Sa1194 Consistently High C Reactive Protein Is Associated With Subsequent Development of Perianal Fistulae in Patients With Crohn's Disease
2
Citation
0
Reference
10
Related Paper
Citation Trend
Keywords:
Indeterminate
Medical record
Gold standard (test)
Background: The tuberculin skin test (TST) has limitations in diagnosing a latent tuberculosis infection (LTBI). The interferon-gamma release assay (IGRA) was introduced to middle- and high-school students since 2009 by the Korea Centers for Disease Control and Prevention. The aim was to evaluate the utility of IGRA in diagnosing LTBI in middle- and high-school students.
Interferon γ
Skin test
Tuberculin test
Disease Control
Cite
Citations (2)
Abstract Background Interferon‐γ (IFN‐γ) release assay (IGRA) is used for diagnosis of latent tuberculosis infection (LTBI), and for serial testing of active tuberculosis (TB). The aim of this study was to evaluate the results of IGRA for diagnosis and treatment monitoring of children with LTBI and children with TB. IGRA was performed in BCG vaccinated children before and six months after the beginning of treatment. Methods A total of 59 BCG vaccinated children aged 4–18 years were investigated due to exposure to active TB. The participants were divided into two groups: Group 1, children with LTBI (N = 41), and Group 2, children with TB (N = 18). IGRA (QuantiFERON‐TB Gold In‐Tube) was performed twice, i.e., before treatment and at the end of prophylaxis and therapy. Results There was no significant difference in IFN‐γ concentrations between Group 1 and Group 2 subjects either before or after the treatment. Difference between pre‐treatment and post‐treatment IFN‐γ concentrations compared in either Group 1 or Group 2 was not statistically significant. During follow‐up, children with LTBI did not develop active TB. In addition, in children with TB, signs and symptoms of TB improved with anti‐TB therapy. Conclusion This study showed that the concentrations of IFN‐γ did not differ in children with LTBI and TB either before or at the end of treatment. IGRA may remain positive over a long period of time. It seems that IGRA is not useful for monitoring treatment of children with LTBI and children with TB. Pediatr Pulmonol. 2012; 47:401–408. © 2011 Wiley Periodicals, Inc.
Interferon γ
QuantiFERON
Active tuberculosis
Tuberculosis diagnosis
Cite
Citations (21)
Purpose of review The primary purpose is to review guidance on the testing and treatment of latent tuberculosis infection (LTBI) in children. Most children and adults with LTBI have positive tuberculin skin test (TST) or interferon gamma release assay (IGRA) results, normal examinations, and normal chest radiographs. Diagnosis of and treatment completion for LTBI are critical to diminish future cases of tuberculosis (TB) disease. Recent findings Children should be screened for TB risk factors, and only children with risk factors should be tested with either a TST or an IGRA. IGRAs measure interferon gamma production by lymphocytes after they are stimulated ex vivo by antigens that are primarily Mycobacterium tuberculosis-specific. The foundation of LTBI therapy in the United States has been 9 months of daily isoniazid, but shorter treatment regimens now exist, including a 12-dose regimen of weekly isoniazid and rifapentine. These shorter regimens are associated with higher completion rates. Summary There are two distinct modalities for LTBI diagnosis and several treatment regimens that can prevent TB disease in infected children. The selection of treatment regimen should take several factors into consideration, including adherence, drug susceptibility results of the presumed source case (if known), safety, cost, and patient preference.
Rifapentine
Regimen
Cite
Citations (27)
Indeterminate
QuantiFERON
Interferon γ
Tuberculosis diagnosis
Cite
Citations (0)
Objectives We aimed to evaluate the indeterminate rate of interferon gamma release assays (IGRAs) in the detection of latent tuberculosis infection (LTBI). Methods On 15 November 2022, we searched the PubMed® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two investigators independently extracted the study data and assessed their quality using a modified quality assessment of diagnostic accuracy studies (i.e., QUADAS-2) tool. A random-effects model was used to calculate pooled results. Results We included 403 studies involving 486,886 individuals and found that the pooled indeterminate rate was 3.9% (95% CI 3.5%–4.2%). The pooled indeterminate rate for QuantiFERON®-TB (QFT) was similar to that for T-SPOT®.TB (T-SPOT) [odds ratio (OR) = 0.88, 95% CI 0.59–1.32]; however, the indeterminate rate for a new generation of QFT (QFT-plus) was lower than that of T-SPOT (OR = 0.24, 95% CI 0.16–0.35). The indeterminate rate in the immunocompromised population was significantly higher than that in healthy controls (OR = 3.51, 95% CI 2.11–5.82), and it increased with the reduction of CD4+ cell count in HIV-positive patients. Children’s pooled indeterminate rates (OR = 2.56, 95% CI 1.79–3.57) were significantly higher than those of adults, and the rates increased as the children’s age decreased. Conclusion On average, 1 in 26 tests yields indeterminate IGRA results in LTBI screening. The use of advanced versions of the QuantiFERON-TB assay (QFT-plus), may potentially reduce the occurrence of an indeterminate result. Our study emphasizes the high risk of immunosuppression and young age in relation to indeterminate IGRA, which should receive more attention in the management of LTBI. Systematic review registration PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211363 , CRD42020211363.
