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Questionable role of interferon-γ assays for smear-negative pulmonary TB in immunocompromised patients

 Ji Ye Jung  ;  Ju Eun Lim  ;  Hye-jeong Lee  ;  Young Mi Kim  ;  Sang-Nae Cho  ;  Se Kyu Kim  ;  Joon Chang  ;  Young Ae Kang 
 JOURNAL OF INFECTION, Vol.64(2) : 188-196, 2012 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Immunocompromised Host* ; Interferon-gamma/analysis ; Interferon-gamma Release Tests/methods* ; Male ; Middle Aged ; Predictive Value of Tests ; Reagent Kits, Diagnostic ; Republic of Korea ; Sensitivity and Specificity ; Tuberculin Test/methods* ; Tuberculosis, Pulmonary/diagnosis* ; Tuberculosis, Pulmonary/immunology
Diagnostics ; Tuberculosis ; Interferon-γ release assays ; Immunocompromised
OBJECTIVE: The purpose of this study was to examine the usefulness of the TST and the interferon-γ release assays (IGRA) for diagnosing smear-negative pulmonary TB in immunocompromised patients in an intermediate TB burden. METHODS: We conducted a prospective study enrolling 119 immunocompromised participants with suspected smear-negative pulmonary TB in Seoul, South Korea. Clinical assessment, TST, QuantiFERON-TB Gold In Tube (QFT-GIT), and T-SPOT.TB were performed in immunosuppressed condition. RESULTS: All participants were categorized according to the type of immunosuppression: 29 patients with diabetes mellitus, 53 with malignancy, 23 with taking immunosuppressive drugs, and 14 with end stage renal disease. IGRA sensitivity and specificity (95% CI) were: QFT-GIT [59.0% (44.9-72.0)] and [61.3% (54.4-67.6)] and T-SPOT.TB [72.0% (54.2-86.2)] and [42.3% (33.8-49.1)], respectively. For TST, sensitivity was 41.2% (28.3-50.8) and specificity was 91.8% (85.8-96.30). The sensitivities of the three diagnostic methods tended to be lower in the immunosuppressive drug group than in other groups (QFT-GIT 11.1%, T-SPOT.TB 40.0% and TST 25.0% in patients with taking immunosuppressive drugs). Among 111 patients who underwent a chest CT examination, there were no significant differences in the CT findings between the immunocompromised TB and non-TB patients. CONCLUSIONS: The IGRAs and TST had no value as a single test either to rule-in or rule-out active TB in immunocompromised patients in an intermediate burden.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Microbiology (미생물학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ae(강영애) ORCID logo https://orcid.org/0000-0002-7783-5271
Kim, Se Kyu(김세규)
Lee, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
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
Cho, Sang Nae(조상래)
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