This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (103)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Tuberculosis/ Other Mycobacterium  • World Health  • Pulmonary Diseases  • Pulmonary Diseases, Other  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Comparison of a Whole-Blood Interferon Assay With Tuberculin Skin Testing

Madhukar Pai, MD, PhD; Kaustubh Gokhale, MD; Rajnish Joshi, MD; Sandeep Dogra, MD; Shriprakash Kalantri, MD, MPH; Deepak K. Mendiratta, MD; Pratibha Narang, MD; Charles L. Daley, MD; Reuben M. Granich, MD, MPH; Gerald H. Mazurek, MD; Arthur L. Reingold, MD; Lee W. Riley, MD; John M. Colford, Jr, MD, PhD

JAMA. 2005;293:2746-2755.

Context  Mycobacterium tuberculosis infection in health care workers has not been adequately studied in developing countries using newer diagnostic tests.

Objectives  To estimate latent tuberculosis infection prevalence in health care workers using the tuberculin skin test (TST) and a whole-blood interferon (IFN-) assay; to determine agreement between the tests; and to compare their correlation with risk factors.

Design, Setting, and Participants  A cross-sectional comparison study of 726 health care workers aged 18 to 61 years (median age, 22 years) with no history of active tuberculosis conducted from January to May 2004, at a rural medical school in India. A total of 493 (68%) of the health care workers had direct contact with patients with tuberculosis and 514 (71%) had BCG vaccine scars.

Interventions  Tuberculin skin testing was performed using 1-TU dose of purified protein derivative RT23, and the IFN- assay was performed by measuring IFN- response to early secreted antigenic target 6, culture filtrate protein 10, and a portion of tuberculosis antigen TB7.7.

Main Outcome Measures  Agreement between TST and the IFN- assay, and comparison of the tests with respect to their association with risk factors.

Results  A large proportion of the health care workers were latently infected; 360 (50%) were positive by either TST or IFN- assay, and 226 (31%) were positive by both tests. The prevalence estimates of TST and IFN- assay positivity were comparable (41%; 95% confidence interval [CI], 38%-45% and 40%; 95% CI, 37%-43%, respectively). Agreement between the tests was high (81.4%;  = 0.61; 95% CI, 0.56-0.67). Increasing age and years in the health profession were significant risk factors for both IFN- assay and TST positivity. BCG vaccination had little impact on TST and IFN- assay results.

Conclusions  Our study showed high latent tuberculosis infection prevalence in Indian health care workers, high agreement between TST and IFN- assay, and similar association between positive test results and risk factors. Although TST and IFN- assay appear comparable in this population, they have different performance and operational characteristics; therefore, the decision to select one test over the other will depend on the population, purpose of testing, and resource availability.

Author Affiliations: Departments of Medicine and Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India (Drs Pai, Gokhale, Joshi, Dogra, Kalantri, Mendiratta, and Narang); Divisions of Epidemiology and Infectious Diseases, School of Public Health, University of California, Berkeley (Drs Pai, Reingold, Riley, and Colford); Department of Medicine, University of California, San Francisco (Dr Daley); Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Granich and Mazurek); and Office of World Health Organization Representative to India, New Delhi (Dr Granich). Dr Daley is now with the National Jewish Medical and Research Center, Denver, Colo. Dr Granich is now with the Office of the United States Global AIDS Coordinator, Washington, DC.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Discrepancy Between the Tuberculin Skin Test and the Whole-Blood Interferon Assay for the Diagnosis of Latent Tuberculosis Infection in an Intermediate Tuberculosis-Burden Country
Young Ae Kang, Hye Won Lee, Ho Il Yoon, BeLong Cho, Sung Koo Han, Young-Soo Shim, and Jae-Joon Yim
JAMA. 2005;293(22):2756-2761.
ABSTRACT | FULL TEXT  

Diagnosis of Latent Tuberculosis Infection: Measure for Measure
Christopher C. Whalen
JAMA. 2005;293(22):2785-2787.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Is the QuantiFERON-TB Blood Assay a Good Replacement for the Tuberculin Skin Test in Tuberculosis Screening?: A Pilot Study at Berkshire Medical Center
Zhao et al.
Am J Clin Pathol 2009;132:678-686.
ABSTRACT | FULL TEXT  

Short-Term Reproducibility of a Commercial Interferon Gamma Release Assay
Detjen et al.
CVI 2009;16:1170-1175.
ABSTRACT | FULL TEXT  

Interferon-gamma release assays versus tuberculin skin testing for detection of latent tuberculosis in chronic haemodialysis patients
Triverio et al.
Nephrol Dial Transplant 2009;24:1952-1956.
ABSTRACT | FULL TEXT  

Indeterminate results of QuantiFERON TB-2G test performed in routine clinical practice
Kobashi et al.
Eur Respir J 2009;33:812-815.
ABSTRACT | FULL TEXT  

Serial Testing of Refugees for Latent Tuberculosis Using the QuantiFERON-Gold In-Tube: Effects of an Antecedent Tuberculin Skin Test
Baker et al.
Am J Trop Med Hyg 2009;80:628-633.
ABSTRACT | FULL TEXT  

The Effect of Previous Tuberculin Skin Test on the Follow-up Examination of Whole-Blood Interferon-{gamma} Assay in the Screening for Latent Tuberculosis Infection
Choi et al.
Chest 2008;133:1415-1420.
ABSTRACT | FULL TEXT  

Evaluation of a Model for Efficient Screening of Tuberculosis Contact Subjects
Aissa et al.
Am. J. Respir. Crit. Care Med. 2008;177:1041-1047.
ABSTRACT | FULL TEXT  

Worlds Apart -- Tuberculosis in India and the United States
Paralkar
NEJM 2008;358:1092-1095.
FULL TEXT  

