Miguel Arias-Guillén1, Sabino Riestra, Ruth de Francisco, Juan José Palacios, José Belda, Patricio Escalante, Isabel Pérez-Martínez, Luis M Molinos, Marta Garcia-Clemente, Ana Pando-Sandoval, Luis Rodrigo, Amador Prieto, Pablo Martínez-Camblor, Ana Losada, Pere Casan. 1. *Department of Respiratory Medicine, Instituto Nacional de Silicosis, Hospital Universitario Central de Asturias, Oviedo, Spain; †Department of Digestive Diseases, Hospital Universitario Central de Asturias, Oviedo, Spain; ‡Department of Microbiology, Mycobacterial Reference Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; §Department of Respiratory Medicine, Hospital Arnau de Villanova, Valencia, Spain; ‖Division of Pulmonary and Critical Care Medicine and Mayo Clinic Center for Tuberculosis, Mayo Clinic, Rochester, Minnesota; ¶Department of Radiology, Hospital Universitario Central de Asturias, Oviedo; and **Oficina de Investigación Biosanitaria, Hospital Universitario Central de Asturias, Oviedo, Spain.
Abstract
BACKGROUND: Factors associated with performance of interferon-γ release assays (IGRA) and the tuberculin skin test (TST) in screening for latent tuberculosis infection in patients with inflammatory bowel diseases (IBD) are still poorly understood. The influence of peripheral T-cell subset counts on the results also remain unclear. METHODS: Prospective single-center study in 205 patients with IBD. Latent tuberculosis infection screening included a chest radiograph, TST (retest if negative), and 2 IGRAs: QuantiFERON-TB Gold In-Tube (QFT-GIT) and TSPOT-TB (TSPOT). T-cell subpopulations were determined by flow cytometry. RESULTS: Twenty-one (10.2%) patients had an abnormal chest radiograph, 55 (26.8%) had a positive TST, 16 (7.8%) had a positive QFT-GIT, and 25 (12.6%) had a positive TSPOT. TST positivity was lower in patients on ≥2 immunosuppressants compared with the controls (5-aminosalicylic acid treatment) (10.4% versus 38.2%, respectively) (P = 0.0057). No other drugs influenced TST or IGRA positivity. In patients on corticosteroid treatment, anti-TNF treatment, or ≥2 immunosuppressants, IGRAs detected 10 cases of latent tuberculosis infection not identified by TST. TSPOT and QFT-GIT increased yield by 56% and 22%, respectively. No significant differences in T-cell subpopulations were found between patients with positive or negative TST or TSPOT results. However, patients with positive QFT-GIT findings had more CD8 T cells (mean, 883 ± 576 versus 484 ± 385 cells per microliter in patients with negative results) (P = 0.022). CONCLUSIONS: IGRAs can improve TST-based screening in patients with IBD on immunosuppressive therapy. A low CD8 count can affect QFT-GIT results. We suggest combining TSPOT and TST screening in patients with IBD on immunosuppressants.
BACKGROUND: Factors associated with performance of interferon-γ release assays (IGRA) and the tuberculin skin test (TST) in screening for latent tuberculosis infection in patients with inflammatory bowel diseases (IBD) are still poorly understood. The influence of peripheral T-cell subset counts on the results also remain unclear. METHODS: Prospective single-center study in 205 patients with IBD. Latent tuberculosis infection screening included a chest radiograph, TST (retest if negative), and 2 IGRAs: QuantiFERON-TB Gold In-Tube (QFT-GIT) and TSPOT-TB (TSPOT). T-cell subpopulations were determined by flow cytometry. RESULTS: Twenty-one (10.2%) patients had an abnormal chest radiograph, 55 (26.8%) had a positive TST, 16 (7.8%) had a positive QFT-GIT, and 25 (12.6%) had a positive TSPOT. TST positivity was lower in patients on ≥2 immunosuppressants compared with the controls (5-aminosalicylic acid treatment) (10.4% versus 38.2%, respectively) (P = 0.0057). No other drugs influenced TST or IGRA positivity. In patients on corticosteroid treatment, anti-TNF treatment, or ≥2 immunosuppressants, IGRAs detected 10 cases of latent tuberculosis infection not identified by TST. TSPOT and QFT-GIT increased yield by 56% and 22%, respectively. No significant differences in T-cell subpopulations were found between patients with positive or negative TST or TSPOT results. However, patients with positive QFT-GIT findings had more CD8 T cells (mean, 883 ± 576 versus 484 ± 385 cells per microliter in patients with negative results) (P = 0.022). CONCLUSIONS: IGRAs can improve TST-based screening in patients with IBD on immunosuppressive therapy. A low CD8 count can affect QFT-GIT results. We suggest combining TSPOT and TST screening in patients with IBD on immunosuppressants.
Authors: Sabino Riestra; Carlos Taxonera; Yamile Zabana; Daniel Carpio; María Chaparro; Jesús Barrio; Montserrat Rivero; Antonio López-Sanroman; María Esteve; Ruth de Francisco; Guillermo Bastida; Santiago García-López; Miriam Mañosa; María Dolores Martin-Arranz; José Lázaro Pérez-Calle; Jordi Guardiola; Fernando Muñoz; Laura Arranz; José Luis Cabriada; Mariana Fe García-Sepulcre; Mercè Navarro; Miguel Ángel Montoro-Huguet; Elena Ricart; Fernando Bermejo; Xavier Calvet; Marta Piqueras; Esther Garcia-Planella; Lucía Márquez; Miguel Mínguez; Manuel Van Domselar; Luis Bujanda; Xavier Aldeguer; Beatriz Sicilia; Eva Iglesias; Guillermo Alcaín; Isabel Pérez-Martínez; Valeria Rolle; Andrés Castaño-García; Javier P Gisbert; Eugeni Domènech Journal: J Clin Med Date: 2022-07-05 Impact factor: 4.964