
National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: francesco.lauria@inmi.it.
4
National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: fabrizio.palmieri@inmi.it.
5
National Institute for Medical Research Muhimbili, Dar es Salaam, Tanzania; Liverpool School of Tropical Medicine, Liverpool, UK. Electronic address: gsmfinanga@yahoo.com.
6
UNZA-UCLMS Project, and Lusaka Apex University Medical School, Lusaka, Zambia. Electronic address: pbmwaba2000@gmail.com.
7
International Union Against TB and Lung Diseases, Paris, France; Department of Medicine, Kenyatta University, Nairobi, Kenya. Electronic address: chakaya.jm@gmail.com.
8
Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, & NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: a.i.zumla@ucl.ac.uk.
9
National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy. Electronic address: giuseppe.ippolito@inmi.it.

Abstract

OBJECTIVE:

To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB Infection (LTBI) in different geographical settings.

METHODS:

We reviewed the current literature on TST compared to IGRA, including national implementation of WHO LTBI recommendations and retrospective data over the past 7 years at the National Institute for Infectious Diseases "L. Spallanzani" as indirect indicator of usage of both tests under actual programmatic conditions.

RESULTS:

Current national guidelines vary considerably, reflecting the uncertainty and rapidly evolving evidence about the potential use of these tests. Data from Institute "L. Spallanzani" showed IGRA concordance in TST positive subjects only in 54.74% of subjects, while there was strong concordance between two tests in TST negative subjects (93.78%).

CONCLUSION:

Neither IGRAs nor TST can distinguish active TB from LTBI. TST will continue to be clinically useful in low and high TB endemic areas until more accurate and predictive tests will become available. Clinical judgment remains fundamental in choosing between IGRA/TST tests and interpreting their results.

KEYWORDS:

IGRA; Interferon-γ release assays; LTBI; Latent TB; Quantiferon; TB; TST; Tuberculin skin test; Tuberculosis

PMID:
30738186
DOI:
10.1016/j.ijid.2019.01.048
[Indexed for MEDLINE]
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