Korean J Lab Med.  2011 Oct;31(4):271-278. 10.3343/kjlm.2011.31.4.271.

Serial Interferon-gamma Release Assays for the Diagnosis of Latent Tuberculosis Infection in Patients Treated with Immunosuppressive Agents

• Kim KH
• Lee SW
• Chung WT
• Kim BG
• Woo KS
• Han JY
• Kim JM

• KMID: 1781691
• DOI: http://doi.org/10.3343/kjlm.2011.31.4.271

Abstract

BACKGROUND
We assessed the efficacy of serial interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in patients receiving immunosuppressive agents for treatment of rheumatic diseases in Korea.
METHODS
Of 276 patients who underwent consecutive screening with one of two IGRAs [QuantiFERON-TB Gold or QuantiFERON-TB Gold In-Tube], 66 patients were evaluated by the serial IGRA for detection of LTBI during therapy with immunosuppressive agents. Information on clinical diagnosis, medication, previous TB, blood cell count, tuberculin skin test, and interferon-gamma (IFN-gamma) level measured by IGRA was collected.
RESULTS
Of the 66 patients, the initial IGRA was positive in 24.2%, negative in 65.2%, and indeterminate in 10.6%. Forty-six patients (69.7%) showed consistent IGRA results during follow-up, and 13 patients (19.7%) had consistently positive results. IGRA conversion rate was 12.1% (8/66) and reversion rate was 4.5% (3/66). Conversion of IGRA results was only observed in ankylosing spondylitis patients, and the median interval between the two tests in patients with conversion was 8.5 months. The mean IFN-gamma level in the group of patients with consistently positive IGRA results was higher than that in the group with inconsistently positive results, although this trend was not statistically significant (P=0.293). Indeterminate results were observed most frequently in patients with systemic lupus erythematosus.
CONCLUSIONS
In patients receiving immunosuppressive agents, both IGRA conversions and reversions were observed. Serial IGRA testing may not be needed in patients with a positive initial IGRA result showing high IFN-gamma levels, because of high consistency in the test results.

Keyword

Interferon-gamma release assay; Latent tuberculosis infection; Immunosuppressive agent; Conversion

MeSH Terms

Adult
Blood Cell Count
Female
Follow-Up Studies
Humans
Immunosuppressive Agents/*therapeutic use
Interferon-gamma/*analysis
*Interferon-gamma Release Tests
Latent Tuberculosis/complications/*diagnosis/metabolism
Lupus Erythematosus, Systemic/complications/diagnosis/metabolism
Male
Middle Aged
Rheumatic Diseases/complications/diagnosis/drug therapy
Spondylitis, Ankylosing/complications/diagnosis/metabolism
Tuberculin Test

Figure

• 

  Fig. 1 Study flow diagram.Abbreviations: IGRA, interferon-gamma release assay; AS, ankylosing spondylitis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; JRA, juvenile rheumatoid arthritis; AOSD, adult-onset Still's disease; I, indeterminate IGRA result.

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