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Performance of the tuberculin skin test and interferon-gamma release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population.

Authors
 Eun Young Kim  ;  Ju Eun Lim  ;  Ji Ye Jung  ;  Ji Young Son  ;  Kyung Jong Lee  ;  Yoe Wun Yoon  ;  Byung Hoon Park  ;  Jin Wook Moon  ;  Moo Suk Park  ;  Young Sam Kim  ;  Se Kyu Kim  ;  Joon Chang  ;  Young Ae Kang 
Citation
 BMC INFECTIOUS DISEASES, Vol.9 : 207, 2009 
Journal Title
 BMC INFECTIOUS DISEASES 
Issue Date
2009
MeSH
Adult ; Aged ; Aged, 80 and over ; BCG Vaccine/administration & dosage ; Female ; Humans ; Immunocompromised Host* ; Interferon-gamma/blood* ; Latent Tuberculosis/diagnosis* ; Latent Tuberculosis/epidemiology ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculin Test* ; Young Adult
Keywords
Immunocompromised Patient ; Tuberculin Skin Test ; Indeterminate Result ; Tuberculin Skin Test Result ; Advanced Liver Cirrhosis
Abstract
BACKGROUND: Interferon-gamma release assay (IGRA) may improve diagnostic accuracy for latent tuberculosis infection (LTBI). This study compared the performance of the tuberculin skin test (TST) with that of IGRA for the diagnosis of LTBI in immunocompromised patients in an intermediate TB burden country where BCG vaccination is mandatory. METHODS: We conducted a retrospective observational study of patients given the TST and an IGRA, the QuantiFERON-TB Gold In-Tube (QFT-IT), at Severance Hospital, a tertiary hospital in South Korea, from December 2006 to May 2009. RESULTS: Of 211 patients who underwent TST and QFT-IT testing, 117 (55%) were classified as immunocompromised. Significantly fewer immunocompromised than immunocompetent patients had positive TST results (10.3% vs. 27.7%, p 0.001), whereas the percentage of positive QFT-IT results was comparable for both groups (21.4% vs. 25.5%). However, indeterminate QFT-IT results were more frequent in immunocompromised than immunocompetent patients (21.4% vs. 9.6%, p 0.021). Agreement between the TST and QFT-IT was fair for the immunocompromised group (kappa = 0.38), but moderate agreement was observed for the immunocompetent group (kappa = 0.57). Indeterminate QFT-IT results were associated with anaemia, lymphocytopenia, hypoproteinemia, and hypoalbuminemia. CONCLUSION: In immunocompromised patients, the QFT-IT may be more sensitive than the TST for detection of LTBI, but it resulted in a considerable proportion of indeterminate results. Therefore, both tests may maximise the efficacy of screening for LTBI in immunocompromised patients.
Files in This Item:
T200905118.pdf Download
DOI
10.1186/1471-2334-9-207
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ae(강영애) ORCID logo https://orcid.org/0000-0002-7783-5271
Kim, Se Kyu(김세규)
Kim, Young Sam(김영삼) ORCID logo https://orcid.org/0000-0001-9656-8482
Kim, Eun Young(김은영) ORCID logo https://orcid.org/0000-0002-3281-5744
Moon, Jin Wook(문진욱)
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Park, Byung Hoon(박병훈)
Son, Ji Young(손지영)
Yoon, Yoe Wun(윤여운)
Lee, Kyung Jong(이경종)
Lim, Ju Eun(임주은)
Chang, Joon(장준) ORCID logo https://orcid.org/0000-0003-4542-6841
Jung, Ji Ye(정지예) ORCID logo https://orcid.org/0000-0003-1589-4142
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/105738
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