Tuberc Respir Dis.  2011 Feb;70(2):125-131. 10.4046/trd.2011.70.2.125.

Sensitivity of Whole-Blood Interferon-Gamma Release Assay According to the Severity and the Location of Disease in Patients with Active Tuberculosis

• Kim YY
• Lee J
• Lee YJ
• Lee SY
• Lee YH
• Choi KJ
• Hwangbo Y
• Cha SI
• Park JY
• Jung TH
• Park JS
• Kim CH

• KMID: 1442861
• DOI: http://doi.org/10.4046/trd.2011.70.2.125

Abstract

BACKGROUND
The clinical manifestation of M. tuberculosis infection ranges from asymptomatic latent infection, to focal forms with minimal symptoms and low bacterial burdens, and finally to advanced tuberculosis (TB) with severe symptoms and high bacillary loads. We investigated the diagnostic sensitivity of the whole-blood interferon-gamma release assay according to the wide spectrum of clinical phenotypes.
METHODS
In patients diagnosed with active TB that underwent QuantiFERON(R) (QFT) testing, the QFT results were compared with patients known to be infected with pulmonary tuberculosis (P-TB) and extra-pulmonary TB (EP-TB). In addition, the results of the QFT test were further analyzed according to the radiographic extent of disease in patients with P-TB and the location of disease in patients with EP-TB.
RESULTS
There were no statistical differences in the overall distribution of QFT results between 177 patients with P-TB and 84 patients with EP-TB; the positive results of QFT test in patients with P-TB and EP-TB were 70.1% and 64.3%, respectively. Among patients with P-TB, patients with mild extents of disease showed higher frequency of positive results of QFT test than that of patients with severe form (75.2% vs. 57.1%, respectively; p=0.043) mainly due to an increase of indeterminate results in severe P-TB. Patients with TB pleurisy showed lower sensitivity by the QFT test than those with tuberculous lymphadenitis (48.8% vs. 78.8%, respectively; p=0.019).
CONCLUSION
Although QFT test showed similar results between overall patients with P-TB and EP-TB, individual sensitivity was different according to the radiographic extent of disease in P-TB and the location of disease in EP-TB.

Keyword

Interferon-gamma Release Assay; Tuberculosis, Pulmonary

MeSH Terms

Humans
Interferon-gamma
Interferon-gamma Release Tests
Pleurisy
Tuberculosis
Tuberculosis, Lymph Node
Tuberculosis, Pulmonary
Interferon-gamma

Figure

• 

  Figure 1 Results of interferon-gamma release assay according to the radiographic extent of disease in patients with pulmonary tuberculosis. There is significant difference in the distribution of interferon-gamma release assay results between patients with mild and severe extent of disease (p=0.043). Mild: extension within one-third of the unilateral lung field; Moderate: within the unilateral lung field; Severe: beyond the unilateral lung field.

• 

  Figure 2 Results of interferon-gamma release assay according to the location of disease in patients with extra-pulmonary tuberculosis. There is significant difference in the distribution of interferon-gamma release assay results between patients with pleural and lymphnode tuberculosis (p=0.019). *Including spine (n=2), breast (n=1), maxillary sinus (n=1), peritoneum (n=1), rectum (n=1), fallopian tube (n=1), and parotid gland (n=1) tuberculosis.

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