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Tuberculin Skin Test and QuantiFERON-TB Gold Assay before and after Treatment for Latent Tuberculosis Infection among Health Care Workers in Local Tertiary Hospital

Lee, Seung Jun (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Kim, Hyeon Sik (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Ma, Jung Eun (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Lee, Sang Min (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Ham, HyunSeok (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Cho, Yu Ji (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Jeong, Yi Yeong (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Kim, Ho Cheol (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Lee, Jong Deok (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
Kim, Sun-Joo (Department of Laboratory Medicine, College of Medicine, Gyeongsang National University)
Hwang, Young Sil (Department of Internal Medicine, College of Medicine, Gyeongsang National University)

Publication Information

Tuberculosis and Respiratory Diseases / v.62, no.4, 2007 , pp. 270-275 More about this Journal

Abstract

The QuantiFERON-TB Gold assay and tuberculin skin test (TST) have been useful test for diagnosing latent tuberculosis infections (LTBI). However, there are few reports on the efficacy of the QuantiFERON-TB Gold assay and TST in evaluating the response after the treatment of LTBI. This study examined the changes in the TST and QuantiFERON-TB Gold assay before and after a treatment for latent tuberculosis in health care workers (HCWs) at a local tertiary hospital. Methods: A cohort of volunteers working as nurses and doctors who underwent a TST and QuantiFERON-TB Gold assay was established. The volunteers positive for the QuantiFERON-TB Gold assay had been treated with 3 months of isoniazid (INH) and rifampin (RFP). After completing treatment, the TST and QuantiFERON-TB Gold assay were repeated. Results: Of the 48 participants (14 doctors, 34 nurses, M: F=11:37, mean $age=29.9{\pm}5.5$ years, mean employment $period=74.9{\pm}64.3$ months), 19 (39.6%) tested positive to the TST (mean induration= $19.1{\pm}9.7mm$ ) and 8 (16.7%) were QuantiFERON-TB Gold assay. Among them, one had active pulmonary tuberculosis. Seven volunteers were consistently positive to both the TST and QuantiFERON-TB Gold assay after being medicated with INH and RFP for 3 months. Conclusion: TST and QuantiFERON-TB Gold assay are unsuitable for evaluating the treatment response of LTBI because they were consistently positive both before and after the anti-tuberculosis medication.

배 경: 결핵의 완전 퇴치를 위해서는 잠복결핵의 진단 및 치료를 통해 활동성 결핵으로 진행되는 것을 예방하는 것이 중요하다. 최근 QuantiFERON-TB Gold 검사가 잠복결핵의 진단을 위한 방법으로 승인되어 사용되고 있다. 본 연구에서는 지역 3차 종합병원에 근무하는 의료인을 대상으로 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 통해 잠복결핵을 진단하고, 잠복결핵을 치료한 후 투베르쿨린 검사와 QuantiFERON-TB Gold 검사의 변화를 알아보고자 하였다. 방 법: 2006년 경상대학교 병원에 근무중인 의료인 중 48명의 지원자(의사 14명, 간호사 34명, 남:여 =11:37, 평균연령= $29.9{\pm}5.5$ 세, 평균근무기간= $74.9{\pm}64.3$ 개월)를 대상으로 하였다. QuantiFERON-TB Gold 검사와 투베르쿨린 검사를 시행하여 의료인에서 잠복 결핵을 진단하고 두 검사의 일치율을 알아보았다. 그리고 QuantiFERON-TB Gold 검사가 양성인 지원자를 대상으로 Isoniazid(INH, 300 mg/day)와 Rifampin( RFP, 600 mg/day)을 3개월간 투약한 후 다시 투베르쿨린 검사와 QuantiFERON-TB Gold 검사를 시행하여 잠복결핵 치료 전후 두 검사의 변화를 확인하고 경결의 양성 기준에 따른 투베르쿨린 검사와 Quanti FERON-TB Gold 검사의 일치율을 알아보았다. 결 과: 48명의 지원자 중 투베르쿨린 검사는 경결 양성 기준을 10 mm 이상으로 하였을 때 19명(39.6%) 에서 양성, QuantiFERON-TB Gold 검사는 8명 (16.7%)에서 양성이었으며 두 검사의 일치율은 77.1%, ${\kappa}$ 값은 0.468이었고, 투베르쿨린 검사의 경결 양성 기준을 15 mm로 설정하면 두 검사의 일치율은 83.3%, ${\kappa}$ 값은 0.500이었다. 1명의 활동성 결핵 환자를 제외한 QuantiFERON-TB Gold 검사가 양성인 7명의 지원자에서 잠복결핵 치료 후에도 투베르쿨린 검사와 QuantiFERON-TB Gold 검사는 계속 양성이었다. 이들에게서 시행한 투베르쿨린 검사의 평균 경결은 잠복결핵 치료 전 $19.1{\pm}9.7mm$ , 치료 후 $43.6{\pm}25.1mm$ 이었다. 결 론: 이번 연구의 결론으로는 투베르쿨린 검사와 QuantiFERON-TB Gold 검사로 잠복결핵의 치료 반응을 평가하는 것은 부적절하다고 판단되며 향후 이에 대한 더 많은 연구가 필요할 것으로 사료된다.

