• Clinical and Experimental Pediatrics
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• v.51 no.9
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• pp.971-976
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• 2008

Purpose : Surveillance for detecting and managing latent tuberculosis infection (LTBI) is a key component of tuberculosis control. The classic surveillance tool, the tuberculin skin test (TST), may have some limitations when used in the Bacillus Calmette-$Gu{\acute{e}}rin$ (BCG)-vaccinated population. The object was to perform a blood test $QuantiFERON^{(R)}$-TB Gold In Tube (QFT-G IT) based on the detection of interferon-$\gamma$ ($IFN-{\gamma}$) released by T cells in response to Mycobacterium tuberculosis-specific antigens, and to compare the efficacy of this new diagnostic tool for LTBI with that of TST. Methods : For six months, between October 1, 2006 and April 30, 2007, data were collected from 111 patients under 15 years of age at Severance Children's Hospital. TST and QFT-G IT tests were performed with children with or without contact histories of tuberculosis. In addition to these tests, we examined comparative data from 29 adults who had tuberculosis, to detect false negative rates in the QFT-G IT method. Results : Thirty-three children had household contact histories. In this group, 15% and 42% of cases were found to be positive using the QFT-G IT assay and TST, respectively. Agreement was low between these two tests (${\kappa}=0.39$). In the adult active tuberculosis group, the QFT-G IT false negative rate defined as a positive culture and a negative QFT-G IT result was 12.5%. Conclusion : In diagnosing LTBI in children, the usefulness of a whole-blood $IFN-{\gamma}$ assay employing TB-specific antigens will be revealed only by examining additional longitudinal clinical data; this study serves as a starting point in that process.

• The Journal of the Korea Contents Association
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• v.18 no.5
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• pp.432-445
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• 2018

For health care professionals(HCPs) who have relatively higher possibility of exposing tuberculosis(Tb), it is important for them to equip with proper levels of knowledge and prevention activities. In terms of establishment of Tb education model for junior HCPs, therefore, literature review was done alongside 129 junior HCPs and 14 HCPs were asked to answer questionnaires and telephone survey. The results are follows.; Firstly, six educational themes such as epidermiology of Tb, Tb transmission and patho-physiology, test and diagnosis, latent Tb, Tb treatment, and Tb prevention were identified, based on the literature review. Secondly, the junior HCPs showed lower levels of knowledge regarding epidermiology, transmission and patho-physiology and latent Tb, compared to the other themes. When education courses are planned, longer period of time should be given to the lower level of knowledge areas. Thirdly, the HCPs emphasized that definition and type of Tb should be well integrated into the education in particular epidermiology education. They also responded that hospital infection and infection cycle of Tb need to be addressed during educational session about transmission and patho-physiology. in addition, they said that specific and detailed contents about diagnosis and group examination should be carefully delivered during the education, along with diagnosis, test and application of personal protective devices during education of latent Tb. They also answered that patient education and adverse effect of Tb medication should be taught during Tb treatment session, as well as self activities of health promotion for junior HCPs and systematic TB education as key way of Tb prevention. As the findings were from limited numbers of respondents and contained the sampling bias, the result has to be carefully interpretated prior to generalization. Therefore, further survey with larger study population is required in terms of development of Tb education model.

• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.191-198
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• 2014

Purpose: The aim of this study was to evaluate the clinical manifestations, contact history, and status of tuberculosis contact investigations in school-age children and adolescents with pulmonary tuberculosis (TB) at two centers. Methods: This study was conducted with 54 patients in the age ranging from 10 to 18 years, who were diagnosed with pulmonary TB at the Pusan National University Hospital and Pusan National University Children's Hospital, January 2008 to December 2012. We retrospectively reviewed the medical records of the patients. Results: The median age of the patients was 16 years old; 11 patients were aged 10 to 14 and 43 patients were aged 15 to 18. Among 54 patients, 19 had history of contact with pulmonary TB, 10 had contact with house members (household), and remaining 9 had contact with classmates (non-household). One out of 10 patients who had household contacts and 6 out of 9 patients who had non-household contacts were evaluated with contact investigation after the exposure to pulmonary TB. Among 7 patients who were evaluated with contact investigation, 3 were diagnosed with active pulmonary TB, 1 had latent tuberculosis infection (LTBI), and 3 had no evidence of TB or LTBI. The median period of diagnosis after the exposure to active pulmonary TB was 2 years in patients with household contacts and 0.23 years in patients with non-household contacts. Conclusion: This study suggested that if the contact investigation conducted properly, it would be helpful for early diagnosis and prevention of pulmonary TB.

