Summary
Objectives
QuantiFERON value to diagnose tuberculosis (TB) in young children remains to be clarified.
To this aim QF-TB-IT performance was evaluated in a large series of immunocompetent
children that were stratified according to age and clinical conditions.
Methods
QF-TB-IT reactivity was analyzed in 226 immunocompetent children (0–15 years old):
31 were uninfected despite TB contact; 51 presented TB disease; 39 had Latent TB (LTBI)
and 105 had TB disease suspected but an alternative diagnosis (TB excluded).
Results
QF-TB-IT specificity was 100% in TB excluded. In TB disease, low sensitivity of QF-TB-IT
in infants (40%) increased with aging (77% in 1–<5 years and 82% in 5–<15 years old
subgroups). In LTBI, agreement between TST and QF-TB-IT was 0% in infants, 40% in
1–<5 years and 57% in children >5 years old. Finally, the incidence of indeterminate
results was high (24%) in children <5 years old with TB excluded, especially with
non-TB pneumonitis (61%), but was low (0–6%) regardless of age group in TB disease,
LTBI and uninfected contact cases.
Conclusions
In our low burden country, i) QF-TB-IT specificity was 100%, ii) QF-TB-IT sensitivity
was low in infants but commensurable to adult values in older children, and iii) indeterminate
results mostly relied on ongoing infections unrelated to TB.
Keywords
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References
- Childhood pulmonary tuberculosis: old wisdom and new challenges.Am J Respir Crit Care Med. 2006; 173 ([Epub 2006/02/18]): 1078-1090
- Childhood tuberculosis: out of control?.Curr Opin Pulm Med. 2002; 8 ([Epub 2002/05/01]): 178-182
- Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research.Ann Intern Med. 2007; 146 ([Epub 2007/03/07]): 340-354
- Can we accurately diagnose tuberculosis infection in children?.Pediatr Infect Dis J. 2011; 30 ([Epub 2011/08/19]): 817-818
- The utility of an interferon gamma release assay for diagnosis of latent tuberculosis infection and disease in children: a systematic review and meta-analysis.Pediatr Infect Dis J. 2011; 30 ([Epub 2011/03/24]): 694-700
- Interferon gamma release assay in diagnosis of pediatric tuberculosis: a meta-analysis.FEMS Immunol Med Microbiol. 2011; 63 ([Epub 2011/11/15]): 165-173
- Interferon-gamma release assays for the diagnosis of Mycobacterium tuberculosis infection in children: a literature review.Int J Immunopathol Pharmacol. 2012; 25 ([Epub 2012/06/16]): 335-343
- Performance of commercial blood tests for the diagnosis of latent tuberculosis infection in children and adolescents.Pediatrics. 2009; 123 ([Epub 2009/03/04]): e419-e424
- From the American Academy of Pediatrics: policy statements – modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections.Pediatrics. 2009; 124 ([Epub 2009/09/09]): 1694-1701
- Elk Grove Village Committee on infectious Diseases: tuberculosis report of the Committee on infectious disease 28th. American Academy of Pediatrics, 2009: 686-687
- Interferon-gamma release assay improves the diagnosis of tuberculosis in children.Pediatr Infect Dis J. 2009; 28 ([Epub 2009/06/09]): 510-514
- Bacillus Calmette-Guerin (BCG) vaccine coverage in newborns and infants at risk before and after a change in BCG policy.Arch Pediatr. 2010; 17 ([Epub 2010/03/12]): 359-365
- Societe de Pneumologie de Langue Francaise: guidelines for the management of tuberculosis in France.Rev Mal Respir. 2004; 21 ([Epub 2004/06/24]): 414-420
- Interferon-gamma release assay performance for diagnosing tuberculosis disease in 0- to 5-year-old children.Pediatr Infect Dis J. 2011; 30 ([Epub 2011/06/23]): 995-997
- Tuberculin skin test and QuantiFERON(R) assay in young children investigated for tuberculosis in South Africa.Int J Tuberc Lung Dis. 2011; 15 (i. [Epub 2011/09/29]): 1176-1181
- Latent tuberculosis diagnosis in children by using the QuantiFERON-TB Gold In-Tube test.Pediatrics. 2009; 123 ([Epub 2009/01/02]): 30-37
