High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis

Comparison of quantiFERON-TB GOLD, ELISPOT, and tuberculin skin test

S. S J Lee, K. J. Chou, I. J. Su, Y. S. Chen, H. C. Fang, T. S. Huang, H. C. Tsai, S. R. Wann, H. H. Lin, Y. C. Liu

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background: : Individuals with end-stage renal disease (ESRD) are 10- to 25-fold more likely than immunocompetent people to develop active tuberculosis (TB) and are candidates for being treated for latent TB infection (LTBI). However, diagnosis using the tuberculin skin test (TST) is doubly difficult due to cutaneous anergy and cross-reactions with Bacille-Calmette-Guérin (BCG) vaccination. Materials and Methods: : This was a prospective, doublematched, cohort study in which 32 ESRD patients and 32 age-matched, healthy controls were enrolled. The TST and two new interferon-γ blood tests, QuantiFERON-TB Gold (QFT-G) and T-SPOT.TB (ELISPOT), were performed. The subjects were followed up 2 years for active TB disease. ELISPOT was done in ESRD patients only. Results: : Compared to the healthy controls, a high prevalence of LTBI was found in the ESRD patients by TST (62.5%, 95% confidence interval [CI] 43.7-78.9), QFT-G (40.0%, 95% CI 22.7-59.4), and ELISPOT (46.9%, 95% CI 29.1-65.3). Agreement was moderate (kappa [κ] = 0.53) for QFT-G and ELISPOT but only slight between TST and QFT-G (κ = 0.25) and fair between TST and ELISPOT (κ = 0.32). ESRD (p = 0.03) and diabetes mellitus (p = 0.04) were significant risk factors for QFT-G positivity on the multivariable analysis. The overall rate of active TB was 1.66 cases per 100 person-years (pys), with the rate higher in patients with ESRD (3.53 per 100 pys) and those with positive (3.40 per 100 pys) and indeterminate QFT results (30.16 per 100 pys), although the difference was not statistically significant. Sensitivity, specificity, and positive and negative predictive values of QFT-G for active TB was 100%, 62.1%, 8.3% and 100%. Conclusion: : This pilot study is the first to compare QFT-G, ELISPOT, and TST in ESRD patients on hemodialysis and demonstrates a high prevalence of LTBI in this population. In our study, the QFT-G was the more accurate method for identifying those truly infected with Mycobacterium tuberculosis, even in BCG-vaccinated individuals.

Original languageEnglish
Pages (from-to)96-102
Number of pages7
JournalInfection
Volume37
Issue number2
DOIs
Publication statusPublished - Apr 2009
Externally publishedYes

Fingerprint

Latent Tuberculosis
Enzyme-Linked Immunospot Assay
Tuberculin Test
Skin Tests
Gold
Chronic Kidney Failure
Renal Dialysis
Tuberculosis
Confidence Intervals
Cross Reactions
Hematologic Tests
Infection
Mycobacterium tuberculosis
Interferons
Diabetes Mellitus
Vaccination
Cohort Studies
Sensitivity and Specificity
Skin

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis : Comparison of quantiFERON-TB GOLD, ELISPOT, and tuberculin skin test. / Lee, S. S J; Chou, K. J.; Su, I. J.; Chen, Y. S.; Fang, H. C.; Huang, T. S.; Tsai, H. C.; Wann, S. R.; Lin, H. H.; Liu, Y. C.

In: Infection, Vol. 37, No. 2, 04.2009, p. 96-102.