• Proceedings of The Korean Society of Health Promotion Conference
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• 2005.11a
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• pp.234-243
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• 2005

상당히 성공적인 사람병원체인 결핵균을 Robert Koch가 발견한 이래, 결핵 방제의 상당한 진보에도 불구하고, 결핵의 발생은 현재까지 계속되어오고 있다(Tiruviluamala and Reichman 2002). 그러므로, 완전한 민감성과 특이성을 갖는 신속한 진단방법이 결핵과 결핵의 잠복감염을 진단하는데 요구되어지며(Tiruviluamala and Reichman 2002), 계속적으로 결핵균과 BCG의 유전체와 단백질체 연구를 통하여 결핵 방제수단이 발전되어질 것이다 (Jungblut et al. 1999). 본 연구는 PPD가 결핵을 진단하는 특이한 항원만으로 정확하게 조화를 이루고 있지 않다는 것을 보여주었으며, 그것의 역가는 결론적으로 생물학적으로 평가되어져야 하지만, PPD의 제조는 단백질체 분석 기법에 의해 분석되고 표준화될 수 있음을 보여주었다. 이를 통하여 결핵 피내진단의 일괄된 결과를 위해 PPD 사용 전에 이와같은 단백질체 분석기법을 적용할 수 있을 것으로 사료되며, 본 연구에서 밝혀진 특이 항원은 새로운 피내진단항원으로 적용될 수 있을 것으로 사료된다.

• Journal of Korean Biological Nursing Science
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• v.21 no.4
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• pp.300-307
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• 2019

Purpose: The purpose of this study was to provide basic data on the infection prevention management program, which is one of the infectious disease control program by identifying the prevalence and risk factors of latent tuberculosis infection (LTBI) in healthcare workers. Methods: We surveyed a total of 3,046 LTBI test results, including those of 2,269 existing staff and 777 new employees. An interferon-gamma release assay (IGRA) for the diagnosis of LTBI was performed using QuantiFERON^®-TB Gold In-Tube (QFT-IT). The risk factors of LTBI were analyzed using logistic regression analysis. Results: The overall prevalence of LTBI was 16.0% (487/3,046). The prevalence of LTBI in the existing staff was 17.9% (406/2,269) and the prevalence of LTBI in new employees was 10.4% (81/777). Multivariate logistic regression analysis revealed that the risk factors of latent tuberculosis infection among the existing staff were gender, age and work period wheres, the risk factor amongst the new employees depended on their age. Conclusion: The LTBI was not related to the type of occupation and work unit. Therefore, while establishing an infection control program for the prevention of tuberculosis infection at medical institurions, institutional heads and infection control experts should encompass a policy for all the employees.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.18-24
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• 2016

Purpose: There is a the great diagnostic challenge in pediatric tuberculosis especially in high burden setting. The purpose of this preliminary study is to evaluate the agreement between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) including T-SPOT$^{(R)}$.TB and QuantiFERON$^{(R)}$-TB Gold (QFT-G) in Korean children. Method: This retrospective study included children and adolescents who visited to Asan Medical Center to evaluate tuberculosis infection using at least two assays of TST, T-SPOT.TB and QFT-G, from January 2014 to April 2015. Results: A total of 20 patients were included, whose median age was 13.3 years (range, 3.8-18.1 years), and all of them had history of BCG vaccination. Eleven patients had underlying diseases including 7 patients with immunosuppressant medication. The concordance rate between T-SPOT.TB and QFT-G was 90%. However, the concordance rate between TST and T-SPOT.TB was 50%, and between TST and QFT-G was 42.9%. Specificity for the diagnosis of tuberculosis infection of T-SPOT.TB, QFT-G, and TST was 93.3%, 86.7%, and 58.3%, respectively. Conclusions: Although there was a discrepancy between TST and IGRA to diagnose tuberculosis, agreement between T-SPOT.TB and QFT-G was relatively high. Further prospective study to validate the clinical usefulness of each assay for immunologic evidence of tuberculosis infection in Korean children will be mandatory.

• Pediatric Infection and Vaccine
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• v.26 no.2
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• pp.89-98
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• 2019

Purpose: Despite the decline in tuberculosis (TB) incidence and mortality rates in the Republic of Korea through a national TB control program, TB remains one of the most critical infectious diseases in Korean children. We investigated the trends and research areas of published articles on TB in Korean children and adolescents. Methods: In 6 Korean and overseas databases, we searched titles and abstracts including "tuberculo*" or "TB," "child*" or "adolescen*" or "neonat*" or "infant*" or "pediatric*," and "korea*." The publication type, publication year, research areas, journal title, and research subjects were analyzed. Results: Out of the 257 searched documents, 120 papers were included in the analysis. Of these, 82 were original articles (68.3%), 33 case reports (27.5%), 4 review articles (3.3%), and 1 guideline (0.8%). In the original articles, the most common subject of studies was the clinical characteristics of patients with TB (36.6%), followed by diagnostics (29.3%), contact investigations (9.8%), epidemiology (6.1%), treatment (4.9%), vaccine (3.6%), latent TB infection (3.6%), complications (3.6%), and surveys on perception of TB (2.4%). From 1962, 4 articles were published in the 1960s, 10 articles in the 1970s, 11 articles in the 1980s, 22 articles in the 1990s, 26 articles in the 2000s, and 47 articles since 2010. Conclusions: The amount of research on TB in Korean children has increased over the past 5 decades; however, it has mainly focused on the clinical characteristics and diagnostics. Research in different areas, such as treatment and vaccine, is needed in the future.