- The effect of age on whole blood interferon-gamma release assay response among children investigated for latent tuberculosis infection.J Pediatr. 2012; 161 ([Epub 2012/05/29]): 632-638
- Diagnosis and treatment of tuberculosis in children.Lancet Infect Dis. 2003; 3 ([Epub 2003/10/03]): 624-632
- Disseminated tuberculosis in interferon gamma gene-disrupted mice.J Exp Med. 1993; 178 ([Epub 1993/12/01]): 2243-2247
- Complex cytokine profiles induced by BCG vaccination in UK infants.Vaccine. 2010; 28 ([Epub 2009/11/28]): 1635-1641
- Increased Interleukin-4 production by CD8 and gammadelta T cells in health-care workers is associated with the subsequent development of active tuberculosis.J Infect Dis. 2004; 190 ([Epub 2004/07/24]): 756-766
- Th2-polarisation of cellular immune memory to neonatal pertussis vaccination.Vaccine. 2010; 28 ([Epub 2010/01/26]): 2648-2652
- Comparison of interferon-gamma release assays and tuberculin skin test in predicting active tuberculosis (TB) in children in the UK: a paediatric TB network study.Arch Dis Child. 2010; 95 ([Epub 2009/10/10]): 180-186
- Interferon-gamma release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis.Clin Infect Dis. 2007; 45 ([Epub 2007/06/30]): 322-328
- Under what circumstances and how should latent tuberculosis be treated?.Rev Mal Respir. 2004; 21 ([Epub 2004/09/04]): S25-S34
- Comparison of T-SPOT.TB assay and tuberculin skin test for the evaluation of young children at high risk for tuberculosis in a community setting.Pediatrics. 2009; 123 ([Epub 2009/01/02]): 38-43
- Commercial interferon gamma release assays compared to the tuberculin skin test for diagnosis of latent Mycobacterium tuberculosis infection in childhood contacts in the Gambia.Pediatr Infect Dis J. 2010; 29 ([Epub 2010/01/14]): 439-443
- Malnutrition and helminth infection affect performance of an interferon gamma-release assay.Pediatrics. 2010; 126 ([Epub 2010/11/10]): e1522-e1529
- Chronic intestinal helminth infections are associated with immune hyporesponsiveness and induction of a regulatory network.Infect Immun. 2010; 78 ([Epub 2010/04/21]): 3160-3167
- Indeterminate results of QuantiFERON-TB Gold In-Tube assay in nonimmunosuppressed children.Arch Med Res. 2011; 42 ([Epub 2011/05/14]): 138-143
- The likelihood of an indeterminate test result from a whole-blood interferon-gamma release assay for the diagnosis of Mycobacterium tuberculosis infection in children correlates with age and immune status.Pediatr Infect Dis J. 2009; 28 ([Epub 2009/07/28]): 669-673
- Comparison of a whole blood interferon-gamma assay with tuberculin skin testing for the detection of tuberculosis infection in hospitalized children in rural India.J Infect. 2007; 54 ([Epub 2006/05/31]): 267-276
- Host biomarkers of clinical relevance in tuberculosis: review of gene and protein expression studies.Biomarkers. 2012; 17 ([Epub 2011/11/10]): 1-8
Article info
Publication history
Published online: June 24, 2013
Accepted:
June 12,
2013
Footnotes
☆This work was partly supported by Assistance Publique-Hôpitaux de Paris.
☆There was no grant to anyone for this study.
☆The authors declare that they have no conflict of interest in publishing this article.
☆Adeline Blandinières and Nadège Gourgouillon performed the retrospective analysis of QuantiFERON data.
☆Agathe de Lauzanne and Hélène See took care of the patients and collected clinical data.
☆Valérie Guérin-El Khourouj and Béatrice Pédron performed and validated immunological investigation.
☆Albert Faye and Ghislaine Sterkers designed the study (clinical part Albert Faye and immunological part Ghislaine Sterkers) and wrote the manuscript.
☆Ghislaine Sterkers wrote the first draft of the manuscript. The manuscript has been corrected for language by http://www.proof-reading-service.com.
☆Each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.
Identification
Copyright
© 2013 The British Infection Association. Published by Elsevier Inc. All rights reserved.
