Bijan J Ghassemieh1, Engi F Attia1, David M Koelle2,3,4,5, James D Mancuso6, Masahiro Narita1,7,8, David J Horne1,4,7. 1. 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine. 2. 2 Division of Allergy and Infectious Diseases, Department of Medicine. 3. 3 Department of Laboratory Medicine. 4. 5 Department of Global Health, and. 5. 4 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 6. 6 Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and. 7. 7 Firland Northwest Tuberculosis Center, University of Washington, Seattle, Washington. 8. 8 TB Control Program, Public Health - Seattle & King County, Seattle, Washington.
Abstract
RATIONALE: Latent tuberculosis infection (LTBI) test discordance is poorly understood. OBJECTIVES: To determine the frequency and predictors of tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT) discordance in the U.S. METHODS: We analyzed data from a representative sample of the U.S. population ages 6 years and older who participated in the 2011-2012 National Health and Nutrition Examination Survey. We determined prevalence estimates of test positivity, calculated test agreement and kappa statistics, and performed multivariable logistic regression to determine predictors of discordance. MEASUREMENTS AND MAIN RESULTS: LTBI prevalence among the U.S. born ranged from 0.6% to 2.8%, depending on how LTBI was defined, with test agreement 97.0% and kappa 0.27 (95% confidence interval, 0.18-0.36). Prevalence among the foreign born ranged from 9.1% to 20.3%, depending on how LTBI was defined, with test agreement 81.6% and kappa 0.38 (95% confidence interval, 0.33-0.44). TST(+)/QFT(-) discordance was associated with age, male sex, black race, Mexican-American ethnicity, previous TB exposure, and past LTBI treatment in U.S.-born participants, but only with higher lymphocyte count in foreign-born participants. TST(-)/QFT(+) discordance was associated with older age, previous TB exposure, and past LTBI treatment in U.S.-born participants and with older age, male sex, and past LTBI treatment in foreign-born participants. CONCLUSIONS: In the largest population-based sample of concurrently performed TST and QFT tests in a low tuberculosis incidence population, prevalence estimates depended heavily on how LTBI was defined and test agreement was only fair. We identified several predictors of discordance warranting further study.
RATIONALE: Latent tuberculosis infection (LTBI) test discordance is poorly understood. OBJECTIVES: To determine the frequency and predictors of tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT) discordance in the U.S. METHODS: We analyzed data from a representative sample of the U.S. population ages 6 years and older who participated in the 2011-2012 National Health and Nutrition Examination Survey. We determined prevalence estimates of test positivity, calculated test agreement and kappa statistics, and performed multivariable logistic regression to determine predictors of discordance. MEASUREMENTS AND MAIN RESULTS: LTBI prevalence among the U.S. born ranged from 0.6% to 2.8%, depending on how LTBI was defined, with test agreement 97.0% and kappa 0.27 (95% confidence interval, 0.18-0.36). Prevalence among the foreign born ranged from 9.1% to 20.3%, depending on how LTBI was defined, with test agreement 81.6% and kappa 0.38 (95% confidence interval, 0.33-0.44). TST(+)/QFT(-) discordance was associated with age, male sex, black race, Mexican-American ethnicity, previous TB exposure, and past LTBI treatment in U.S.-born participants, but only with higher lymphocyte count in foreign-born participants. TST(-)/QFT(+) discordance was associated with older age, previous TB exposure, and past LTBI treatment in U.S.-born participants and with older age, male sex, and past LTBI treatment in foreign-born participants. CONCLUSIONS: In the largest population-based sample of concurrently performed TST and QFT tests in a low tuberculosis incidence population, prevalence estimates depended heavily on how LTBI was defined and test agreement was only fair. We identified several predictors of discordance warranting further study.
Entities:
Keywords:
United States; epidemiology; latent tuberculosis; test discordance
Authors: R Diel; D Goletti; G Ferrara; G Bothamley; D Cirillo; B Kampmann; C Lange; M Losi; R Markova; G B Migliori; A Nienhaus; M Ruhwald; D Wagner; J P Zellweger; E Huitric; A Sandgren; D Manissero Journal: Eur Respir J Date: 2010-10-28 Impact factor: 16.671
Authors: P Weinfurter; H M Blumberg; G Goldbaum; R Royce; J Pang; J Tapia; J Bethel; G H Mazurek; S Toney; R Albalak Journal: Int J Tuberc Lung Dis Date: 2011-08 Impact factor: 2.373
Authors: Kamran Khan; Jun Wang; Wei Hu; Arlene Bierman; Yukit Li; Michael Gardam Journal: Am J Respir Crit Care Med Date: 2007-11-20 Impact factor: 21.405
Authors: John Z Metcalfe; Adithya Cattamanchi; Charles E McCulloch; Justin D Lew; Ngan P Ha; Edward A Graviss Journal: Am J Respir Crit Care Med Date: 2012-10-26 Impact factor: 21.405
Authors: Roque Miramontes; Andrew N Hill; Rachel S Yelk Woodruff; Lauren A Lambert; Thomas R Navin; Kenneth G Castro; Philip A LoBue Journal: PLoS One Date: 2015-11-04 Impact factor: 3.240
Authors: M E Castellanos; S Kirimunda; L Martinez; T Quach; H Woldu; R Kakaire; A Handel; S Zalwango; N Kiwanuka; C C Whalen Journal: Int J Tuberc Lung Dis Date: 2018-09-01 Impact factor: 2.373
Authors: Christine S Ho; Pei-Jean I Feng; Masahiro Narita; Jason E Stout; Michael Chen; Lisa Pascopella; Richard Garfein; Randall Reves; Dolly J Katz Journal: Lancet Infect Dis Date: 2021-09-06 Impact factor: 25.071
Authors: Javier Leonardo Galindo; Adriana Catalina Galeano; David Alfonso Suarez-Zamora; Ana Milena Callejas; Mónica Patricia Caicedo-Verástegui; Darío Londoño; Luis Gerardo García-Herreros; Aylen Vanessa Ospina-Serrano; Alfredo Saavedra; Plutarco Garcíaherreros; Diana María Palacios; Margarita Baldión Journal: ERJ Open Res Date: 2019-10-15
Authors: Leonardo Martinez; Limei Zhu; Maria E Castellanos; Qiao Liu; Cheng Chen; Benjamin D Hallowell; Christopher C Whalen Journal: Clin Infect Dis Date: 2017-11-29 Impact factor: 9.079