Comparison of Interferon-γ Release Assay to Two Cut-off Points of Tuberculin Skin Test to Detect Latent Mycobacterium Tuberculosis Infection in Primary Health Care Workers

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2014 Aug 20

PMID 25137040

Citations 12

Authors

Fernanda Mattos de Souza

Thiago Nascimento do Prado

Jair Dos Santos Pinheiro

Renata Lyrio Peres

Thamy Carvalho Lacerda

Rafaela Borge Loureiro

Jose Americo Carvalho

Geisa Fregona

Elias Santos Dias

Lorrayne Beliqui Cosme

Rodrigo Ribeiro Rodrigues

Lee Wood Riley

Ethel Leonor Noia Maciel

Affiliations

Soon will be listed here.

Abstract

Background: An interferon-γ release assay, QuantiFERON-TB (QFT) test, has been introduced an alternative test for the diagnosis of latent Mycobacterium tuberculosis infection (LTBI). Here, we compared the performance of QFT with tuberculin skin test (TST) measured at two different cut-off points among primary health care work (HCW) in Brazil.

Methods: A cross-sectional study was carried out among HCWs in four Brazilian cities with a known history of high incidence of TB. Results of the QFT were compared to TST results based on both ≥5 mm and ≥10 mm as cut-off points.

Results: We enrolled 632 HCWs. When the cut-off value of ≥10 mm was used, agreement between QFT and TST was 69% (k = 0.31), and when the cut-off of ≥5 mm was chosen, the agreement was 57% (k = 0.22). We investigated possible factors of discordance of TST vs QFT. Compared to the TST-/QFT- group, risk factors for discordance in the TST+/QFT- group with TST cut-off of ≥5 mm included age between 41-45 years [OR = 2.70; CI 95%: 1.32-5.51] and 46-64 years [OR = 2.04; CI 95%: 1.05-3.93], BCG scar [OR = 2.72; CI 95%: 1.40-5.25], and having worked only in primary health care [OR = 2.30; CI 95%: 1.09-4.86]. On the other hand, for the cut-off of ≥10 mm, BCG scar [OR = 2.26; CI 95%: 1.03-4.91], being a household contact of a TB patient [OR = 1.72; CI 95%: 1.01-2.92] and having had a previous TST [OR = 1.66; CI 95%: 1.05-2.62], were significantly associated with the TST+/QFT- group. No statistically significant associations were found among the TST-/QFT+ discordant group with either TST cut-off value.

Conclusions: Although we identified BCG vaccination to contribute to the discordance at both TST cut-off measures, the current Brazilian recommendation for the initiation of LTBI treatment, based on information gathered from medical history, TST, chest radiograph and physical examination, should not be changed.

Citing Articles

TB antigen-based skin tests and QFT-Plus for Mycobacterium tuberculosis infection diagnosis in Brazilian healthcare workers: a cost-effectiveness analysis.

Souza F, Steffen R, Pinto M, do Prado T, Maciel E, Trajman A Cad Saude Publica. 2025; 41(1):e00178623.

PMID: 40008709 PMC: 11863634. DOI: 10.1590/0102-311XEN178623.

Epidemiology of Latent Tuberculosis in Moroccan Healthcare Workers: Prevalence Patterns and Predisposing Factors.

Boucaid A, Zegmout A, Bhairis M, Amraoui M, Laaraje A, Hassane Kabiri E Cureus. 2025; 16(12):e75740.

PMID: 39816277 PMC: 11732615. DOI: 10.7759/cureus.75740.

Sex differences in tuberculosis infection and disease among people with HIV.

Chaisson L, Durovni B, Umar N, Cohn S, Moulton L, Scully E AIDS. 2024; 39(2):184-192.

PMID: 39453876 PMC: 11717608. DOI: 10.1097/QAD.0000000000004045.

Prevalence of latent tuberculosis infection (LTBI) in healthcare workers in Latin America and the Caribbean: systematic review and meta-analysis.

Meregildo-Rodriguez E, Ortiz-Pizarro M, Asmat-Rubio M, Rojas-Benites M, Vasquez-Tirado G Infez Med. 2024; 32(3):292-311.

PMID: 39282545 PMC: 11392545. DOI: 10.53854/liim-3203-4.

The prevalence and risk factors for tuberculosis among healthcare workers in Yogyakarta, Indonesia.

Main S, Triasih R, Greig J, Hidayat A, Brilliandi I, Khodijah S PLoS One. 2023; 18(5):e0279215.

PMID: 37200338 PMC: 10194884. DOI: 10.1371/journal.pone.0279215.

