Thomas E Gamsky1,2, Thomas Lum3, Melody Hung-Fan4, Jon A Green3,2. 1. 1 Contra Costa County Employee Occupational Medicine Clinic, Department of Health Services, Division of Public Health, Martinez, California. 2. 2 Veterans Affairs Northern California Health Care System, Martinez, California. 3. 3 East Bay Institute for Research and Education, Rancho Cordova, California. 4. 4 Contra Costa County Public Health Laboratory, Department of Health Services, Martinez, California; and.
Abstract
RATIONALE: Despite reports of unreliability, the QuantiFERON-TB interferon-γ release assay is increasingly used for the annual screening of individuals at risk for latent tuberculosis. Continued use of the QuantiFERON-TB assay suggests the need for more definitive evidence of its reproducibility and accuracy. OBJECTIVES: To examine reproducibility and the accumulation of false-positive test results when the QuantiFERON-TB is repeated annually and to examine the validity of confirming positive test results with the performance of a second QuantiFERON-TB. METHODS: We performed a retrospective, longitudinal evaluation of results from serial screening of a cohort of emergency responders from 2001 to 2013. MEASUREMENTS AND MAIN RESULTS: Results of tuberculin tests and QuantiFERON-TB tests performed annually as part of a mandated first responder examination were retroactively reviewed. In this population, positive results occurred in new individuals each year. QuantiFERON-TB results were positive in 80 of 557 tuberculin test-negative individuals examined annually for a maximum of 7 years. Only 10 individuals with initially positive results remained positive when the test was repeated the next year, and 9 of these 10 were QuantiFERON-TB-negative within 3 years. The number of individuals with a positive result increased annually, and, after 7 years, 32 (27.4%) of 117 people had a positive result. CONCLUSIONS: When viewed in the context of the extensive literature documenting unreliable QuantiFERON-TB test performance, our findings of frequent, cumulative, sporadic, and irreproducible positive results support discontinuing the use of the QuantiFERON-TB assay for the diagnosis of latent tuberculosis in low-risk populations.
RATIONALE: Despite reports of unreliability, the QuantiFERON-TB interferon-γ release assay is increasingly used for the annual screening of individuals at risk for latent tuberculosis. Continued use of the QuantiFERON-TB assay suggests the need for more definitive evidence of its reproducibility and accuracy. OBJECTIVES: To examine reproducibility and the accumulation of false-positive test results when the QuantiFERON-TB is repeated annually and to examine the validity of confirming positive test results with the performance of a second QuantiFERON-TB. METHODS: We performed a retrospective, longitudinal evaluation of results from serial screening of a cohort of emergency responders from 2001 to 2013. MEASUREMENTS AND MAIN RESULTS: Results of tuberculin tests and QuantiFERON-TB tests performed annually as part of a mandated first responder examination were retroactively reviewed. In this population, positive results occurred in new individuals each year. QuantiFERON-TB results were positive in 80 of 557 tuberculin test-negative individuals examined annually for a maximum of 7 years. Only 10 individuals with initially positive results remained positive when the test was repeated the next year, and 9 of these 10 were QuantiFERON-TB-negative within 3 years. The number of individuals with a positive result increased annually, and, after 7 years, 32 (27.4%) of 117 people had a positive result. CONCLUSIONS: When viewed in the context of the extensive literature documenting unreliable QuantiFERON-TB test performance, our findings of frequent, cumulative, sporadic, and irreproducible positive results support discontinuing the use of the QuantiFERON-TB assay for the diagnosis of latent tuberculosis in low-risk populations.
Entities:
Keywords:
interferon-γ release tests; latent tuberculosis; reproducibility of results; tuberculin; tuberculin test
Authors: Betty A Forbes; Geraldine S Hall; Melissa B Miller; Susan M Novak; Marie-Claire Rowlinson; Max Salfinger; Akos Somoskövi; David M Warshauer; Michael L Wilson Journal: Clin Microbiol Rev Date: 2018-01-31 Impact factor: 26.132
Authors: Jerker Jonsson; Anna Westman; Judith Bruchfeld; Erik Sturegård; Hans Gaines; Thomas Schön Journal: PLoS One Date: 2017-11-02 Impact factor: 3.240
Authors: Steven B Welch; Marc Tebruegge; Alasdair Bamford; Garth Dixon; Nigel Klein; Stephen D Marks; Nicole Ritz Journal: Pediatr Nephrol Date: 2020-11-27 Impact factor: 3.714