Discordance in latent tuberculosis (TB) test results in patients with end-stage renal disease

Autor: Saranya Sridhar, Jo Southern, Ibrahim Abubakar, Vladyslav Nikolayevskyy, Sophie Collier, Ajit Lalvani, Marc Lipman, S Lozewicz, CY Tsou, Susan Hopkins
Rok vydání: 2019
Předmět:
Male
medicine.medical_treatment
Interferon gamma release assay
HEMODIALYSIS-PATIENTS
0302 clinical medicine
Mass Screening
030212 general & internal medicine
Public
Environmental & Occupational Health
Aged
80 and over
IGRA
Tuberculin skin test
biology
Latent tuberculosis
030503 health policy & services
TST
General Medicine
GAMMA RELEASE ASSAYS
Middle Aged
1117 Public Health And Health Services
Female
Public Health
medicine.symptom
0305 other medical science
Life Sciences & Biomedicine
Adult
medicine.medical_specialty
Tuberculosis
SKIN-TEST
Interferon-gamma release assay
Tuberculin
End stage renal disease
Renal disease
Mycobacterium tuberculosis
Young Adult
03 medical and health sciences
Latent Tuberculosis
Renal Dialysis
Internal medicine
medicine
Humans
ESRD
Dialysis
Aged
Immunosuppression Therapy
Science & Technology
Tuberculin Test
business.industry
Public Health
Environmental and Occupational Health
Reproducibility of Results
medicine.disease
biology.organism_classification
Kidney Failure
Chronic
Sputum
ANERGY
business
Interferon-gamma Release Tests
Follow-Up Studies
Zdroj: Public Health. 166:34-39
ISSN: 0033-3506
DOI: 10.1016/j.puhe.2018.09.023
Popis: Objectives This natural experiment was designed to assess the impact of exposure to an active case of tuberculosis (TB) on a group of immunosuppressed individuals, with end-stage renal disease over an extended follow-up. Study design Close contacts of people with sputum smear–positive Mycobacterium tuberculosis are at high risk of infection, particularly immunosuppressed individuals. An infectious TB healthcare worker worked in a renal dialysis unit for a month before diagnosis, with 104 renal dialysis patients, was exposed for ≥8 h. Methods Patients were informed and invited for screening 8–10 weeks postexposure. They either underwent standard two-step assessment with tuberculin skin test (TST) and QuantiFERON®-TB Gold (Cellestis GmbH; QFN) interferon-gamma release assay (IGRA) or after consent, enrolled in a study where these two tests were performed simultaneously with T-SPOT®-TB (Oxford Immunotec Ltd; TSPOT). Patients within the study were followed up for 2 years from exposure, with QFN and TSPOT repeated at months 3 and 6 from the first testing. Results Of 104 exposed individuals, 75 enrolled in the study. There was a high degree of discordance among QFN, TSPOT and TST. This was seen at both the first time point and also over time in subjects who were retested. No patients had active TB at the baseline testing. None received treatment for latent TB infection. Over the following 2 years, no one developed TB disease. Conclusion This study suggests that there is a low risk of progression to active TB in low-incidence countries even in high-risk groups. This plus the degree of the test result discordance emphasises the complexities of managing TB in such settings as it is unclear which of these tests, if any, provides the best diagnostic accuracy.
Databáze: OpenAIRE
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