폐결핵 접촉력을 가진 소아에서 잠복 결핵 감염의 진단을 위한 결핵 특이항원 자극 인터페론-감마 측정의 유용성
Usefulness of Interferon-γ measurement following stimulation of tuberculosis-sp ecific antig ens for diagnosis of latent tuberculosis infection in children ex posed to pulmonary tuberculosis
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Purpose : Whole blood interferon-γ assay was developed and many studies showed its usefulness in diagnosing tuberculosis (TB) including latent tuberculosis infection (LTBI). However, assessment in children has been limited. This study was undertaken to evaluate the usefulness of QuantiFERON-TB Gold for the diagnosis of LTBI in children exposed to pulmonary TB. Methods : Children who visited Seoul National University Bundang Hospital with a history of TB exposure were enrolled from January 2006 to December 2007. They were evaluated with chest x-rays, tuberculin skin test (TST) and QuantiFERON-TB Gold test. TST was retested 3 months later for those with initial negative reactivity. Definition of LTBI was made on the basis of the TST reactivity. Results : Among the 103 children with a history of TB exposure, 49 children were tested with chest x-ray, TST, and QuantiFERON-TB Gold. Twenty-two were males. Median age was 7.5 years (range; 3 months to 14.7 years). According to TST reactivity, LTBI was in 8 (19%), no infection was in 21 (50%), possible LTBI was in 13 (31%). QuantiFERON-TB Gold test was positive in 5 of the 49 subjects (10%); 3 of the 13 subjects (23.1%) in unknown status, 1 of the 8 subjects (13%) in LTBI, and 1 of the 21 subjects (5%) without infection. The agreement between the QuantiFERON-TB Gold and the TST was poor (κ=0.101). Conclus ion : QuantiFERON-TB Gold showed poor sensitivity for the diagnosis of LTBI in children with exposure to TB. QuantiFERON-TB Gold alone does not seem to be useful in the diagnosis of LTBI in children. (Korean J Pediatr Infect Dis 2008;15:50-57)
Abstract
Purpose : Whole blood interferon-γ assay was developed and many studies showed its usefulness in diagnosing tuberculosis (TB) including latent tuberculosis infection (LTBI). However, assessment in children has been limited. This study was undertaken to evaluate the usefulness of QuantiFERON-TB Gold for the diagnosis of LTBI in children exposed to pulmonary TB. Methods : Children who visited Seoul National University Bundang Hospital with a history of TB exposure were enrolled from January 2006 to December 2007. They were evaluated with chest x-rays, tuberculin skin test (TST) and QuantiFERON-TB Gold test. TST was retested 3 months later for those with initial negative reactivity. Definition of LTBI was made on the basis of the TST reactivity. Results : Among the 103 children with a history of TB exposure, 49 children were tested with chest x-ray, TST, and QuantiFERON-TB Gold. Twenty-two were males. Median age was 7.5 years (range; 3 months to 14.7 years). According to TST reactivity, LTBI was in 8 (19%), no infection was in 21 (50%), possible LTBI was in 13 (31%). QuantiFERON-TB Gold test was positive in 5 of the 49 subjects (10%); 3 of the 13 subjects (23.1%) in unknown status, 1 of the 8 subjects (13%) in LTBI, and 1 of the 21 subjects (5%) without infection. The agreement between the QuantiFERON-TB Gold and the TST was poor (κ=0.101). Conclus ion : QuantiFERON-TB Gold showed poor sensitivity for the diagnosis of LTBI in children with exposure to TB. QuantiFERON-TB Gold alone does not seem to be useful in the diagnosis of LTBI in children. (Korean J Pediatr Infect Dis 2008;15:50-57)
참고문헌 (24)
- Khan EA, "Diagnosis of tuberculosis in children: Increased need for better methods", Emerg Infect Dis, 1, pp.115~123 (1995)
- 제7차 전국결핵실태조사 결과보고서, "대한 결핵협회", ~ (1996)
- 질병관리본부, "결핵환자 신고현황 연보" (2006), 결핵연구원
- Connell TG, "Performance of a whole blood interferon gamma assay for detecting latent infection with Mycobacterium tuberculosis in children", Thorax, 61, pp.616~620 (2006)
- Menzies D, "Meta-analysis:New tests for the diagnosis of latent tuberculosis infection: Areas of uncertainty and recommendations for research", Ann Intern Med, 146, pp.340~354 (2007)
- Farhat M, "False-positive tuberculin skin tests: what is th absolute effect of BCG and non-tuberculous mycobacteria?", Int J Tuberc Lung Dis, 10, pp.1192~1204 (2006)
- Okada K, "Performance of an interferon-gamma release assay for diagnosing latent tuberculosis infection in children", Epidemiol Infect, 8, pp.1~9 (2007)
- Kang YA, "Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country", JAMA, 293, pp.2756~2761 (2005)
- Lalvani A, "Diagnosing tuberculosis infection in the 21st Century", Chest, 131, pp.1898~1906 (2007)
- 박경운, "결핵특이항원(ESAT-6 및 CFP-10) 자극 후 인터페론-감마 측정을 통한 잠복결핵의 진단", 임상검사와 정도관리, 27, pp.237~242 (2005)
- Mori T, Sakatani M, "detection of tuberculosis infection: an interferon-gamma-based assay using new antigens", Am J Respir Crit Care Med, 170, pp.59~64 (2004)
- Davies PDO, "The use of interferon-gamma-based blood tests for the detection of latent tuberculosis infection", Eur Respir J, 28, pp.1~3 (2006)
- 심태선, "국내에서 잠복결핵의 진단 및 치료", 결핵 및 호흡기질환, 57(2), pp.101~117 (2004), 대한결핵및호흡기학회
- Richeldi L, "T-cell-based diagnosis of neonatal multidrug-resistant latent tuberculosis infection", Pediatrics, 119, pp.1~5 (2007)
- Eum SY, "Evaluation of diagnostic utility of a whole-blood interferon-γ assay for determining the risk of exposure to Mycobacterium tuberculosis in Bacille Calmette-Guerin (BCG)-vaccinated individuals", Diagn Microbiol Infect Dis, 61, pp.181~186 (2008)
- Ewer K, "Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak", Lancet, 361, pp.1168~1173 (2003)
- Brock I, "Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts", Am J Respir Crit Med, 170, pp.65~69 (2004)
- Mazurek GH, "Prospective comparison of the tuberculin skin test and 2 whole-blood interferon-γ release assays in persons with suspected tuberculosis", Clin Infect Dis, 45, pp.837~845 (2007)
- Connell T, "Early detection of perinatal tuberculosis using a whole blood interferon-gamma release assay", Clin Infect Dis, 42, pp.82~85 (2006)
- Molicotti P, "Performance of QuantiFERON-TB testing in a tuberculosis outbreak at a primary school", J Pediatr, 152, pp.585~586 (2008)
- Richeldi L, "An update on the diagnosis of tuberculosis infection", Am J Respir Crit Med, 174, pp.736~742 (2006)
- Mazurek GH, "Guidelines for using the QuantiFERONTB Gold test for detecting Mycobacterium tuberculosis infection, United States", MMWR Recomm Rep, 54(15), pp.49~55 (2005)
- Higuchi K, "Use of QuantiFERON-TB Gold to investigate tuberculosis contacts in a high school", Respirology, 12, pp.88~92 (2007)
- Soysal A, "Effect of BCG vaccination on risk of Mycobacterium tuberculosis infection in children with household tuberculosis contact: a prospective community-based study", Lancet, 366, pp.1443~1451 (2005)