Keywords

Latent tuberculosis infection (LTBI); Treatment; Tuberculin skin test (TST); QuantiFERON-TB Gold assay; Health care workers;

Citations & Related Records

Times Cited By KSCI : 1 (Citation Analysis)
Times Cited By SCOPUS : 0

Reference
Cited By KSCI

1	Brock I, Weldingh K, Lillebaek T, Follmann F, Andersen P. Comparison of a new specific blood test and the skin test in tuberculosis contacts. Am J Respir Crit Care Med 2004;170:65-9 DOI ScienceOn
2	Mori T, Sakatani M, Yamagishi F, Takashima T, Kawabe Y, Nagao K, et al. Specific detection of tuberculosis infection an interferon-gamma based assay using new antigens. Am J Respir Crit Care Med 2004;170:59-64 DOI ScienceOn
3	Mazurek GH, LoBue PA, Daley CL, Bernardo J, Lardizabal AA, Bishai WR, et al. Comparison of a whole-blood interferon gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection. JAMA 2001;286:1740-7 DOI ScienceOn
4	Yim JJ, Shim YS, Han SK, Cho BL, Yoon HI, Lee HW, et al. Discrepancy between the tuberculin skin test and the whole-blood interferon assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005;293:2756-61 DOI ScienceOn
5	Pai M, Joshi R, Dogra S, Mendiratta DK, Narang P, Dheda K, et al. Persistently elevated T cell interferon- $\gamma$ responses after treatment for latent tuberculosis infection among health care workers in India: a preliminary report. J Occup Med Toxicol 2006;1:7 DOI
6	Whalen CC, Johnson JL, Okwera A, Hom DL, Hue bner R, Mugyenyi P, et al. A trial of three regimens to prevent tuberculosis in Ugandan adults infected with the human immunodeficiency virus. N Engl J Med 1997;337:801-8 DOI ScienceOn
7	Shim TS, Koh WJ, Yim JJ, Lew WJ. Diagnosis and treatment of latent tuberculosis infection in Korea. Tuberc Respir Dis 2004;57:101-17 DOI
8	Bellete B, Coberly J, Barnes GL, Ko C, Chaisson RE, Comstock GW, et al. Evaluation of a whole blood interferon-gamma release assay for the detection of Mycobacterium tuberculosis infection in 2 study populations. Clin Infect Dis 2002;34:1449-56 DOI ScienceOn
9	Anti-Tuberculosis Drug Resistance in the World (Report No.2, Prevalence and Trends). WHO/CDS/TB/2000.278
10	Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Consensus statement: global burden of tuberculosis:estimated incidence, prevalence, and mortality by country: WHO Global Surveillance and Monitoring Project. JAMA 1999;282:677-86 DOI ScienceOn
11	Pai M, Gokhale K, Joshi R, Dogra S, Kalantri SP, Mendiratta DK, et al. Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole blood, interferon-g assay with tuberculin skin testing. JAMA 2005;293:2746-55 DOI ScienceOn
12	Centers for Disease Control and Prevention. Update:fatal and severe liver injuries associated with rifampin and pyrazinamide treatment for latent tuberculosis infection. JAMA 2002;288:2967 DOI
13	Stuart RL, Olden D, Johnson PD, Forbes A, Bradley PM, Rothel JS, et al. Effect of anti-tuberculosis treatment on the tuberculin interferon-gamma response in tuberculin skin test (TST) positive health care workers and patients with tuberculosis. Int J Tuberc Lung Dis 2000;4:555-61
14	Pathan AA, Wilkinson KA, Klenerman P, McShane H, Davidson RN, Pasvol G, et al. Direct ex vivo analysis of antigen-specific IFN-gamma secreting CD4 T cells in Mycobacterium tuberculosis-infected individuals:associations with clinical disease state and effect of treatment. J Immunol 2001;167:5217-25 DOI
15	Nolan CM, Goldberg SV. Treatment of isoniazid resistant tuberculosis with isoniazid, rifampin, ethambutol, and pyrazinamide for 6 months. Int J Tuberc Lung Dis 2002;6:952-8
16	Lalvani A, Nagvenkar P, Udwadia Z, Pathan AA, Wilkinson KA, Shastri JS, et al. Enumeration of T cells specific for RD1-encoded antigens suggests a high prevalence of latent Mycobacterium tuberculosis infection in healthy urban Indians. J Infect Dis 2001;183:469-77 DOI ScienceOn
17	Arend SM, van Meijgaarden KE, de Boer K, de Palou EC, van Soolingen D, Ottenhoff TH, et al. Tuberculin skin testing and in vitro T cell responses to ESAT-6 and culture filtrate protein 10 after infection with Mycobacterium marinum or M. kansasii. J Infect Dis 2002;186:1797-807 DOI ScienceOn
18	Ormerod LP. Rifampicin and isoniazid prophylactic chemotherapy for tuberculosis. Arch Dis Child 1998;78:169-71 DOI
19	Medinger A. Death associated with rifampin and pyrazinamide 2-month treatment of latent mycobacterium tuberculosis. Chest 2002;121:1710-2 DOI ScienceOn
20	Fietta A, Meloni F, Cascina A, Morosini M, Marena C, Troupioti P, et al. Comparison of a whole-blood interferon-gamma assay and tuberculin skin testing in patients with active tuberculosis and individuals at high or low risk of Mycobacterium tuberculosis infection. Am J Infect Control 2003;31:347-53 DOI ScienceOn
21	Hong Kong Chest Service/Tuberculosis Research Centre MBMRC. A double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong. Am Rev Respir Dis 1992;145:36-41 DOI ScienceOn
22	Joint Tuberculosis Committee of the British Thoracic Society. Control and prevention of tuberculosis in the United Kingdom: code of practice 2000. Thorax 2000;55:887-901