Research output: Contribution to journalArticle

Lee, S. S J ; Chou, K. J. ; Su, I. J. ; Chen, Y. S. ; Fang, H. C. ; Huang, T. S. ; Tsai, H. C. ; Wann, S. R. ; Lin, H. H. ; Liu, Y. C. / High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis : Comparison of quantiFERON-TB GOLD, ELISPOT, and tuberculin skin test. In: Infection. 2009 ; Vol. 37, No. 2. pp. 96-102.
@article{7128a966fd8242ef944d556290a71276,
title = "High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis: Comparison of quantiFERON-TB GOLD, ELISPOT, and tuberculin skin test",
abstract = "Background: : Individuals with end-stage renal disease (ESRD) are 10- to 25-fold more likely than immunocompetent people to develop active tuberculosis (TB) and are candidates for being treated for latent TB infection (LTBI). However, diagnosis using the tuberculin skin test (TST) is doubly difficult due to cutaneous anergy and cross-reactions with Bacille-Calmette-Gu{\'e}rin (BCG) vaccination. Materials and Methods: : This was a prospective, doublematched, cohort study in which 32 ESRD patients and 32 age-matched, healthy controls were enrolled. The TST and two new interferon-γ blood tests, QuantiFERON-TB Gold (QFT-G) and T-SPOT.TB (ELISPOT), were performed. The subjects were followed up 2 years for active TB disease. ELISPOT was done in ESRD patients only. Results: : Compared to the healthy controls, a high prevalence of LTBI was found in the ESRD patients by TST (62.5{\%}, 95{\%} confidence interval [CI] 43.7-78.9), QFT-G (40.0{\%}, 95{\%} CI 22.7-59.4), and ELISPOT (46.9{\%}, 95{\%} CI 29.1-65.3). Agreement was moderate (kappa [κ] = 0.53) for QFT-G and ELISPOT but only slight between TST and QFT-G (κ = 0.25) and fair between TST and ELISPOT (κ = 0.32). ESRD (p = 0.03) and diabetes mellitus (p = 0.04) were significant risk factors for QFT-G positivity on the multivariable analysis. The overall rate of active TB was 1.66 cases per 100 person-years (pys), with the rate higher in patients with ESRD (3.53 per 100 pys) and those with positive (3.40 per 100 pys) and indeterminate QFT results (30.16 per 100 pys), although the difference was not statistically significant. Sensitivity, specificity, and positive and negative predictive values of QFT-G for active TB was 100{\%}, 62.1{\%}, 8.3{\%} and 100{\%}. Conclusion: : This pilot study is the first to compare QFT-G, ELISPOT, and TST in ESRD patients on hemodialysis and demonstrates a high prevalence of LTBI in this population. In our study, the QFT-G was the more accurate method for identifying those truly infected with Mycobacterium tuberculosis, even in BCG-vaccinated individuals.",
author = "Lee, {S. S J} and Chou, {K. J.} and Su, {I. J.} and Chen, {Y. S.} and Fang, {H. C.} and Huang, {T. S.} and Tsai, {H. C.} and Wann, {S. R.} and Lin, {H. H.} and Liu, {Y. C.}",
year = "2009",
month = "4",
doi = "10.1007/s15010-008-8082-3",
language = "English",
volume = "37",
pages = "96--102",
journal = "Infection",
issn = "0300-8126",
publisher = "Urban und Vogel",
number = "2",

}

TY - JOUR

T1 - High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis

T2 - Comparison of quantiFERON-TB GOLD, ELISPOT, and tuberculin skin test

AU - Lee, S. S J

AU - Chou, K. J.

AU - Su, I. J.

AU - Chen, Y. S.

AU - Fang, H. C.

AU - Huang, T. S.

AU - Tsai, H. C.

AU - Wann, S. R.

AU - Lin, H. H.

AU - Liu, Y. C.

