TY - JOUR
T1 - Risk Assessment of Tuberculosis in Immunocompromised Patients. A TBNET Study
AU - Sester, Martina
AU - van Leth, Frank
AU - Bruchfeld, Judith
AU - Bumbacea, Dragos
AU - Cirillo, Daniela M.
AU - Dilektasli, Asli Gorek
AU - Dominguez, Jose
AU - Duarte, Raquel
AU - Ernst, Martin
AU - Eyuboglu, Fusun Oner
AU - Gerogianni, Irini
AU - Girardi, Enrico
AU - Goletti, Delia
AU - Janssens, Jean-Paul
AU - Julander, Inger
AU - Lange, Bent
AU - Latorre, Irene
AU - Losi, Monica
AU - Markova, Roumiana
AU - Matteelli, Alberto
AU - Milburn, Heather
AU - Ravn, Pernille
AU - Scholman, Theresia
AU - Soccal, Paola M.
AU - Straub, Marina
AU - Wagner, Dirk
AU - Wolf, Timo
AU - Yalcin, Aslihan
AU - Lange, Christoph
AU - TBNET
PY - 2014/11/15
Y1 - 2014/11/15
N2 - Rationale: In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency.Objectives: This study compared the performance of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis.Methods: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT. TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up.Measurements and Main Results: Frequencies of positive test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15.2% in immunocompetent control subjects (n = 211). Eleven patients (10 with HIV infection and one solid-organ transplant recipient) developed tuberculosis during a median follow-up of 1.8 (interquartile range, 0.2-3.0) years. Six of the 11 patients had a negative or indeterminate test result in all three tests at the time of screening. Tuberculosis incidence was generally low, but higher in HIV-infected individuals with a positive TST (3.25 cases per 100 person-years) than with a positive ELISA (1.31 cases per 100 person-years) or enzyme-linked immunospot result (1.78 cases per 100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy.Conclusions: Among immunocompromised patients evaluated in this study, progression toward tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs.
AB - Rationale: In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency.Objectives: This study compared the performance of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis.Methods: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT. TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up.Measurements and Main Results: Frequencies of positive test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15.2% in immunocompetent control subjects (n = 211). Eleven patients (10 with HIV infection and one solid-organ transplant recipient) developed tuberculosis during a median follow-up of 1.8 (interquartile range, 0.2-3.0) years. Six of the 11 patients had a negative or indeterminate test result in all three tests at the time of screening. Tuberculosis incidence was generally low, but higher in HIV-infected individuals with a positive TST (3.25 cases per 100 person-years) than with a positive ELISA (1.31 cases per 100 person-years) or enzyme-linked immunospot result (1.78 cases per 100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy.Conclusions: Among immunocompromised patients evaluated in this study, progression toward tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs.
KW - interferon-gamma release assays
KW - immunocompromised
KW - TBNET
KW - tuberculin-skin test
KW - tuberculosis
KW - GAMMA RELEASE ASSAYS
KW - QUANTIFERON-TB GOLD
KW - LATENT MYCOBACTERIUM-TUBERCULOSIS
KW - LONG-TERM INCIDENCE
KW - RHEUMATOID-ARTHRITIS
KW - ACTIVE TUBERCULOSIS
KW - SKIN-TEST
KW - HEMODIALYSIS-PATIENTS
KW - CONSENSUS STATEMENT
KW - HIV-INFECTION
U2 - 10.1164/rccm.201405-0967OC
DO - 10.1164/rccm.201405-0967OC
M3 - Article
SN - 1073-449X
VL - 190
SP - 1168
EP - 1176
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 10
ER -