Peripheral Blood Gamma Interferon Release Assays Predict Lung Responses and Mycobacterium tuberculosis Disease Outcome in Mice
Beamer et al.
CVI 2008;15:474-483.
ABSTRACT | FULL TEXT  

Comparison of T-Spot.TB and tuberculin skin test among silicotic patients
Leung et al.
Eur Respir J 2008;31:266-272.
ABSTRACT | FULL TEXT  

Use of Whole-Blood Samples in In-House Bulk and Single-Cell Antigen-Specific Gamma Interferon Assays for Surveillance of Mycobacterium tuberculosis Infections
Palazzo et al.
CVI 2008;15:327-337.
ABSTRACT | FULL TEXT  

Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen-specific interferon {gamma} assay
Matulis et al.
Ann Rheum Dis 2008;67:84-90.
ABSTRACT | FULL TEXT  

Clinical Utility of Interferon Gamma Assay in the Diagnosis of Tuberculosis
Madariaga et al.
J Am Board Fam Med 2007;20:540-547.
ABSTRACT | FULL TEXT  

Discrepancy between Mycobacterium tuberculosis-Specific Gamma Interferon Release Assays Using Short and Prolonged In Vitro Incubation
Leyten et al.
CVI 2007;14:880-885.
ABSTRACT | FULL TEXT  

Recent advances in the diagnosis of childhood tuberculosis
Marais and Pai
Arch. Dis. Child. 2007;92:446-452.
ABSTRACT | FULL TEXT  

Comparison of an Interferon-{gamma} Release Assay with Tuberculin Skin Testing in HIV-infected Individuals
Luetkemeyer et al.
Am. J. Respir. Crit. Care Med. 2007;175:737-742.
ABSTRACT | FULL TEXT  

The New IGRA and the Old TST: Making Good Use of Disagreement
Pai and Menzies
Am. J. Respir. Crit. Care Med. 2007;175:529-531.
FULL TEXT  

Comparison of Two Interferon-{gamma} Assays and Tuberculin Skin Test for Tracing Tuberculosis Contacts
Arend et al.
Am. J. Respir. Crit. Care Med. 2007;175:618-627.
ABSTRACT | FULL TEXT  

Meta-analysis: New Tests for the Diagnosis of Latent Tuberculosis Infection: Areas of Uncertainty and Recommendations for Research
Menzies et al.
ANN INTERN MED 2007;146:340-354.
ABSTRACT | FULL TEXT  

Effect of HIV-1 Infection on T-Cell-based and Skin Test Detection of Tuberculosis Infection
Rangaka et al.
Am. J. Respir. Crit. Care Med. 2007;175:514-520.
ABSTRACT | FULL TEXT  

Loss of leishmanin skin test antigen sensitivity and potency in a longitudinal study of visceral leishmaniasis in bangladesh.
BERN et al.
Am J Trop Med Hyg 2006;75:744-748.
ABSTRACT | FULL TEXT  

Whole blood IFN-{gamma} assay for detecting TB in children.
Radford et al.
Thorax 2006;61:919-921.
FULL TEXT  

An Update on the Diagnosis of Tuberculosis Infection
Richeldi
Am. J. Respir. Crit. Care Med. 2006;174:736-742.
ABSTRACT | FULL TEXT  

Serial Testing of Health Care Workers for Tuberculosis Using Interferon-{gamma} Assay
Pai et al.
Am. J. Respir. Crit. Care Med. 2006;174:349-355.
ABSTRACT | FULL TEXT  

Avoiding the effect of BCG vaccination in detecting Mycobacterium tuberculosis infection with a blood test
Diel et al.
Eur Respir J 2006;28:16-23.
ABSTRACT | FULL TEXT  

An In-House RD1-Based Enzyme-Linked Immunospot-Gamma Interferon Assay Instead of the Tuberculin Skin Test for Diagnosis of Latent Mycobacterium tuberculosis Infection.
Codecasa et al.
J. Clin. Microbiol. 2006;44:1944-1950.
ABSTRACT | FULL TEXT  

Transmission of Mycobacterium tuberculosis Undetected by Tuberculin Skin Testing
Anderson et al.
Am. J. Respir. Crit. Care Med. 2006;173:1038-1042.
ABSTRACT | FULL TEXT  

Comparison of Enzyme-Linked Immunospot Assay and Tuberculin Skin Test in Healthy Children Exposed to Mycobacterium tuberculosis
Hill et al.
Pediatrics 2006;117:1542-1548.
ABSTRACT | FULL TEXT  

Update in tuberculosis 2005.
Yew and Leung
Am. J. Respir. Crit. Care Med. 2006;173:491-498.
FULL TEXT  

Comparison of a New ESAT-6/CFP-10 Peptide-Based Gamma Interferon Assay and a Tuberculin Skin Test for Tuberculosis Screening in a Moderate-Risk Population
Porsa et al.
CVI 2006;13:53-58.
ABSTRACT | FULL TEXT  

Interferon-{gamma} Assays for Tuberculosis: Is Anergy the Achilles' Heel?
Pai and Lewinsohn
Am. J. Respir. Crit. Care Med. 2005;172:519-521.
FULL TEXT  

Diagnosis of Latent TB: Simple Skin Test or "High-Tech" Interferon Assay?
JWatch Infect. Diseases 2005;2005:8-8.
FULL TEXT  

Diagnosis of Latent Tuberculosis Infection: Measure for Measure
Whalen
JAMA 2005;293:2785-2787.
FULL TEXT  

Tuberculosis--A Global Problem Requiring a Global Solution
DeAngelis and Flanagin
JAMA 2005;293:2793-2794.
FULL TEXT