Influencial factors of the performance of interferon-γ release assays in the diagnosis of childhood tuberculosis

Clin Exp Med. 2015 Aug;15(3):303-9. doi: 10.1007/s10238-014-0296-3. Epub 2014 Jun 13.

Abstract

Diagnosis of active tuberculosis (TB) in children remains difficult. This study aimed at evaluating the ability of interferon-gamma release assays (IGRAs) in the detection of active TB in human immunodeficiency virus-negative children vaccinated with Bacille Calmette-Guérin and investigating the effect of prednisolone treatment on the IGRAs performance. Among the 162 children with suspected TB disease recruited in China, 60 were tested with QuantiFERON-TB Gold In Tube (QFT-GIT) and 102 were tested with T-SPOT.TB. QFT-GIT presented a sensitivity of 83.9 % (95 % CI 66.9-93.4 %) and a specificity of 88.5 % (95 % CI 70.2-96.8 %), while T-SPOT.TB had a sensitivity of 75.9 % (95 % CI 63.4-85.2 %) and a specificity of 94.7 % (95 % CI 81.8-99.5 %). The positive predictive value was high in both assays, 92.9 % for QFT-GIT and 95.7 % for T-SPOT.TB. In total of these two kinds of IGRAs, false negative rate was significantly higher in children receiving systemic prednisolone (1 mg/kg/day) therapy for >1 week (two tested with T-SPOT.TB and five tested with QFT-GIT) than in those with ≤1 week of prednisolone therapy and without prednisolone therapy (57.1 vs. 18.3 %, p = 0.035). There was no significant difference of the positive rate of both tests in children <5 years old compared with those ≥5 years old. Both types of IGRAs showed good diagnostic values in detecting childhood TB before microbiological evidence was available. Glucocorticoids had a significant negative influence on IGRAs if treated for >1 week. Age made no difference on the performance of these tests in children.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents / therapeutic use*
  • Child
  • Child, Preschool
  • China
  • False Negative Reactions
  • Female
  • HIV
  • Humans
  • Infant
  • Interferon-gamma Release Tests / methods*
  • Male
  • Predictive Value of Tests
  • Prednisolone / therapeutic use*
  • Sensitivity and Specificity
  • Tuberculosis / diagnosis*

Substances

  • Anti-Inflammatory Agents
  • Prednisolone