Influence of age and nutritional status on the performance of the tuberculin skin test and QuantiFERON-TB Gold in-Tube in young children evaluated for tuberculosis in Southern India
Pediatric Infectious Disease Journal
Center for Immune Regulation, Oslo University Hospital, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway; Division of Epidemiology, Biostatistics and Population Health, United States; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Aeras, Rockville, MD, United States; Department of Paediatrics and Child Health, Desmond Tutu TB Center, Stellenbosch University, Cape Town, South Africa; GlaxoSmithKline Pharma, Vaccines, Copenhagen, Denmark; Division of Health and Humanities, St. John's Research Institute, Bangalore, India; Department of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
Background: Reliable identification of Mycobacterium tuberculosis infection or tuberculosis (TB) disease in young children is vital to assure adequate preventive and curative treatment. The tuberculin skin test (TST) and IFNγ-release assays may supplement the diagnosis of pediatric TB as cases are typically bacteriologically unconfirmed. However, it is unclear to what extent the performance of TST and QuantiFERON-TB Gold In-Tube (QFT; Cellestis' IFNγ-release assay test) depends on the demographic, clinical and nutritional characteristics of children in whom they are tested. Methods: During a 2-year prospective observational study of 4382 neonates in Southern India, children with suspected TB were investigated and classified by a standard TB diagnostic algorithm. Results: Clinical TB was diagnosed in 13 of 705 children referred for case verification with suspected TB. TST and QFT had a susceptibility for clinical TB of 31% and 23%, respectively, in this group. Children <2 years were more likely to test QFT indeterminate. A height-for-age Z score within the lowest quartile increased the odds ratio (OR) for a positive or indeterminate QFT result [OR 2.46 (1.19-5.06), OR 3.08 (1.10-8.58)], whereas the OR for a positive TST was reduced with a weight-for-height Z score within the lowest quartile [OR 0.17 (0.06-0.47)]. Conclusion: The sensitivities of the TST and QFT for clinical TB in children <3 years of age were equally poor in this population. Stunted children were more susceptible to Mycobacterium tuberculosis infection and more prone to indeterminate QFT results. TST was less reliable in children with wasting. Copyright © 2014 by Lippincott Williams & Wilkins.
age; algorithm; Article; child; coughing; demography; diagnostic procedure; diagnostic test accuracy study; female; fever; human; India; infant; infection sensitivity; interferon gamma release assay; major clinical study; male; Mycobacterium tuberculosis test kit; newborn; nutritional health; nutritional status; observational study; preschool child; priority journal; prospective study; tuberculin test; tuberculosis; age; comparative study; evaluation study; immunology; interferon gamma release assay; Mycobacterium tuberculosis; procedures; sensitivity and specificity; skin test; tuberculin test; tuberculosis; Age Factors; Child, Preschool; Female; Humans; India; Infant; Interferon-gamma Release Tests; Male; Mycobacterium tuberculosis; Nutritional Status; Prospective Studies; Sensitivity and Specificity; Skin Tests; Tuberculin Test; Tuberculosis