Interferon-γ release assays for diagnosis of tuberculosis infection and disease in children

Committee on Infectious Diseases

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Tuberculosis (TB) remains an important problem among children in the United States and throughout the world. Although diagnosis and treatment of infection with Mycobacterium tuberculosis (also referred to as latent tuberculosis infection [LTBI] or TB infection) remain the lynchpins of TB prevention, there is no diagnostic reference standard for LTBI. The tuberculin skin test (TST) has many limitations, including difficulty in administration and interpretation, the need for a return visit by the patient, and false-positive results caused by significant cross-reaction with Mycobacterium bovis-bacille Calmette- Guérin (BCG) vaccines and many nontuberculous mycobacteria. Interferon-γ release assays (IGRAs) are blood tests that measure ex vivo T-lymphocyte release of interferon-γ after stimulation by antigens specific for M tuberculosis. Because these antigens are not found on M bovis- BCG or most nontuberculous mycobacteria, IGRAs are more specific tests than the TST, yielding fewer false-positive results. However, IGRAs have little advantage over the TST in sensitivity, and both methods have reduced sensitivity in immunocompromised children, including children with severe TB disease. Both methods have a higher positive predictive value when applied to children with risk factors for LTBI. Unfortunately, neither method distinguishes between TB infection and TB disease. The objective of this technical report is to review what IGRAs are most useful for: (1) increasing test specificity in children who have received a BCG vaccine and may have a falsepositive TST result; (2) using with the TST to increase sensitivity for finding LTBI in patients at high risk of developing progression from LTBI to disease; and (3) helping to diagnose TB disease.

Original languageEnglish (US)
Pages (from-to)e1763-e1773
JournalPediatrics
Volume134
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Interferons
Latent Tuberculosis
Tuberculosis
Tuberculin Test
Skin Tests
Infection
BCG Vaccine
Nontuberculous Mycobacteria
Antigens
Cross Reactions
Hematologic Tests
Mycobacterium bovis
Mycobacterium tuberculosis
T-Lymphocytes

Keywords

  • Bacille calmette-guerin
  • Interferon-γ release assay
  • Tuberculin skin test
  • Tuberculosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Interferon-γ release assays for diagnosis of tuberculosis infection and disease in children. / Committee on Infectious Diseases.

In: Pediatrics, Vol. 134, No. 6, 01.12.2014, p. e1763-e1773.

Research output: Contribution to journalArticle

Committee on Infectious Diseases. / Interferon-γ release assays for diagnosis of tuberculosis infection and disease in children. In: Pediatrics. 2014 ; Vol. 134, No. 6. pp. e1763-e1773.
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