• Pediatric Infection and Vaccine
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• v.20 no.1
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• pp.17-27
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• 2013

Purpose: Recently, two tests are commercially available for the identification of latent tuberculosis infection (LTBI): tuberculin skin test (TST) and interferon-${\gamma}$ release assay (IGRA). Due to its false positiveness, TST tends to be preferred by IGRA until now. In our study, we simultaneously performed both TST and QuantiFERON$^{(R)}$-TB Gold In-Tube (QFT-GIT) and compared their results. Methods: TST and QFT-GIT were done for the diagnosis of LTBI among children who visited pediatric out-patient clinic at St. Vincent's Hospital, The Catholic University of Korea from February of 2007 to May of 2008. The study group was stratified into two groups in terms of whether there was intrafamilial contact or not. Results: Out of total 35 children, 29 were tuberculosis (TB)-exposed cases and the remainders were diagnosed as clinical pulmonary TB. Among these 29 children, TST was positive 38.9% (7/18) for the intrafamilial and 45.5% (5/11) for the nonintrafamilial, and at the same time, the result for QFT-GIT was positive 5.6% (1/18) and 9.1% (1/11), respectively which implies that TST was more sensitive than QFT-GIT. Among 29 TB-exposed cases, 26 initially went through TST and QFTGIT together on their first visit to out-patient clinic, and 15 continued the follow-up tests. Out of total 41 cases collected, the agreement (known as kappa value) was 0.063 which was relatively low. Including 6 cases with pulmonary TB who were all positive for TST and only 5 being positive for QFT-GIT, the final kappa value was 0.334. Conclusion: In our study, the agreement for TST and QFT-GIT was low, and the majorities were almost the cases of positive TST. In current situation with lacking a gold standard test and limited data on children to adolescents, this result is quite alarming that the recent trend tends to replace TST by QFT-GIT when diagnosing LTBI.

• Korean Journal of Clinical Laboratory Science
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• v.51 no.3
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• pp.323-328
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• 2019

Tuberculosis, a chronic bacterial infection caused by Mycobacterium tuberculosis (MTB), differs in its status latency and activity because of the characteristics of MTB, immune status of the host, and genetic susceptibility. The host defense mechanism against MTB is caused mainly by interactions between macrophages, T cells, and dendritic cells. CD44 is expressed in activated T cells when infected with MTB and regulates lymphocyte migration. In addition, CD44 mediates leukocyte adhesion to the ECM and plays a role in attracting macrophages and $CD4^+$ T cells to the lungs. Therefore, genetic polymorphism of the CD44 gene will inhibit the host cell immune mechanisms against MTB. This study examined whether the genetic polymorphism of the CD44 gene affects the susceptibility of tuberculosis. A total of 237 SNPs corresponding to the CD44 genes were analyzed using the genotype data of 443 tuberculosis cases and 3,228 healthy controls from the Korean Association Resource (KARE). Of these, 17 SNPs showed a significant association with the tuberculosis case. The most significant SNP was rs75137824 (OR=0.231, CI: 1.51~3.56, $P=1.3{\times}10^{-4}$). In addition, rs10488809, one of the 17 significant SNPs, is important for the tuberculosis outbreak can bind to the JUND and FOS transcription factors and can affect CD44 gene expression. This study suggests that polymorphism of the CD44 gene modulates the host susceptibility to tuberculosis in a variety of ways, resulting in differences in the status of tuberculosis.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.27 no.3
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• pp.238-244
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• 2017

Objectives: The major objective of this study was to investigate the prevalence of and risk factors for latent tuberculosis infection (LTBI) among employees at a workers' compensation hospital. Methods: Among the 394 employees at Incheon Hospital, 362 were enrolled in the study. An interferon-gamma release assay(IGRA) for diagnosis of LTBI was performed using QuantiFERON$^{(R)}$ TB Gold In-Tube(QFT-IT). Risk factors for LTBI were analyzed using logistic regression analysis. Results: The overall prevalence of LTBI was 32.0%(116/362). The non-medical departments have a significantly high prevalence compared to medical departments(39.7% vs 23.2%). In multivariate logistic regression analysis, experience working in the pneumoconiosis hospital(OR, 3.6; 95% CI, 1.3-10.3) was associated with development of LTBI. Conclusions: Korean guidelines for the management of tuberculosis recommend annual regular health examinations for TB and LTBI for health care workers(HCWs). Considering the high prevalence of and risk factors for LTBI among non-HCWs, it suggests a need for annual regular health examinations for TB and LTBI for all employees at workers' compensation hospitals, including pneumoconiosis hospitals.