Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases

Bolette Soborg; Morten Ruhwald; Merete Lund Hetland; Søren Jacobsen; Aase Bengaard Andersen; Nils Milman; Vibeke Ostergaard Thomsen; Dorte Vendelbo Jensen; Anders Koch; Jan Wohlfahrt; Pernille Ravn

doi:10.3899/jrheum.081292

Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases

Bolette Soborg, Morten Ruhwald, Merete Lund Hetland, Søren Jacobsen, Aase Bengaard Andersen, Nils Milman, Vibeke Ostergaard Thomsen, Dorte Vendelbo Jensen, Anders Koch, Jan Wohlfahrt, Pernille Ravn

48 Citations (Scopus)

Abstract

OBJECTIVE: To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression. METHODS: The interferon-gamma response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests. RESULTS: QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5-18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6-13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1-11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6-10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1-1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02-0.3, p = 0.002). CONCLUSION: The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.

Original language	English
Journal	Journal of Rheumatology
Volume	36
Issue number	9
Pages (from-to)	1876-84
Number of pages	8
ISSN	0315-162X
DOIs	https://doi.org/10.3899/jrheum.081292
Publication status	Published - 2009

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@article{44719d106a3d11df928f000ea68e967b,

title = "Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases",

abstract = "OBJECTIVE: To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression. METHODS: The interferon-gamma response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests. RESULTS: QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5-18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6-13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1-11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6-10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1-1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02-0.3, p = 0.002). CONCLUSION: The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.",

author = "Bolette Soborg and Morten Ruhwald and Hetland, {Merete Lund} and S{\o}ren Jacobsen and Andersen, {Aase Bengaard} and Nils Milman and Thomsen, {Vibeke Ostergaard} and Jensen, {Dorte Vendelbo} and Anders Koch and Jan Wohlfahrt and Pernille Ravn",

note = "Keywords: Adult; Aged; BCG Vaccine; Diagnostic Tests, Routine; Female; Humans; Immunosuppressive Agents; Male; Mass Screening; Middle Aged; Mycobacterium tuberculosis; Predictive Value of Tests; Rheumatic Diseases; Risk Factors; Sensitivity and Specificity; Tuberculin Test; Tuberculosis; Tumor Necrosis Factor-alpha",

year = "2009",

doi = "10.3899/jrheum.081292",

language = "English",

volume = "36",

pages = "1876--84",

journal = "Journal of Rheumatology",

issn = "0315-162X",

publisher = "Journal of Rheumatology Publishing Co. Ltd.",

number = "9",

}

TY - JOUR

T1 - Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases

AU - Soborg, Bolette

AU - Ruhwald, Morten

AU - Hetland, Merete Lund

AU - Jacobsen, Søren

AU - Andersen, Aase Bengaard

AU - Milman, Nils

AU - Thomsen, Vibeke Ostergaard

AU - Jensen, Dorte Vendelbo

AU - Koch, Anders

AU - Wohlfahrt, Jan

AU - Ravn, Pernille

N1 - Keywords: Adult; Aged; BCG Vaccine; Diagnostic Tests, Routine; Female; Humans; Immunosuppressive Agents; Male; Mass Screening; Middle Aged; Mycobacterium tuberculosis; Predictive Value of Tests; Rheumatic Diseases; Risk Factors; Sensitivity and Specificity; Tuberculin Test; Tuberculosis; Tumor Necrosis Factor-alpha

PY - 2009

Y1 - 2009

N2 - OBJECTIVE: To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression. METHODS: The interferon-gamma response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests. RESULTS: QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5-18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6-13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1-11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6-10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1-1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02-0.3, p = 0.002). CONCLUSION: The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.

AB - OBJECTIVE: To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression. METHODS: The interferon-gamma response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests. RESULTS: QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5-18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6-13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1-11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6-10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1-1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02-0.3, p = 0.002). CONCLUSION: The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.

U2 - 10.3899/jrheum.081292

DO - 10.3899/jrheum.081292

M3 - Journal article

C2 - 19648300

SN - 0315-162X

VL - 36

SP - 1876

EP - 1884

JO - Journal of Rheumatology

JF - Journal of Rheumatology

IS - 9

ER -

Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases

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