References

Park J, Lee J, Kim M, Lee C, Yoon H, Lee S . Monthly follow-ups of interferon-γ release assays among health-care workers in contact with patients with TB. Chest. 2012; 142(6):1461-1468. DOI: 10.1378/chest.11-3299. View

Del Corral H, Paris S, Marin N, Marin D, Lopez L, Henao H . IFNgamma response to Mycobacterium tuberculosis, risk of infection and disease in household contacts of tuberculosis patients in Colombia. PLoS One. 2009; 4(12):e8257. PMC: 2788133. DOI: 10.1371/journal.pone.0008257. View

Wang L, Turner M, Elwood R, Schulzer M, Fitzgerald J . A meta-analysis of the effect of Bacille Calmette Guérin vaccination on tuberculin skin test measurements. Thorax. 2002; 57(9):804-9. PMC: 1746436. DOI: 10.1136/thorax.57.9.804. View

Pai M, Gokhale K, Joshi R, Dogra S, Kalantri S, Mendiratta D . Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. JAMA. 2005; 293(22):2746-55. DOI: 10.1001/jama.293.22.2746. View

. American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis. 1990; 142(3):725-35. DOI: 10.1164/ajrccm/142.3.725. View

Weinfurter P, Blumberg H, Goldbaum G, Royce R, Pang J, Tapia J . Predictors of discordant tuberculin skin test and QuantiFERON®-TB Gold In-Tube results in various high-risk groups. Int J Tuberc Lung Dis. 2011; 15(8):1056-61. DOI: 10.5588/ijtld.10.0650. View

Mazurek G, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K . Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep. 2010; 59(RR-5):1-25. View

Trajman A, Steffen R, Menzies D . Interferon-Gamma Release Assays versus Tuberculin Skin Testing for the Diagnosis of Latent Tuberculosis Infection: An Overview of the Evidence. Pulm Med. 2013; 2013:601737. PMC: 3582085. DOI: 10.1155/2013/601737. View

Moreira T, Zandonade E, Maciel E . Risk of tuberculosis infection among community health agents. Rev Saude Publica. 2010; 44(2):332-8. DOI: 10.1590/s0034-89102010000200014. View

10.

Zhao X, Mazlagic D, Flynn E, Hernandez H, Abbott C . Is the QuantiFERON-TB blood assay a good replacement for the tuberculin skin test in tuberculosis screening? a pilot study at Berkshire Medical Center. Am J Clin Pathol. 2009; 132(5):678-86. DOI: 10.1309/AJCPUHC34NBDGKKL. View

11.

Joshi R, Reingold A, Menzies D, Pai M . Tuberculosis among health-care workers in low- and middle-income countries: a systematic review. PLoS Med. 2006; 3(12):e494. PMC: 1716189. DOI: 10.1371/journal.pmed.0030494. View

12.

Ringshausen F, Nienhaus A, Schablon A, Schlosser S, Schultze-Werninghaus G, Rohde G . Predictors of persistently positive Mycobacterium-tuberculosis-specific interferon-gamma responses in the serial testing of health care workers. BMC Infect Dis. 2010; 10:220. PMC: 2916913. DOI: 10.1186/1471-2334-10-220. View

13.

Shanaube K, Hargreaves J, Fielding K, Schaap A, Lawrence K, Hensen B . Risk factors associated with positive QuantiFERON-TB Gold In-Tube and tuberculin skin tests results in Zambia and South Africa. PLoS One. 2011; 6(4):e18206. PMC: 3070723. DOI: 10.1371/journal.pone.0018206. View

14.

Pollock N, Campos-Neto A, Kashino S, Napolitano D, Behar S, Shin D . Discordant QuantiFERON-TB Gold test results among US healthcare workers with increased risk of latent tuberculosis infection: a problem or solution?. Infect Control Hosp Epidemiol. 2008; 29(9):878-86. PMC: 3578293. DOI: 10.1086/590262. View

15.

Kang Y, Lee H, Yoon H, Cho B, Han S, Shim Y . Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA. 2005; 293(22):2756-61. DOI: 10.1001/jama.293.22.2756. View

16.

Pai M, Joshi R, Dogra S, Mendiratta D, Narang P, Kalantri S . Serial testing of health care workers for tuberculosis using interferon-gamma assay. Am J Respir Crit Care Med. 2006; 174(3):349-55. PMC: 2648116. DOI: 10.1164/rccm.200604-472OC. View

17.

Nienhaus A, Schablon A, Diel R . Interferon-gamma release assay for the diagnosis of latent TB infection--analysis of discordant results, when compared to the tuberculin skin test. PLoS One. 2008; 3(7):e2665. PMC: 2441828. DOI: 10.1371/journal.pone.0002665. View

18.

Menzies D, Joshi R, Pai M . Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis. 2007; 11(6):593-605. View

19.

Lee S, Oh D, Lee S, Kang H, Lee C, Yim J . Time interval to conversion of interferon-gamma release assay after exposure to tuberculosis. Eur Respir J. 2010; 37(6):1447-52. DOI: 10.1183/09031936.00089510. View

20.

Cook S, Maw K, Munsiff S, Fujiwara P, Frieden T . Prevalence of tuberculin skin test positivity and conversions among healthcare workers in New York City during 1994 to 2001. Infect Control Hosp Epidemiol. 2003; 24(11):807-13. DOI: 10.1086/502141. View