DOI QR코드

DOI QR Code

Poor agreement between QuantiFERON-TB Gold test and tuberculin skin test results for the diagnosis of latent tuberculosis infection in rheumatoid arthritis patients and healthy controls

  • Lee, Joo-Hyun (Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Sohn, Hae Sook (Department of Preventive Medicine, Inje University College of Medicine) ;
  • Chun, Jin Ho (Department of Preventive Medicine, Inje University College of Medicine) ;
  • Kim, Hyoun-Ah (Department of Rheumatology, Ajou University School of Medicine) ;
  • Suh, Chang Hee (Department of Rheumatology, Ajou University School of Medicine) ;
  • Lee, Yun Woo (Withus Medical Clinic) ;
  • Yoon, Bo Young (Department of Internal Medicine, Inje University Ilsan Paik Hospital)
  • Received : 2013.02.06
  • Accepted : 2013.04.15
  • Published : 2014.01.01

Abstract

Background/Aims: We investigated the agreement between the QuantiFERON-TB Gold (QFT-Gold) test and the tuberculin skin test (TST) in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis (RA), compared with healthy controls, in Korea. Methods: We recruited 64 patients with RA and 79 healthy controls at two university hospitals in South Korea. The participants underwent both the QFT-Gold test and the TST simultaneously between August 2006 and February 2009. All patients were diagnosed using the classification criteria for RA revised in 1987 by the American College of Rheumatology. Bacillus Calmette-Gu$\acute{e}$rin vaccination status and current medications were evaluated, and disease activities were assessed using the Disease Activity Score in 28 joints. Eleven patients with RA produced indeterminate QFT-Gold test results and were thus excluded from the kappa analysis. Results: Based on an induration of 10 mm in diameter as the TST cutoff value, the QFT-Gold test and TST demonstrated 75.0% agreement (${\kappa}$= 0.23) in patients with RA and 75.9% agreement (${\kappa}$= 0.19) in healthy controls. Among the 56 patients with RA who had negative TST results, 11 patients (17.2%) also yielded indeterminate QFT-Gold results. Conclusions: Our study showed poor agreement between the results of the QFT-Gold test and the TST in both RA patients and healthy controls. Based on these findings, we emphasize the importance of making clinical decisions in the diagnosis of latent tuberculosis in Koreans with or without RA.

