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First published online on January 15, 2008
Chest, doi:10.1378/chest.07-1815
doi:10.1378/chest.07-1815
(Chest. 2008; 133:869-874)
© 2008 American College of Chest Physicians
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Use of an Interferon-{gamma} Release Assay To Diagnose Latent Tuberculosis Infection in Foreign-Born Patients*

Daniel Brodie, MD; David J. Lederer, MD, MS; Jade S. Gallardo, MD; Saumil H. Trivedi, MD; Joseph N. Burzynski, MD and Neil W. Schluger, MD

* From the Division of Pulmonary, Allergy, and Critical Care Medicine (Drs. Brodie, Lederer, Gallardo, Trivedi, and Schluger), Columbia University Medical Center; and New York City Department of Health and Mental Hygiene (Dr. Burzynski), Bureau of Tuberculosis Control, New York, NY.

Correspondence to: Neil Schluger, MD, Columbia University Medical Center, 622 West 168th St, PH 8 East, Room 101, New York, NY 10032; e-mail: ns311{at}columbia.edu

Abstract

Background: The tuberculin skin test (TST) has a low specificity in the setting of bacille Calmette-Guérin (BCG) vaccination. Interferon-{gamma} release assays (IGRAs) appear to be more specific but have not been validated in this population under routine clinical conditions. We sought to validate the routine clinical use of the T-SPOT.TB test (Oxford Immunotec; Oxford, UK), an IGRA, in a predominantly foreign-born population with a high rate of BCG vaccination.

Methods: We compared the TST and the T-SPOT.TB test in 96 subjects at a New York City Department of Health tuberculosis clinic. We aimed to determine which test better predicted being a close contact of a case of active tuberculosis, a surrogate for latent tuberculosis infection.

Results: A positive T-SPOT.TB test result was strongly associated with being a close contact of a case of active tuberculosis after adjustment for potential confounders (adjusted odds ratio, 2.9; 95% confidence interval, 1.1 to 7.3; p = 0.03). A positive TST result was associated with being a contact only in subjects without BCG vaccination (p = 0.02). The T-SPOT.TB test was more specific for being a close contact than the TST (p < 0.001). Specificity in BCG-vaccinated subjects was 3% for the TST compared with 70% for the T-SPOT.TB test (p < 0.001).

Conclusions: The T-SPOT.TB test is superior in routine clinical use to the TST for identifying high-risk individuals among foreign-born populations with high rates of BCG vaccination.

Key Words: infection • interferon • tuberculosis • tuberculosis testing






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