Jennifer Lighter-Fisher1, Ann-Marie Surette. 1. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. lightj03@med.nyu.edu
Abstract
OBJECTIVE: To evaluate an interferon (IFN)-gamma release assay in diagnosing latent tuberculosis infection in pregnant adolescents and women at risk for exposure to Mycobacterium tuberculosis. METHODS: This was a prospective study of women and adolescents receiving health care at Bellevue Hospital Outpatient Clinics in New York City. Each patient was assessed for M tuberculosis risk factors, had a tuberculin skin test placed, and an IFN-gamma release assay performed. The concordance between the tuberculin skin test and the IFN-gamma release assay was calculated and the results analyzed according to the likelihood of exposure to M tuberculosis. Mean mitogen IFN-γ levels were used across groups to compare reliability between trimesters and assay performance in pregnant compared with nonpregnant females of childbearing age. RESULTS: A total of 140 pregnant and 140 nonpregnant females were enrolled in the study. The IFN-gamma release assay was highly specific, and IFN-gamma release assay positivity was associated with a greater likelihood of exposure to M tuberculosis. The overall agreement between the tuberculin skin test and IFN-gamma release assay results was 88% for all pregnant patients, corresponding to a κ of 0.452 (confidence interval 0.26-0.64). Interferon-γ release from the mitogen did not appear to have any temporal association with pregnancy trimester in cross-sectional or longitudinal studies. The IFN-gamma release assay performed equally well in pregnant and nonpregnant females. CONCLUSION: The IFN-gamma release assay performed equally well in each trimester of pregnancy with comparable results to nonpregnant females. Interferon-gamma release assays are much more specific, at least as sensitive, and may be a better predictor of disease progression than the tuberculin skin test. LEVEL OF EVIDENCE: : II.
OBJECTIVE: To evaluate an interferon (IFN)-gamma release assay in diagnosing latent tuberculosis infection in pregnant adolescents and women at risk for exposure to Mycobacterium tuberculosis. METHODS: This was a prospective study of women and adolescents receiving health care at Bellevue Hospital Outpatient Clinics in New York City. Each patient was assessed for M tuberculosis risk factors, had a tuberculin skin test placed, and an IFN-gamma release assay performed. The concordance between the tuberculin skin test and the IFN-gamma release assay was calculated and the results analyzed according to the likelihood of exposure to M tuberculosis. Mean mitogen IFN-γ levels were used across groups to compare reliability between trimesters and assay performance in pregnant compared with nonpregnant females of childbearing age. RESULTS: A total of 140 pregnant and 140 nonpregnant females were enrolled in the study. The IFN-gamma release assay was highly specific, and IFN-gamma release assay positivity was associated with a greater likelihood of exposure to M tuberculosis. The overall agreement between the tuberculin skin test and IFN-gamma release assay results was 88% for all pregnant patients, corresponding to a κ of 0.452 (confidence interval 0.26-0.64). Interferon-γ release from the mitogen did not appear to have any temporal association with pregnancy trimester in cross-sectional or longitudinal studies. The IFN-gamma release assay performed equally well in pregnant and nonpregnant females. CONCLUSION: The IFN-gamma release assay performed equally well in each trimester of pregnancy with comparable results to nonpregnant females. Interferon-gamma release assays are much more specific, at least as sensitive, and may be a better predictor of disease progression than the tuberculin skin test. LEVEL OF EVIDENCE: : II.
Authors: Sylvia M LaCourse; Lisa M Cranmer; Daniel Matemo; John Kinuthia; Barbra A Richardson; David J Horne; Grace John-Stewart Journal: J Acquir Immune Defic Syndr Date: 2017-05-01 Impact factor: 3.731
Authors: S Jonnalagadda; S M LaCourse; P Otieno; B Lohman-Payne; E Maleche-Obimbo; L M Cranmer; G C John-Stewart Journal: Int J Tuberc Lung Dis Date: 2015-07 Impact factor: 2.373