Details

Autor(en) / Beteiligte

• Bakir, Mustafa
• Dosanjh, Davinder P. S.
• Deeks, Jonathan J.
• Soysal, Ahmet
• Millington, Kerry A.
• Efe, Serpil
• Aslan, Yasemin
• Polat, Dilek
• Kodalli, Nihat
• Yagci, Aysegul
• Barlan, Isil
• Bahceciler, Nerin
• Demiralp, Emel E.
• Lalvani, Ajit

Titel

Use of T Cell-Based Diagnosis of Tuberculosis Infection to Optimize Interpretation of Tuberculin Skin Testing for Child Tuberculosis Contacts

Ist Teil von

• Clinical infectious diseases, 2009-02, Vol.48 (3), p.302-312

Ort / Verlag

Oxford: The University of Chicago Press

Erscheinungsjahr

2009

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Background. Treatment of recent tuberculosis infection in children aged <2 years is essential, because of high risk of progression to disease, but diagnosis is hindered by the inaccuracy of the tuberculin skin test (TST). More-accurate T cell–based tests of infection could enhance diagnosis by optimizing interpretation of the TST results. Methods. A total of 979 child tuberculosis contacts in Istanbul underwent the TST and enzyme-linked immunospot assay. Using enzyme-linked immunospot test results as a reference standard, we assessed the effect of age and bacille Calmette-Guérin (BCG) vaccination on the sensitivity and specificity of the TST, and we computed the optimal TST cutoff points, using receiver operating characteristic curves. Results. With a TST cutoff point of ⩾10 mm, the sensitivity of the TST was 66% for children aged <2 years, which was lower than that for older children (P=.006). Specificity was 75% for BCG-vaccinated children, compared with 92% for unvaccinated children (P=.001). Optimal cutoff points improved TST specificity for children with 1 BCG scar, with little loss of sensitivity. Despite the use of optimal cutoff points, TST sensitivity remained <70% for children aged <2 years, specificity remained <87% for BCG-vaccinated children aged ⩾2 years, and overall accuracy was low for children with >1 BCG scar. Conclusions. Negative results of the TST cannot exclude tuberculosis infection for child tuberculosis contacts aged <2 years, which supports the use of preventive therapy regardless of the TST results for this age group. In children aged ⩾2 years, the accuracy of the TST can be improved by adjustment of cutoff points for BCG-vaccinated children but remains poor for children with >1 BCG scar. This methodology can define optimal TST cutoff points for diagnosis of tuberculosis infection tailored to target populations.