Korean J Pediatr Infect Dis.  2011 Jun;18(1):48-53.

Accuracy of an Interferon-gamma Release Assay to Detect Active Tuberculosis in Children: A Pilot Study

• Lee YJ
• Chun P
• We JH
• Park SE

Abstract

PURPOSE
Early diagnosis of active tuberculosis (TB) in children is difficult. The widely used tuberculin skin test has low sensitivity and cross reactivity with non-tuberculous mycobacteria or Bacille Calmette-Guerin vaccination. Interferon gamma release assays have been shown good diagnostic accuracy for active in adults. But studies in children were limited. The purpose of this study was to examine the performance of enzyme-linked immunospot assay (ELISpot) as an initial test in the diagnosis of active tuberculosis in children.
METHODS
In a hospital-based study, we prospectively examined the performance of ELISPot in 33 children suspected of active TB. TB was confirmed bacteriologically or histologically.
RESULTS
Among 33 patients, 9 had active tuberculosis. When tested, they all had a positive test result from the ELISpot. The sensitivity and specificity of the assay were 100% (95% CI, 66.4-100%) and 95.8% (95% CI, 78.9-99.9%) respectively.
CONCLUSION
ELISpot might be an useful and improved clinical diagnostic method for the detection of active TB in children.

Keyword

Active tuberculosis; Interferon gamma; Children

MeSH Terms

Adult
Child
Early Diagnosis
Enzyme-Linked Immunospot Assay
Humans
Interferon-gamma
Interferon-gamma Release Tests
Pilot Projects
Prospective Studies
Sensitivity and Specificity
Skin Tests
Tuberculin
Tuberculosis
Vaccination
Interferon-gamma
Tuberculin

Reference

1. Tuberculosis, fact sheet no. 104. World Health Organization. 2007. Geneva, Switzerland: World Health Organization;http://www.who.int/mediacentre/factsheets/fs104/en/.

2. Chan ED, Heifets L, Iseman MD. Immunologic diagnosis of tuberculosis: a review. Tuber Lung Dis. 2000. 80:131–140.

3. Keeler E, Perkins MD, Small P, Hanson C, Reed S, Cunningham J, et al. Reducing the global burden of tuberculosis: the contribution of improved diagnostics. Nature. 2006. 444:49–57.

4. Hesseling AC, Schaaf HS, Gie RP, Starke JR, Beyers N. A critical review of diagnostic approaches used in the diagnosis of childhood tuberculosis. Int J Tuberc Lung Dis. 2002. 6:1038–1045.

5. Shingadia D, Novelli V. Diagnosis and treatment of tuberculosis in children. Lancet Infect Dis. 2003. 3:624–632.

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.

7. Richeldi L. An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med. 2006. 174:736–742.

8. Pai M, Dheda K, Cunningham J, Scano F, O'Brien R. T-cell assays for the diagnosis of latent tuberculosis infection: moving the research agenda forward. Lancet Infect Dis. 2007. 7:428–438.

9. Detjen AK, Keil T, Roll S, Hauer B, Mauch H, Wahn U, et al. Interferon-γ release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis. Clin Infect Dis. 2007. 45:322–328.

10. Kampmann B, Whittaker E, Williams A, Walters S, Gordon A, Martinez-Alier N, et al. Interferon-gamma release assays do not identify more children with active tuberculosis than tuberculin skin test. Eur Respir J. 2009. 33:1374–1382.

11. Pai M, Menzies D. Interferon-gamma release assays: what is their role in the diagnosis of active tuberculosis? Clin Infect Dis. 2007. 44:74–77.

12. Nishimura T, Hasegawa N, Mori M, Takebayashi T, Harada N, Higuchi K, et al. Accuracy of an interferon-gamma release assay to detect active pulmonary and extra-pulmonary tuberculosis. Int J Tuberc Lung Dis. 2008. 12:269–274.

13. Dosanjh DP, Hinks TS, Innes JA, Deeks JJ, Pasvol G, Hackforth S, et al. Improved diagnostic evaluation of suspected tuberculosis. Ann Intern Med. 2008. 148:325–336.

14. Liebeschuetz S, Bamber S, Ewer K, Deeks J, Pathan AA, Lalvani A. Diagnosis of tuberculosis in South African children with a T-cell-based assay: a prospective cohort study. Lancet. 2004. 364:2196–2203.