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Diagnosis of Latent Tuberculosis Infection: Too Soon to Pull the Plug on the Tuberculin Skin Test

2015; American College of Physicians; Volume: 164; Issue: 2 Linguagem: Inglês

10.7326/m15-1522

1539-3704

Lauren F. Collins, Carolina Geadas, Jerrold J. Ellner,

Mycobacterium research and diagnosis

Ideas and Opinions19 January 2016Diagnosis of Latent Tuberculosis Infection: Too Soon to Pull the Plug on the Tuberculin Skin TestLauren F. Collins, MD, Carolina Geadas, MD, and Jerrold J. Ellner, MDLauren F. Collins, MDFrom Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, Carolina Geadas, MDFrom Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, and Jerrold J. Ellner, MDFrom Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-1522 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Accurate identification of persons recently infected with Mycobacterium tuberculosis (MTB) is critical for tuberculosis (TB) control because they are at greatest risk for progression to active disease in 1 to 2 years. Two diagnostic methods exist for latent TB infection (LTBI): the historic and widely used tuberculin skin testing (TST) and the newer interferon-γ release assays (IGRAs). Both tests measure host immunity to MTB antigens, representing an indirect “immunologic footprint” of past infection rather than direct microbial presence; however, neither predicts persons at high risk for progression (1). Current guidelines by the Centers for Disease Control and Prevention consider these ...References1. Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies D, Mwansa-Kambafwile J, et al. Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:45-55. [PMID: 21846592] doi:10.1016/S1473-3099(11)70210-M151522 CrossrefMedlineGoogle Scholar2. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K; IGRA Expert Committee. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection—United States, 2010. MMWR Recomm Rep. 2010;59:1-25. [PMID: 20577159] MedlineGoogle Scholar3. Ribeiro-Rodrigues R, Kim S, Coelho da Silva FD, Uzelac A, Collins L, Palaci M, et al. Discordance of tuberculin skin test and interferon gamma release assay in recently exposed household contacts of pulmonary TB cases in Brazil. PLoS One. 2014;9:e96564. [PMID: 24819060] doi:10.1371/journal.pone.0096564 CrossrefMedlineGoogle Scholar4. Anibarro L, Trigo M, Villaverde C, Pena A, González-Fernández A. Tuberculin skin test and interferon-γ release assay show better correlation after the tuberculin ‘window period' in tuberculosis contacts. Scand J Infect Dis. 2011;43:424-9. [PMID: 21332285] doi:10.3109/00365548.2011.558912 CrossrefMedlineGoogle Scholar5. Mahan CS, Zalwango S, Thiel BA, Malone LL, Chervenak KA, Baseke J, et al. Innate and adaptive immune responses during acute M. tuberculosis infection in adult household contacts in Kampala, Uganda. Am J Trop Med Hyg. 2012;86:690-7. [PMID: 22492155] doi:10.4269/ajtmh.2012.11-0553 CrossrefMedlineGoogle Scholar6. Lee SW, Oh DK, Lee SH, Kang HY, Lee CT, Yim JJ. Time interval to conversion of interferon-gamma release assay after exposure to tuberculosis. Eur Respir J. 2011;37:1447-52. [PMID: 21148232] doi:10.1183/09031936.00089510 CrossrefMedlineGoogle Scholar7. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006;10:1192-204. [PMID: 17131776] MedlineGoogle Scholar8. Slater ML, Welland G, Pai M, Parsonnet J, Banaei N. Challenges with QuantiFERON-TB Gold assay for large-scale, routine screening of U.S. healthcare workers. Am J Respir Crit Care Med. 2013;188:1005-10. [PMID: 23978270] doi:10.1164/rccm.201305-0831OC CrossrefMedlineGoogle Scholar9. Metcalfe JZ, Cattamanchi A, McCulloch CE, Lew JD, Ha NP, Graviss EA. Test variability of the QuantiFERON-TB gold in-tube assay in clinical practice. Am J Respir Crit Care Med. 2013;187:206-11. [PMID: 23103734] doi:10.1164/rccm.201203-0430OC CrossrefMedlineGoogle Scholar10. Kasaie P, Andrews JR, Kelton WD, Dowdy DW. Timing of tuberculosis transmission and the impact of household contact tracing. An agent-based simulation model. Am J Respir Crit Care Med. 2014;189:845-52. [PMID: 24559425] doi:10.1164/rccm.201310-1846OC CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Grant Support: By National Institutes of Health National Institute of Allergy and Infectious Diseases awards 5UO1AI065663 (U.S. Brazil Collaboration on Immunity and Biomarkers in Tuberculosis) and 1U19AI111276 (Biomarkers and Mechanisms of Paucibacillary and Latent Tuberculosis).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1522.Corresponding Author: Jerrold J. Ellner, MD, Division of Infectious Diseases, Boston Medical Center and Boston University School of Medicine, Crosstown Building, 801 Massachusetts Avenue, Second Floor, Room 20, Boston, MA 02118; e-mail, jerrold.[email protected]org.Current Author Addresses: Dr. Collins: Medical Education Office, Duke University Medical Center, 2301 Erwin Road, 8th Floor, Room 8254, Durham, NC 27710.Dr. Geadas: Crosstown Building, 801 Massachusetts Avenue, Second Floor, Room 21, Boston, MA 02118.Dr. Ellner: Section of Infectious Diseases, Crosstown Building, 801 Massachusetts Avenue, Second Floor, Room 20, Boston, MA 02118.Author Contributions: Conception and design: L.F. Collins, C. Geadas, J.J. Ellner.Analysis and interpretation of the data: L.F. Collins, C. Geadas, J.J. Ellner.Drafting of the article: L.F. Collins, C. Geadas, J.J. Ellner.Critical revision of the article for important intellectual content: L.F. Collins, C. Geadas, J.J. Ellner.Final approval of the article: L.F. Collins, J.J. Ellner.Collection and assembly of data: L.F. Collins, C. Geadas, J.J. Ellner.This article was published at www.annals.org on 8 December 2015. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis of Latent Tuberculous Infection Thomas C. Bailey Diagnosis of Latent Tuberculous Infection Lauren F. Collins , Carolina Geadas , and Jerrold J. Ellner Diagnosis of Latent Tuberculous Infection Colin L. Crawford Metrics Cited byTuberculosis pulmonarReactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: current evidence and clinical practice recommendationsCough-aerosol cultures of Mycobacterium tuberculosis in the prediction of outcomes after exposure. A household contact study in BrazilScreening for latent tuberculosis infection among patients with rheumatoid arthritis in the era of biologics and targeted synthetic disease‐modifying anti‐rheumatic drugs in India, a high‐burden TB country: The importance of Mantoux and Quantiferon‐ TB Gold testsInfecciones bacterianas crónicas (I). TuberculosisMeasurement of Skin Induration Size Using Smartphone Images and Photogrammetric Reconstruction: Pilot StudyDiagnosis of Latent Tuberculous InfectionColin L. Crawford, MBChBDiagnosis of Latent Tuberculous InfectionThomas C. Bailey, MD 19 January 2016Volume 164, Issue 2Page: 122-124KeywordsBacille calmette guerinDisclosureImmunityInfectious diseasesPopulation statisticsSkin infectionsSkin testsSpecificityTuberculinTuberculosis ePublished: 8 December 2016 Issue Published: 19 January 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...