PY - 2009/4

Y1 - 2009/4

N2 - Background: : Individuals with end-stage renal disease (ESRD) are 10- to 25-fold more likely than immunocompetent people to develop active tuberculosis (TB) and are candidates for being treated for latent TB infection (LTBI). However, diagnosis using the tuberculin skin test (TST) is doubly difficult due to cutaneous anergy and cross-reactions with Bacille-Calmette-Guérin (BCG) vaccination. Materials and Methods: : This was a prospective, doublematched, cohort study in which 32 ESRD patients and 32 age-matched, healthy controls were enrolled. The TST and two new interferon-γ blood tests, QuantiFERON-TB Gold (QFT-G) and T-SPOT.TB (ELISPOT), were performed. The subjects were followed up 2 years for active TB disease. ELISPOT was done in ESRD patients only. Results: : Compared to the healthy controls, a high prevalence of LTBI was found in the ESRD patients by TST (62.5%, 95% confidence interval [CI] 43.7-78.9), QFT-G (40.0%, 95% CI 22.7-59.4), and ELISPOT (46.9%, 95% CI 29.1-65.3). Agreement was moderate (kappa [κ] = 0.53) for QFT-G and ELISPOT but only slight between TST and QFT-G (κ = 0.25) and fair between TST and ELISPOT (κ = 0.32). ESRD (p = 0.03) and diabetes mellitus (p = 0.04) were significant risk factors for QFT-G positivity on the multivariable analysis. The overall rate of active TB was 1.66 cases per 100 person-years (pys), with the rate higher in patients with ESRD (3.53 per 100 pys) and those with positive (3.40 per 100 pys) and indeterminate QFT results (30.16 per 100 pys), although the difference was not statistically significant. Sensitivity, specificity, and positive and negative predictive values of QFT-G for active TB was 100%, 62.1%, 8.3% and 100%. Conclusion: : This pilot study is the first to compare QFT-G, ELISPOT, and TST in ESRD patients on hemodialysis and demonstrates a high prevalence of LTBI in this population. In our study, the QFT-G was the more accurate method for identifying those truly infected with Mycobacterium tuberculosis, even in BCG-vaccinated individuals.

AB - Background: : Individuals with end-stage renal disease (ESRD) are 10- to 25-fold more likely than immunocompetent people to develop active tuberculosis (TB) and are candidates for being treated for latent TB infection (LTBI). However, diagnosis using the tuberculin skin test (TST) is doubly difficult due to cutaneous anergy and cross-reactions with Bacille-Calmette-Guérin (BCG) vaccination. Materials and Methods: : This was a prospective, doublematched, cohort study in which 32 ESRD patients and 32 age-matched, healthy controls were enrolled. The TST and two new interferon-γ blood tests, QuantiFERON-TB Gold (QFT-G) and T-SPOT.TB (ELISPOT), were performed. The subjects were followed up 2 years for active TB disease. ELISPOT was done in ESRD patients only. Results: : Compared to the healthy controls, a high prevalence of LTBI was found in the ESRD patients by TST (62.5%, 95% confidence interval [CI] 43.7-78.9), QFT-G (40.0%, 95% CI 22.7-59.4), and ELISPOT (46.9%, 95% CI 29.1-65.3). Agreement was moderate (kappa [κ] = 0.53) for QFT-G and ELISPOT but only slight between TST and QFT-G (κ = 0.25) and fair between TST and ELISPOT (κ = 0.32). ESRD (p = 0.03) and diabetes mellitus (p = 0.04) were significant risk factors for QFT-G positivity on the multivariable analysis. The overall rate of active TB was 1.66 cases per 100 person-years (pys), with the rate higher in patients with ESRD (3.53 per 100 pys) and those with positive (3.40 per 100 pys) and indeterminate QFT results (30.16 per 100 pys), although the difference was not statistically significant. Sensitivity, specificity, and positive and negative predictive values of QFT-G for active TB was 100%, 62.1%, 8.3% and 100%. Conclusion: : This pilot study is the first to compare QFT-G, ELISPOT, and TST in ESRD patients on hemodialysis and demonstrates a high prevalence of LTBI in this population. In our study, the QFT-G was the more accurate method for identifying those truly infected with Mycobacterium tuberculosis, even in BCG-vaccinated individuals.

UR - http://www.scopus.com/inward/record.url?scp=67349155024&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67349155024&partnerID=8YFLogxK

U2 - 10.1007/s15010-008-8082-3

DO - 10.1007/s15010-008-8082-3

M3 - Article

VL - 37

SP - 96

EP - 102

JO - Infection

JF - Infection

SN - 0300-8126

IS - 2

ER -