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Screening for Tuberculosis Infection in Spanish Healthcare Workers Comparison of the QuantiFERON-TB Gold In-Tube Test with the Tuberculin Skin Test

Published online by Cambridge University Press:  02 January 2015

Eva Elisa Àlvarez-León ,
Elizabeth Espinosa-Vega ,
Évora Santana-Rodríguez ,
Jesús M. Molina-Cabrillana ,
Jose Luis Pérez-Arellano ,
Jose Antonio Caminero  and
Pedro Serrano-Aguilar
Eva Elisa Àlvarez-León*
Affiliation:
Preventive Medicine Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
Elizabeth Espinosa-Vega
Affiliation:
Microbiology Service, Hospital Universitario Insular de Gran Canaria, Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
Évora Santana-Rodríguez
Affiliation:
Microbiology Service, Hospital Universitario Insular de Gran Canaria, Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
Jesús M. Molina-Cabrillana
Affiliation:
Preventive Medicine Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
Jose Luis Pérez-Arellano
Affiliation:
Infectious Diseases and Tropical Medicine Unit, Hospital Universitario Insular de Gran Canaria, Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
Jose Antonio Caminero
Affiliation:
Neumology Service, Hospital Universitario Dr. Negrin, Las Palmas, Gran Canaria, Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
Pedro Serrano-Aguilar
Affiliation:
Planning and Evaluation Unit, Canary Health Service, Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
*
Medicina Preventiva, Planta 10N, Hospital Insular, Avenida Maritima del sur, 35016 Las Palmas GC, Spain( [email protected])
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Abstract

Objective.

The risk of latent tuberculosis (LTBI) in healthcare workers (HCWs) is high. Until recently, the tuberculin skin test (TST) was the only diagnostic test available for Mycobacterium tuberculosis infection. A new enzyme-linked immunosorbent assay test, the QuantiFERON-TB Gold (QFT-G) test, was recommended by the US Centers for Disease Control and Prevention as an alternative test for the diagnosis of LTBI in HCWs. The purpose of our study was to compare the TST and the QFT-G test in Spanish HCWs in order to improve procedures for the detection of LTBI.

Methods.

A cross-sectional study with blinded comparison of TST and QFT-G test results was carried out among 134 HCWs at an 800-bed Spanish university hospital. The level of interferon-7 production stimulated by the QFT-G test was measured. A concentration of at least 0.35 IU/mL was considered a positive result. An induration of at least 5 mm in non-BCG-vaccinated or at least 15 mm in BCG-vaccinated HCWs for the TST was considered positive.

Results.

Of the 134 HCWs included (mean age, 33.4 years; 101 [75.4%] women; 47 [35.1%] BCG vaccinated), the LTBI prevalence diagnosed with any test was 11.2% (95% confidence interval, 6.6%-18.1%), with the TST was 8.96%, and with the QFT-G test was 5.97% (nonsignificant differences). The QFT-G test value was higher in subjects with TST induration of at least 15 mm than in subjects with TST induration of less than 15 mm (P < .001). Overall agreement between the results of the two tests was found in 94% of HCWs (K = 0.56), but agreement was only 59% in HCWs who had a positive result for both tests. Disagreement was present in the results found for 5% of HCWs.

Conclusions.