Indeterminate
QuantiFERON
Pooled analysis
Cite
Citations (22)
Background: Though IGRA has been compared to tuberculin skin test, there is scarce clinical data in India regarding correlation of IGRA for diagnosis of active or latent tuberculosis. The role of IGRA for diagnosis of latent tuberculosis and initiation of prophylaxis in an endemic country has often been questioned. Methods & Materials: All adult patients (age > 18 years) for whom an IGRA test was done as part of their clinical work up in our center, in 2013 were included. Demographic and clinical details including underlying diagnosis, indications, laboratory investigations (Mycobacterial smears, cultures and Xpert MTb/rif), initiation of prophylaxis or development of tuberculosis within 1 year of follow up were recorded. Results: A total of 434 patients were included, the majority were males (61%) and the mean age was 39.4 years. The common indications for ordering IGRA was to rule out active tuberculosis in 329/434(75.8%) and for diagnosis of latent tuberculosis prior to initiation of immunosuppressive therapy in 68(15.7%). IGRA was negative in the majority of the patients (63.6%). Among the IGRA positive 158/434(36.4%) only 4 were initiated on prophylaxis for possible latent tuberculosis whereas in the IGRA negative none received prophylaxis. In the IGRA positive 50(32%) and in the IGRA negative 47(17.6%) received empirical antituberculosis therapy for suspected tuberculosis. M. tuberculosis was however confirmed by cultures and/or PCR in 14(3.2%) of which 8 were initially IGRA positive and 6 were IGRA negative. In the sub group where IGRA was used to diagnose latent tuberculosis- 42/53(79%) in the IGRA negative and 14/15(93%) among the IGRA positive were on immunosuppressive drugs. Of these though 15 patients were IGRA positive, only 2 (13.3%) initiated prophylaxis possibly due to high level of Isoniazid monoresistance in our hospital. Conclusion: A majority of the patients were found to be IGRA negative, which was a surprising finding in a high tuberculosis burden country. IGRA is still being used as a supporting tool for a diagnosis of active tuberculosis in the absence of other confirmatory microbiological evidence. Even if IGRA is used to rule out latent tuberculosis there is a reluctance to initiate prophylaxis.
Active tuberculosis
Tuberculosis diagnosis
Cite
Citations (0)
ABSTRACT In this prospective, longitudinal study on 948 HIV-1-infected patients, subjects with an indeterminate IFN-γ (gamma interferon) release assay (IGRA) result at baseline were at significantly higher risk of developing AIDS-defining manifestations other than tuberculosis (TB) irrespective of CD4 + T cell count. Thus, in HIV-1-infected patients with advanced quantitative CD4 + T cell depletion, an indeterminate IGRA might indicate an additional loss of global T cell function, warranting detailed clinical evaluation and careful follow-up.
Indeterminate
Cite
Citations (19)
Background
Interferon-γ release assays (IGRA) are a crucial diagnostic tool for the detection of a Mycobacterium tuberculosis infection in order to control and eliminate the tuberculosis (TB) epidemic. Indeterminate results can occur and represent a considerable problem for clinical management, since they imply the lack of clear information about the patient's TB infection status. The aim of the study was to identify risk factors that could be associated with indeterminate IGRA results.Methods
Retrospective cohort study carried out using data from the Portuguese National Tuberculosis Surveillance system, from 2008 to 2015. Were included in the study 1230 patients with active TB and an IGRA result. The IGRA test used in the patients enrolled in the study was the QuantiFERON-TB Gold In-Tube (Qiagen). The association between indeterminate IGRA results and sociodemographic factors, comorbidities and the site of disease were evaluated through bivariate and multivariate logistic regression analysis.Results
Of the 1230 patients reported with active TB in the SVIG-TB database (2008–2015) that underwent an IGRA test, 857 patients (69.7%) had a positive test result, 212 (17.2%) had a negative result and 161 (13.1%) had an indeterminate result. Majority of the patients with indeterminate results were male (67.7%) and more than half had more than 50 years (57.1%). The proportion of indeterminate results increased as the age increased, with patients over 80 years old presenting the highest proportion of indeterminate results. Age ≥ 65 years (OR 2.51, p<0.001), alcohol abuse (OR 3.04, p=0.001) and pulmonary TB (OR 3.07, p<0.001) were predictive factors for indeterminate IGRA results.Conclusion
Age ≥ 65 years, alcohol abuse and pulmonary TB were identified as factors for the occurrence of indeterminate IGRA results. The first two factors can be identified prior to the test and thus help to quickly identify the probable cause of an indeterminate outcome and lead to the use of other clinical and diagnostic means to detect a possible infection.Indeterminate
QuantiFERON
Tuberculosis diagnosis
Cite
Citations (0)
Erythema
Cite
Citations (2)
Recent immigrantyouth have multiple health needs that need to be adapted to the context of migration. School health services provide a systematic health check to allyoung immigrants starting school in Geneva, including a tuberculin skin test if coming from a middle or high incidence country. Positive tests are confirmed with Interferon Gamma Release Assay (IGRA) and if indicated, offered treatment of latent tuberculosis even in the absence of clear guidelines. Collective and individual benefits outweigh the difficult logistics: reducing risk of reactivation of latent tuberculosis for populations living in promiscuity, effective collaboration between primary care and school health services to answer the needs of these underserved youth.
Promiscuity
School health
Cite
Citations (0)