Silvia Garazzino1, Luisa Galli, Elena Chiappini, Michele Pinon, Barbara Maria Bergamini, Salvatore Cazzato, Paola Dal Monte, Icilio Dodi, Laura Lancella, Susanna Esposito, Lorenzo Iughetti, Carlotta Montagnani, Maurizio De Martino, Pier-Angelo Tovo. 1. From the *Department of Pediatrics, University of Turin, AOU Città della Salute e della Scienza, Regina Margherita Children's Hospital, Turin; †Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence; ‡Department of Pediatrics, University of Modena and Reggio Emilia, Modena; §Department of Pediatrics, University of Bologna, S. Orsola-Malpighi General Hospital, Bologna; ¶Unit of Microbiology, Department DIMES, University of Bologna, S. Orsola-Malpighi General Hospital, Bologna; ‖Pietro Barilla Children's Hospital, Parma; **Pediatrics and Infectious Diseases, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome; and ††Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
BACKGROUND: The diagnosis of latent or active tuberculosis in children is often challenging. Recently, interferon-γ release assays have been licensed, but their diagnostic accuracy in young children remains questionable as frequent false-negative or indeterminate results have been reported. METHODS: We performed a multicenter, retrospective study in children 0-24 months of age who were tested at least once with QuantiFERON-TB Gold-in-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice. RESULTS: Eight-hundred and twenty-three children (449 males, median age 13.5 months) were enrolled. QTF-IT sensitivity and specificity for active tuberculosis were 92.4% and 98.6%, respectively. Indeterminate tests (4.2 %) were not related to age (P = 0.838) or gender (P = 0.223); 32 children (91.4 %) with an indeterminate QTF-IT ultimately resulted uninfected. In the 616 subjects with valid paired results of QTF-IT and TST, sensitivity and specificity were comparable (91.1% vs. 85.1% and 98.1% vs. 97.9%, respectively). Diagnostic concordance between tests was higher in Bacillus Calmétte-Guerin nonvaccinated children (κ = 0.802). A high rate of discordant tests was observed in latent infections. CONCLUSIONS: QTF-IT showed good sensitivity and specificity, and a low rate of indeterminate results in the first 2 years of life, supporting its use at this age. However, considering costs and the similar performance between QTF-IT and TST, it is reasonable to suggest the latter as first-line testing in young children. The complementary use of TST and interferon-γ release assays may be considered in selected cases to improve the accuracy of testing.
BACKGROUND: The diagnosis of latent or active tuberculosis in children is often challenging. Recently, interferon-γ release assays have been licensed, but their diagnostic accuracy in young children remains questionable as frequent false-negative or indeterminate results have been reported. METHODS: We performed a multicenter, retrospective study in children 0-24 months of age who were tested at least once with QuantiFERON-TB Gold-in-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice. RESULTS: Eight-hundred and twenty-three children (449 males, median age 13.5 months) were enrolled. QTF-IT sensitivity and specificity for active tuberculosis were 92.4% and 98.6%, respectively. Indeterminate tests (4.2 %) were not related to age (P = 0.838) or gender (P = 0.223); 32 children (91.4 %) with an indeterminate QTF-IT ultimately resulted uninfected. In the 616 subjects with valid paired results of QTF-IT and TST, sensitivity and specificity were comparable (91.1% vs. 85.1% and 98.1% vs. 97.9%, respectively). Diagnostic concordance between tests was higher in Bacillus Calmétte-Guerin nonvaccinated children (κ = 0.802). A high rate of discordant tests was observed in latent infections. CONCLUSIONS:QTF-IT showed good sensitivity and specificity, and a low rate of indeterminate results in the first 2 years of life, supporting its use at this age. However, considering costs and the similar performance between QTF-IT and TST, it is reasonable to suggest the latter as first-line testing in young children. The complementary use of TST and interferon-γ release assays may be considered in selected cases to improve the accuracy of testing.
Authors: Jason R Andrews; Elisa Nemes; Michele Tameris; Bernard S Landry; Hassan Mahomed; J Bruce McClain; Helen A Fletcher; Willem A Hanekom; Robin Wood; Helen McShane; Thomas J Scriba; Mark Hatherill Journal: Lancet Respir Med Date: 2017-02-16 Impact factor: 30.700
Authors: Tan N Doan; Damon P Eisen; Morgan T Rose; Andrew Slack; Grace Stearnes; Emma S McBryde Journal: PLoS One Date: 2017-11-28 Impact factor: 3.240
Authors: Noëmi R Meier; Thomas Volken; Marc Geiger; Ulrich Heininger; Marc Tebruegge; Nicole Ritz Journal: Front Pediatr Date: 2019-05-29 Impact factor: 3.418