Serial Interferon-gamma Release Assays for the Diagnosis of Latent Tuberculosis Infection in Patients Treated with Immunosuppressive Agents
2
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
Background: We assessed the efficacy of serial interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in patients receiving immunosuppressive agents for treatment of rheumatic diseases in Korea. Methods: Of 276 patients who underwent consecutive screening with one of two IGRAs [QuantiFERON-TB Gold or QuantiFERON-TB Gold In-Tube], 66 patients were evaluated by the serial IGRA for detection of LTBI during therapy with immunosuppressive agents. Information on clinical diagnosis, medication, previous TB, blood cell count, tuberculin skin test, and interferon-gamma (IFN-γ) level measured by IGRA was collected. Results: Of the 66 patients, the initial IGRA was positive in 24.2%, negative in 65.2%, and indeterminate in 10.6%. Forty-six patients (69.7%) showed consistent IGRA results during follow-up, and 13 patients (19.7%) had consistently positive results. IGRA conversion rate was 12.1% (8/66) and reversion rate was 4.5% (3/66). Conversion of IGRA results was only observed in ankylosing spondylitis patients, and the median interval between the two tests in patients with conversion was 8.5 months. The mean IFN-γ level in the group of patients with consistently positive IGRA results was higher than that in the group with inconsistently positive results, although this trend was not statistically significant (P=0.293). Indeterminate results were observed most frequently in patients with systemic lupus erythematosus. Conclusions: In patients receiving immunosuppressive agents, both IGRA conversions and reversions were observed. Serial IGRA testing may not be needed in patients with a positive initial IGRA result showing high IFN-γ levels, because of high consistency in the test results.
Abstract
Background: We assessed the efficacy of serial interferon-gamma release assays (IGRAs) for the diagnosis of latent tuberculosis infection (LTBI) in patients receiving immunosuppressive agents for treatment of rheumatic diseases in Korea. Methods: Of 276 patients who underwent consecutive screening with one of two IGRAs [QuantiFERON-TB Gold or QuantiFERON-TB Gold In-Tube], 66 patients were evaluated by the serial IGRA for detection of LTBI during therapy with immunosuppressive agents. Information on clinical diagnosis, medication, previous TB, blood cell count, tuberculin skin test, and interferon-gamma (IFN-γ) level measured by IGRA was collected. Results: Of the 66 patients, the initial IGRA was positive in 24.2%, negative in 65.2%, and indeterminate in 10.6%. Forty-six patients (69.7%) showed consistent IGRA results during follow-up, and 13 patients (19.7%) had consistently positive results. IGRA conversion rate was 12.1% (8/66) and reversion rate was 4.5% (3/66). Conversion of IGRA results was only observed in ankylosing spondylitis patients, and the median interval between the two tests in patients with conversion was 8.5 months. The mean IFN-γ level in the group of patients with consistently positive IGRA results was higher than that in the group with inconsistently positive results, although this trend was not statistically significant (P=0.293). Indeterminate results were observed most frequently in patients with systemic lupus erythematosus. Conclusions: In patients receiving immunosuppressive agents, both IGRA conversions and reversions were observed. Serial IGRA testing may not be needed in patients with a positive initial IGRA result showing high IFN-γ levels, because of high consistency in the test results.
참고문헌 (22)
- Small PM, "Management of tuberculosis in the United States", N Engl J Med, 345, pp.189~200 (2001)
- Horsburgh CR Jr, "Priorities for the treatment of latent tuberculosis infection in the United States", N Engl J Med, 350, pp.2060~2067 (2004)
- Jasmer RM, "Clinical practice. Latent tuberculosis infection", N Engl J Med, 347, pp.1860~1866 (2002)
- Wang L, "A meta-analysis of the effect of Bacille Calmette Guérin vaccination on tuberculin skin test measurements", Thorax, 57, pp.804~809 (2002)
- 강영애, "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-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 293(22), pp.2756~2761
- Mazurek GH, "Guidelines for using the QuantiFERON-TB gold test for detecting mycobacterium tuberculosis infection", United States MMWR Recomm Rep, 54, pp.49~55 (2005)
- Mazurek GH, "Updated guidelines for using interferon gamma release assays to detect mycobacterium tuberculosis infection - United States, 2010", MMWR Recomm Rep, 59, pp.1~25 (2010)
- Keane J, "Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent", N Engl J Med, 345, pp.1098~1104 (2001)
- Korea Food and Drug Administration, "Guideline for diagnosis and treatment of latent tuberculosis infection in patients treated with TNF blockers" (2004), Korea Food and Drug Administration
- Pai M, "Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update", Ann Intern Med, 149, pp.177~184 (2008)
- Park JH, "Positive conversion of tuberculin skin test and performance of interferon release assay to detect hidden tuberculosis infection during anti-tumor necrosis factor agent trial", J Rheumatol, 36, pp.2158~2163 (2009)
- Chen DY, "Effectiveness of the combination of a whole-blood interferon-gamma assay and the tuberculin skin test in detecting latent tuberculosis infection in rheumatoid arthritis patients receiving adalimumab therapy", Arthritis Rheum, 59, pp.800~806 (2008)
- Perry S, "Reproducibility of QuantiFERON-TB gold in-tube assay", Clin Vaccine Immunol, 15, pp.425~432 (2008)
- Won-Jung Koh, "Diagnosis and Treatment of Nontuberculous Mycobacterial Pulmonary Diseases: A Korean Perspective", Journal of Korean Medical Science, 20(6), pp.913~925 (2005), 대한의학회
- Hamdi H, "Inhibition of anti-tuberculosis T-lymphocyte function with tumour necrosis factor antagonists", Arthritis Res Ther, 8, pp.114~ (2006)
- Matulis G, "Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a mycobacterium tuberculosis antigen-specific interferon gamma assay", Ann Rheum Dis, 67, pp.84~90 (2008)
- Inanc N, "Agreement between Quantiferon-TB gold test and tuberculin skin test in the identification of latent tuberculosis infection in patients with rheumatoid arthritis and ankylosing spondylitis", J Rheumatol, 36, pp.2675~2681 (2009)
- Malaviya AN, "Preventing tuberculosis flare in patients with inflammatory rheumatic diseases receiving tumor necrosis factor-alpha inhibitors in India -- An audit report", J Rheumatol, 36, pp.1414~1420 (2009)
- Shovman O, "QuantiFERON-TB gold in the identification of latent tuberculosis infection in rheumatoid arthritis: a pilot study", Int J Tuberc Lung Dis, 13, pp.1427~1432 (2009)
- Kobashi Y, "Clinical reevaluation of the QuantiFERON TB-2G test as a diagnostic method for differentiating active tuberculosis from nontuberculous mycobacteriosis", Clin Infect Dis, 43, pp.1540~1546 (2006)
- Komiya K, "Impact of peripheral lymphocyte count on the sensitivity of 2 IFN-gamma release assays, QFT-G and ELISPOT, in patients with pulmonary tuberculosis", Intern Med, 49, pp.1849~1855 (2010)