Journal article
Superiority of Interferon Gamma Assay Over Tuberculin Skin Test for Latent Tuberculosis in Inflammatory Bowel Disease Patients in Brazil
Digestive diseases and sciences, Vol.64(7), pp.1916-1922
07/01/2019
DOI: 10.1007/s10620-019-5475-3
PMID: 30673986
Abstract
Background and Aims
To compare tuberculin skin test (TST) and interferon gamma release assay (IGRA) in the screening of LTBI among patients with inflammatory bowel disease (IBD) in an endemic area for tuberculosis, to evaluate the need for repeating tests during anti-TNFα, therapy, and to check whether the results may be affected by immunosuppression.
Methods
A cross-sectional study of 110 IBD patients and 64 controls was conducted in Rio de Janeiro, Brazil. The TST was administered after the Quantiferon(®)-TB Gold In-tube test was performed.
Results
TST and IGRA agreement was poor regarding diagnosis (kappa: control = 0.318; UC = 0.202; and CD = − 0.093), anti-TNFα therapy (kappa: with anti-TNFα = 0.150; w/o anti-TNFα = − 0.123), and immunosuppressive therapy (IST) (kappa: with IS = − 0.088; w/o IS = 0.146). Indeterminate IGRA was reported in four CD patients on IST. Follow-up tests after anti-TNFα identified conversion in 8.62% using TST and 20.0% using IGRA. Considering IGRA as a criterion standard, TST showed low sensitivity (19.05%) and positive predictive value (PPV) (21.05%). LTBI detection remarkably improved when IGRA was added to TST (sensitivity of 80.95% and PPV of 53.13%). Results were particularly relevant among CD patients where rates started from zero to reach sensitivity and PPV of more than 60%.
Conclusion
IGRA alone was more effective to detect LTBI than TST alone and had an overall remarkable added value as an add-on sequential test, particularly in CD patients. While cost-effectiveness of these strategies remains to be evaluated, IGRA appears to be justified in CD prior to and during anti-TNFα therapy, where tuberculosis is endemic.
Details
- Title: Subtitle
- Superiority of Interferon Gamma Assay Over Tuberculin Skin Test for Latent Tuberculosis in Inflammatory Bowel Disease Patients in Brazil
- Creators
- Renata F Amorim - Department of Gastroenterology, The State University of Rio de Janeiro, Rio de Janeiro, RJ, BrazilEduardo R C Viegas - Universidade do Estado do Rio de JaneiroAntonio José V Carneiro - Universidade Federal do Rio de JaneiroBarbara C Esberard - Universidade do Estado do Rio de JaneiroEvelyn S Chinem - Universidade do Estado do Rio de JaneiroRaquel S Correa - Universidade do Estado do Rio de JaneiroLuciana Rodrigues - Universidade do Estado do Rio de JaneiroMarcelo Ribeiro-Alves - Instituto Evandro ChagasKelly S Silva - Department of Gastroenterology, The State University of Rio de Janeiro, Rio de Janeiro, RJ, BrazilHeitor S de Souza - Universidade Federal do Rio de JaneiroAna Teresa P Carvalho - Universidade do Estado do Rio de Janeiro
- Resource Type
- Journal article
- Publication Details
- Digestive diseases and sciences, Vol.64(7), pp.1916-1922
- DOI
- 10.1007/s10620-019-5475-3
- PMID
- 30673986
- NLM abbreviation
- Dig Dis Sci
- ISSN
- 0163-2116
- eISSN
- 1573-2568
- Publisher
- Springer Nature
- Language
- English
- Date published
- 07/01/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985175013102771
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