Performance of two interferon-gamma release assays for tuberculosis infection screening in Kawasaki children before immunosuppressive therapy

Hao Chen; Huiwen Zheng; Lang Cui; Jing Xiao; Feina Li; Yonghong Wang; Yajie Guo; Yuying Chen; Yue Yuan; Chen Shen

doi:10.3389/fped.2023.1162547

Performance of two interferon-gamma release assays for tuberculosis infection screening in Kawasaki children before immunosuppressive therapy

Front Pediatr. 2023 May 18:11:1162547. doi: 10.3389/fped.2023.1162547. eCollection 2023.

Authors

Hao Chen^#¹, Huiwen Zheng^#¹, Lang Cui^#², Jing Xiao¹, Feina Li¹, Yonghong Wang¹, Yajie Guo¹, Yuying Chen¹, Yue Yuan², Chen Shen¹

Affiliations

¹ Laboratory of Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, China.
² Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.

^# Contributed equally.

Abstract

Objective: We aimed to compare QuantiFERON-TB Gold In-Tube (QFT-GIT) and X.DOT-TB for screening latent tuberculosis infection (LTBI) in kawasaki patients, and to identify the risk factors associated with indeterminate IGRA results.

Methods: We conducted a retrospective study on children with KD, who were screened for mycobacterium tuberculosis (Mtb) infection by either ELISA-based QFT-GIT or ELISPOT-based X.DOT-TB tests, admitted in Department of Cardiology, Beijing Children's Hospital from July 2019 to April 2022.

Results: A total of 1327 cases were included. Among them, 932 cases were tested by QFT-GIT and 395 cases by X.DOT-TB. The positive rate of children was 0.1% and 0.2%, and the indeterminate rate was 68.2% and 6.1% for QFT-GIT and X.DOT-TB, respectively. Patients with hypoproteinemia had a higher risk of indeterminate X.DOT-TB result. Female, critical ill, shock or hypoproteinemia presented statistically significant associations with an increased risk of indeterminate QFT-GIT result. High-dose of IVIG inhibited the release of IFN-γ by more than 90%, which might account for the high indeterminate incidence.

Conclusion: It is recommended to perform X.DOT-TB rather than QFT-GIT to screen LTBI in patients with high level of the mitogen that can inhibit IFN-γ release. For KD children with positive IGRA results, it has a higher risk of activation TB infection when treated with immunosuppressive therapy in the future. Children with KD aged <5 years old had higher frequency of indeterminate IGRA results.

Keywords: Kawasaki disease; children; immunosuppressive therapy; interferon-gamma release assays; tuberculosis.

Grants and funding

This work was supported by Beijing Natural Science Foundation (7224328, 702043), high-level public health technical personnel construction project training plan (subject backbone-02-33).