Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Serial Interferon-gamma Release Assays for the Diagnosis of Latent Tuberculosis Infection in Patients Treated with Immunosuppressive Agents

  • Kim, Kyeong-Hee (Department of Laboratory Medicine, Dong-A University College of Medicine) ;
  • Lee, Sung-Won (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Chung, Won-Tae (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Kim, Byoung-Gwon (Department of Preventive Medicine, Dong-A University College of Medicine) ;
  • Woo, Kwang-Sook (Department of Laboratory Medicine, Dong-A University College of Medicine) ;
  • Han, Jin-Yeong (Department of Laboratory Medicine, Dong-A University College of Medicine) ;
  • Kim, Jeong-Man (Department of Laboratory Medicine, Dong-A University College of Medicine)
  • Published : 2011.10.30
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Abstract

Background: We assessed the efficacy of serial interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in patients receiving immunosuppressive agents for treatment of rheumatic diseases in Korea. Methods: Of 276 patients who underwent consecutive screening with one of two IGRAs [QuantiFERON-TB Gold or QuantiFERON-TB Gold In-Tube], 66 patients were evaluated by the serial IGRA for detection of LTBI during therapy with immunosuppressive agents. Information on clinical diagnosis, medication, previous TB, blood cell count, tuberculin skin test, and interferon-gamma (IFN-$\gamma$) level measured by IGRA was collected. Results: Of the 66 patients, the initial IGRA was positive in 24.2%, negative in 65.2%, and indeterminate in 10.6%. Forty-six patients (69.7%) showed consistent IGRA results during follow-up, and 13 patients (19.7%) had consistently positive results. IGRA conversion rate was 12.1% (8/66) and reversion rate was 4.5% (3/66). Conversion of IGRA results was only observed in ankylosing spondylitis patients, and the median interval between the two tests in patients with conversion was 8.5 months. The mean IFN-$\gamma$ level in the group of patients with consistently positive IGRA results was higher than that in the group with inconsistently positive results, although this trend was not statistically significant (P=0.293). Indeterminate results were observed most frequently in patients with systemic lupus erythematosus. Conclusions: In patients receiving immunosuppressive agents, both IGRA conversions and reversions were observed. Serial IGRA testing may not be needed in patients with a positive initial IGRA result showing high IFN-$\gamma$ levels, because of high consistency in the test results.

Keywords

References

  1. Small PM and Fujiwara PI. Management of tuberculosis in the United States. N Engl J Med 2001;345:189-200. https://doi.org/10.1056/NEJM200107193450307
  2. Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 2004;350:2060-7. https://doi.org/10.1056/NEJMsa031667
  3. Jasmer RM, Nahid P, Hopewell PC. Clinical practice. Latent tuberculosis infection. N Engl J Med 2002;347:1860-6. https://doi.org/10.1056/NEJMcp021045
  4. Wang L, Turner MO, Elwood RK, Schulzer M, FitzGerald JM. A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements. Thorax 2002;57:804-9. https://doi.org/10.1136/thorax.57.9.804
  5. Kang YA, Lee HW, Yoon HI, Cho B, Han SK, Shim YS, et al. 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;293:2756-61. https://doi.org/10.1001/jama.293.22.2756
  6. U.S. Food and Drug Administration, (Eds.), T-SPOT-TB - P070006. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfTopic/pma/pma.cfm?num=P070006 (Updated on Jul 2008).
  7. Mazurek GH, Jereb J, Lobue P, Iademarco MF, Metchock B, Vernon A. Guidelines for using the QuantiFERON-TB gold test for detecting mycobacterium tuberculosis infection, United States MMWR Recomm Rep 2005;54:49-55.
  8. Mazurek GH, 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;59:1-25.
  9. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001; 345:1098-104. https://doi.org/10.1056/NEJMoa011110
  10. Korea Food and Drug Administration. Guideline for diagnosis and treatment of latent tuberculosis infection in patients treated with TNF blockers. Korea Food and Drug Administration, 2004.
  11. Pai M, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 2008;149:177-84. https://doi.org/10.7326/0003-4819-149-3-200808050-00241
  12. Park JH, Seo GY, Lee JS, Kim TH, Yoo DH. Positive conversion of tuberculin skin test and performance of interferon release assay to detect hidden tuberculosis infection during anti-tumor necrosis factor agent trial. J Rheumatol 2009;36:2158-63. https://doi.org/10.3899/jrheum.090150
  13. Chen DY, Shen GH, Hsieh TY, Hsieh CW, Lan JL. Effectiveness of the combination of a whole-blood interferon-gamma assay and the tuberculin skin test in detecting latent tuberculosis infection in rheumatoid arthritis patients receiving adalimumab therapy. Arthritis Rheum 2008;59:800-6. https://doi.org/10.1002/art.23705
  14. Perry S, Sanchez L, Yang S, Agarwal Z, Hurst P, Parsonnet J. Reproducibility of QuantiFERON-TB gold in-tube assay. Clin Vaccine Immunol 2008;15:425-32. https://doi.org/10.1128/CVI.00398-07
  15. Koh WJ, Kwon OJ, Lee KS. Diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases: a Korean perspective. J Korean Med Sci 2005;20:913-25. https://doi.org/10.3346/jkms.2005.20.6.913
  16. Hamdi H, Mariette X, Godot V, Weldingh K, Hamid AM, Prejean MV, et al. Inhibition of anti-tuberculosis T-lymphocyte function with tumour necrosis factor antagonists. Arthritis Res Ther 2006; 8:R114. https://doi.org/10.1186/ar1994
  17. Matulis G, Jüni P, Villiger PM, Gadola SD. Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a mycobacterium tuberculosis antigen-specific interferon gamma assay. Ann Rheum Dis 2008;67:84-90. https://doi.org/10.1136/ard.2007.070789
  18. Inanc N, Aydin SZ, Karakurt S, Atagunduz P, Yavuz S, Direskeneli H. Agreement between Quantiferon-TB gold test and tuberculin skin test in the identification of latent tuberculosis infection in patients with rheumatoid arthritis and ankylosing spondylitis. J Rheumatol 2009;36:2675-81. https://doi.org/10.3899/jrheum.090268
  19. Malaviya AN, Kapoor S, Garg S, Rawat R, Shankar S, Nagpal S, et al. Preventing tuberculosis flare in patients with inflammatory rheumatic diseases receiving tumor necrosis factor-alpha inhibitors in India -- An audit report. J Rheumatol 2009;36:1414-20. https://doi.org/10.3899/jrheum.081042
  20. Shovman O, Anouk M, Vinnitsky N, Arad U, Paran D, Litinsky I, et al. QuantiFERON-TB gold in the identification of latent tuberculosis infection in rheumatoid arthritis: a pilot study. Int J Tuberc Lung Dis 2009;13:1427-32.
  21. Kobashi Y, Obase Y, Fukuda M, Yoshida K, Miyashita N, Oka M. Clinical reevaluation of the QuantiFERON TB-2G test as a diagnostic method for differentiating active tuberculosis from nontuberculous mycobacteriosis. Clin Infect Dis 2006;43:1540-6. https://doi.org/10.1086/509327
  22. Komiya K, Ariga H, Nagai H, Teramoto S, Kurashima A, Shoji S, et al. Impact of peripheral lymphocyte count on the sensitivity of 2 IFN-gamma release assays, QFT-G and ELISPOT, in patients with pulmonary tuberculosis. Intern Med 2010;49:1849-55. https://doi.org/10.2169/internalmedicine.49.3659

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