Keywords

References

  1. Bieber J, Kavanaugh A. Consideration of the risk and treatment of tuberculosis in patients who have rheumatoid arthritis and receive biologic treatments. Rheum Dis Clin North Am 2004;30:257-270. https://doi.org/10.1016/j.rdc.2004.01.003
  2. World Health Organization. Tuberculosis (TB) [Internet]. Geneva (SW): World Health Organization, c2013 [cited 2005 May 4]. Available from: http://www.who.int/tb/en/.
  3. Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 2004;350:2060-2067. https://doi.org/10.1056/NEJMsa031667
  4. Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis 1993;17:968-975. https://doi.org/10.1093/clinids/17.6.968
  5. Ewer K, Deeks J, Alvarez L, et al. Comparison of T-cellbased assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet 2003;361:1168-1173. https://doi.org/10.1016/S0140-6736(03)12950-9
  6. Brock I, Weldingh K, Lillebaek T, Follmann F, Andersen P. Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts. Am J Respir Crit Care Med 2004;170:65-69. https://doi.org/10.1164/rccm.200402-232OC
  7. Mori T, Sakatani M, Yamagishi F, et al. Specific detection of tuberculosis infection: an interferon-gammabased assay using new antigens. Am J Respir Crit Care Med 2004;170:59-64. https://doi.org/10.1164/rccm.200402-179OC
  8. Mazurek GH, Villarino ME; CDC. Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection: Centers for Disease Control and Prevention. MMWR Recomm Rep 2003;52(RR-2):15-18.
  9. Mazurek GH, Jereb J, Lobue P, et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005;54(RR-15):49-55.
  10. Menzies D. What does tuberculin reactivity after bacille Calmette-Guerin vaccination tell us? Clin Infect Dis 2000;31 Suppl 3:S71-S74. https://doi.org/10.1086/314075
  11. 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. https://doi.org/10.1001/jama.293.22.2756
  12. Hur JA, Seo SH, Park SH, Cho CS, Kim HY. Discrepancy between the tuberculin skin test and the T-SPOT: TB for detecting latent mycobacterium tuberculosis infection in patients with rheumatoid arthritis. J Korean Rheum Assoc 2006;13:285-290.
  13. Park JH, Seo GY, Lee JS, Kim TH, Yoo DH. Positive conversion of tuberculin skin test and performance of interferon release assay to detect hidden tuberculosis infection during anti-tumor necrosis factor agent trial. J Rheumatol 2009;36:2158-2163. https://doi.org/10.3899/jrheum.090150
  14. Bartalesi F, Vicidomini S, Goletti D, et al. QuantiFERON-TB Gold and the TST are both useful for latent tuberculosis infection screening in autoimmune diseases. Eur Respir J 2009;33:586-593. https://doi.org/10.1183/09031936.00107608
  15. Matulis G, Juni P, Villiger PM, Gadola SD. Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen-specific interferon gamma assay. Ann Rheum Dis 2008;67:84-90. https://doi.org/10.1136/ard.2007.070789
  16. Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, et al. Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol 2008;35:776-781.
  17. Chen DY, Shen GH, Hsieh TY, Hsieh CW, Lan JL. Effectiveness of the combination of a whole-blood interferon-gamma assay and the tuberculin skin test in detecting latent tuberculosis infection in rheumatoid arthritis patients receiving adalimumab therapy. Arthritis Rheum 2008;59:800-806. https://doi.org/10.1002/art.23705
  18. Huang YW, Shen GH, Lee JJ, Yang WT. Latent tuberculosis infection among close contacts of multidrugresistant tuberculosis patients in central Taiwan. Int J Tuberc Lung Dis 2010;14:1430-1435.
  19. Shalabi NM, Houssen ME. Discrepancy between the tuberculin skin test and the levels of serum interferon-gamma in the diagnosis of tubercular infection in contacts. Clin Biochem 2009;42:1596-1601. https://doi.org/10.1016/j.clinbiochem.2009.08.013
  20. Wang L, Turner MO, Elwood RK, Schulzer M, FitzGerald JM. A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements. Thorax 2002;57:804-809. https://doi.org/10.1136/thorax.57.9.804
  21. Jeong SJ, Han SH, Kim CO, et al. Predictive factors for indeterminate result on the QuantiFERON test in an intermediate tuberculosis-burden country. J Infect 2011;62:347-354. https://doi.org/10.1016/j.jinf.2011.03.004
  22. Korea Food and Drug Administration. Guideline for diagnosis and treatment of latent tuberculosis infection in patient in patients treated with TNF blockers [Internet]. Cheongwon: Korea Food and Drug Administration, 2004 [2013 Feb 1]. Available from: http://www.mfds.go.kr/index.do?seq=4281&mid=70&cmd=v.
  23. 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. https://doi.org/10.1016/S0140-6736(06)68579-6
  24. Cho K, Cho E, Kwon S, et al. Factors associated with indeterminate and false negative results of QuantiFERON-TB Gold In-Tube test in active tuberculosis. Tuberc Respir Dis (Seoul) 2012;72:416-425. https://doi.org/10.4046/trd.2012.72.5.416
  25. Ferrara G, Losi M, Meacci M, et al. Routine hospital use of a new commercial whole blood interferon-gamma assay for the diagnosis of tuberculosis infection. Am J Respir Crit Care Med 2005;172:631-635. https://doi.org/10.1164/rccm.200502-196OC

Cited by

  1. Different Risk of Tuberculosis and Efficacy of Isoniazid Prophylaxis in Rheumatoid Arthritis Patients with Biologic Therapy: A Nationwide Retrospective Cohort Study in Taiwan vol.11, pp.4, 2014, https://doi.org/10.1371/journal.pone.0153217
  2. Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis vol.12, pp.4, 2014, https://doi.org/10.1371/journal.pone.0176291
  3. 학습된 무력감이 류마티스관절염 대상자의 규칙적 운동에 미치는 영향 vol.24, pp.2, 2014, https://doi.org/10.5953/jmjh.2017.24.2.150
  4. The interplay between tuberculosis and systemic lupus erythematosus vol.30, pp.4, 2014, https://doi.org/10.1097/bor.0000000000000493
  5. QuantiFERON-TB Gold In-tube test for the diagnosis of active and latent tuberculosis in selected health facilities of Addis Ababa, Ethiopia vol.11, pp.None, 2014, https://doi.org/10.1186/s13104-018-3410-x
  6. Tuberculosis comorbidity with rheumatoid arthritis: Gene signatures, associated biomarkers, and screening vol.73, pp.1, 2014, https://doi.org/10.1002/iub.2413
  7. Risk of Tuberculosis Development in Patients with Rheumatoid Arthritis Receiving Targeted Therapy: a Prospective Single Center Cohort Study vol.36, pp.10, 2021, https://doi.org/10.3346/jkms.2021.36.e70