Interferon-gamma release assays versus tuberculin skin testing for detection of latent tuberculosis in chronic haemodialysis patients

Article Article scientifique Article Interferon-gamma release assays versus tuberculin skin testing for detection of latent tuberculosis in chronic haemodialysis patients eng 2009 author Triverio Pierre-Alain 39239 author Bridevaux Pierre-Olivier 0000-0002-8021-0950 656483 author Roux-Lombard Pascale 22481 author Niksic Laurent 87680 author Rochat Thierry 28557 author Martin Pierre-Yves 65591 author Saudan Patrick 41867 author Janssens Jean-Paul 30742 1952-1956 10.1093/ndt/gfn748 19164327 0931-0509 http://ndt.oxfordjournals.org/content/24/6/1952.full.pdf BACKGROUND: End stage renal disease increases the risk of reactivating latent tuberculosis (LTBI). Interferon-gamma release assays (IGRA) are an alternative to the tuberculin skin test (TST) for detecting LTBI. METHODS: Sixty-two hemodialysis patients (46 male, 16 female, aged 65 +/- 15 years) from 3 hemodialysis facilities in the Geneva area were submitted to a TST, 2 IGRA (T-SPOT.TB and QuantiFERON Gold in tube: QFT), a chest radiography, and a questionnaire to record social status, country of birth, history of prior TST, tuberculosis (TB), BCG (Bacillus of Calmette-Guerin vaccine), and any cause of immuno-suppression. LTBI was defined as prior "at risk" contact with a case of contagious TB and/or a chest X-ray suggestive of prior TB infection. RESULTS: Positivity rate was 19% for TST, 21% for QFT and 29% for T-SPOT-TB; 8% of QFT and 11% of T-SPOT-TB were indeterminate. Agreement between IGRA was fair (kappa = 0.60). After adjusting for age and BCG, OR (Odds Ratio) of having a positive QFT was 4.6-fold (p = 0.029) higher in patients with LTBI vs. those without LTBI. In contrast, no association was found between LTBI and having a positive T-SPOT.TB or a positive TST. As expected, there was a strong association between prior BCG vaccination and having a positive TST (OR 5.3, p = 0.017). QFT was the only test with a significant OR of having LTBI (adjusted OR: 4.4; 95%CI: 1.1 - 17.6; p = 0.034). Among 5 patients with definite prior TB, TST and T-SPOT.TB were positive in 1 and QFT, in 2. CONCLUSIONS: In this population, QFT was superior to TST for detecting LTBI, but both IGRAs and TST have important limitations, and are unreliable for screening for LTBI. Aged Aged, 80 and over Female Humans Interferon-gamma/*blood Kidney Failure, Chronic/*complications/immunology/*therapy Male Middle Aged Predictive Value of Tests *Renal Dialysis *Tuberculin Test Tuberculosis, Pulmonary/*diagnosis/*etiology/immunology Dewey 616 56 Département de médecine 221 false 21 Groupe Pierre-Yves Martin (néphrologie) 30 514 L'épithélium respiratoire 852 311 Pneumologie Clinique 576 Nephrology, dialysis, transplantation 24 6 633ee68f-f518-40e0-8d55-ef33fca2a1b5 Article Restricted file1.pdf 82750 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Interferon-gamma release assays versus tuberculin skin testing for detection of latent tuberculosis in chronic haemodialysis patients	Nephrology, dialysis, transplantation	2009	616	0
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