Few studies have compared both tests in populations with high M. tuberculosis exposure but low BCG vaccination prevalence. Agreement between both tests is high, especially among negative Results. Studies are needed to clarify the reasons for disagreement and to establish the best TST and QFT-G test cutoff point.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 9 , September 2009 , pp. 876 - 883
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Grupo de Trabajo, de PMIT. Incidence of tuberculosis in Spain: results of the Multicenter Project of Tuberculosis Research (MPTR). Work Group of the MPTR. Med Clin (Bare) 2000;114:530–537.Google Scholar
2.Cascante, JA, Hueto, J. Tuberculosis comò enfermedad profesional. An Sist Sanit Navar 2005;28(Suppl 1):107–115.CrossRefGoogle Scholar
3.Rullân, JV, Herrera, D, Cano, R, et al.Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in Spain. Emerg Infect Dis 1996;2:125–129.CrossRefGoogle ScholarPubMed
4.Grupo de Trabajo del Àrea TIR de SEPAR. SEPAR guidelines. Guidelines for tuberculosis prevention. Arch Bronconeumol 2002;38:441–451.Google Scholar
5.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR Recomm Rep 1994;43:1–132.Google Scholar
6.Pai, M, Kalantri, S, Dheda, K. New tools and emerging technologies for the diagnosis of tuberculosis: part I. Latent tuberculosis. Expert Rev Mol Diagn 2006;6:413–422.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54:1–141.Google Scholar
8.Diel, R, Loddenkemper, R, Meywald-Walter, K, Niemann, S, Nienhaus, A. Predictive value of a whole-blood IFN-gamma assay for the development of active TB disease. Am J Respir Crit Care Med 2008;177:1164–1170.CrossRefGoogle Scholar
9.National Collaborating Centre for Chronic Conditions. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London: Royal College of Physicians, 2006. Available at http://www.nice.org.uk/guidance/CG33. Accessed September 4, 2008.Google Scholar
10.Mazurek, GH, Jereb, J, Lobue, P, Iademarco, MF, Metchock, B, Vernon, A; Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC). Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005;54:49–55.Google ScholarPubMed
11.Ferrara, G, Losi, M, D'Amico, R, et al.Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study. Lancet 2006;367:1328–1334.CrossRefGoogle ScholarPubMed
12.Wang, L, Turner, MO, Elwood, RK, Schulzer, M, FitzGerald, JM. A metaanalysis of the effect of Bacille Calmette Guérin vaccination on tuberculin skin test measurements. Thorax 2002;57:804–809.CrossRefGoogle ScholarPubMed
13.American Thoracic Society, Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247.Google Scholar
14.Moreno, S, Blázquez, R, Novoa, A, et al.The effect of BCG vaccination on tuberculin reactivity and the booster effect among hospital employees. Arch Intern Med 2001;161:1760–1765.CrossRefGoogle ScholarPubMed
15.Puyuelo-Lanao, T, Hernández-Martínez, E, Gatell-Artigas, JM, Soriano-Marín, E, Agustí-Vidal, A. Prevalencia de infectión tuberculosa en personal sanitario. Med Clin (Bare) 1989;92:564–566.Google Scholar
16.Zarzuela-Ramírez, M, Córdoba-Dona, JA, Perea-Milla, E, Benítez-Rodríguez, E, Escolar-Pujolar, A, López-Fernández, FJ. Factors associated with tuberculin conversion among staff at a university-affiliated hospital. Infect Control Hosp Epidemiol 1999;20:589–590.CrossRefGoogle Scholar
17.Pai, M, Gokhale, K, Joshi, R, et al.Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. JAMA 2005;293:2746–2755.CrossRefGoogle ScholarPubMed
18.Menzies, D, Joshi, R, Pai, M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 2007;11:593–605.Google ScholarPubMed
19.Mirtskhulava, V, Kempker, R, Shields, KL, et al.Prevalence and risk factors for latent tuberculosis infection among health care workers in Georgia. Int J Tuberc Lung Dis 2008;12:513–519.Google ScholarPubMed
20.Ciaschetti, A, Franchi, A, Richeldi, L, et al.Screening of latent tuberculosis infection in health care workers by QuantiFERON-TB and tuberculin skin test. G Ital Med Lav Ergon 2007;29:406–407.Google ScholarPubMed
21.Soborg, B, Andersen, AB, Larsen, HK, et al.Detecting a low prevalence of latent tuberculosis among health care workers in Denmark detected by M. tuberculosis specific IFN-gamma whole-blood test. Scand J Infect Dis 2007;39:554–559.CrossRefGoogle Scholar
22.Harada, N, Nakajima, Y, Higuchi, K, Sekiya, Y, Rohel, J, Mori, T. Screening for tuberculosis infection using whole-blood interferon-7 and Mantoux testing among Japanese healthcare workers. Infect Control Hosp Epidemiol 2006;27:442–448.CrossRefGoogle Scholar
23.Menzies, D, Pai, M, Comstock, G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection—areas of uncertainty and recommendations for research. Ann Intern Med 2007;146:340–354.CrossRefGoogle ScholarPubMed
24.Lee, SS, Liu, YC, Huang, TS, et al.Comparison of the interferon-gamma release assay and the tuberculin skin test for contact investigation of tuberculosis in BCG-vaccinated health care workers. Scand J Infect Dis 2008;40:373–380.Google ScholarPubMed
25.Kang, YA, Lee, HW, Yoon, HI, et al.Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005;293:2756–2761.CrossRefGoogle Scholar
26.Kobashi, Y, Obase, Y, Fukuda, M, Yoshida, K, Miyashita, N, Oka, M. Clinical reevaluation of the QuantiFERON TB-2G test as a diagnostic method for differentiating active tuberculosis from nontuberculous mycobac-teriosis. Clin Infect Dis 2006;43:1540–1546.CrossRefGoogle Scholar
27.Pollock, NR, Campos-Neto, A, Kashino, S, et al.Discordant QuantiFERON-TB Gold test results among US healthcare workers with increased risk of latent tuberculosis infection: a problem or solution? Infect Control Hosp Epidemiol 2008;29:878–886.CrossRefGoogle ScholarPubMed
28.Pai, M, Menzies, D. The new IGRA and the old TST: making good use of disagreement. Am J Respir Crit Care Med 2007;175:529–531.CrossRefGoogle ScholarPubMed
29.Veerapathran, A, Joshi, R, Goswami, K, et al.T-cell assays for tuberculosis infection: deriving cut-offs for conversions using reproducibility data. PLoS ONE 2008;3:e1850.CrossRefGoogle ScholarPubMed
30.Perry, S, Sanchez, L, Yang, S, Agarwal, Z, Hurst, P, Parsonnet, J. Reproducibility of QuantiFERON-TB Gold in-tube assay. Clin Vaccine Immunol 2008;15:425–432.CrossRefGoogle ScholarPubMed
31.Higuchi, K, Harada, N, Fukazawa, K, Mori, T. Relationship between whole-blood interferon-gamma responses and the risk of active tuberculosis. Tuberculosis 2008;88:244–248.CrossRefGoogle ScholarPubMed
32.Diel, R, Loddenkemper, R, Meywald-Walter, K, Niemann, S, Nienhaus, A. Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis. Am J Respir Crit Care Med 2008;177:1164–1170.CrossRefGoogle ScholarPubMed