PMID- 22586160
OWN - NLM
STAT- MEDLINE
DCOM- 20121220
LR  - 20141120
IS  - 1468-2060 (Electronic)
IS  - 0003-4967 (Linking)
VI  - 71
IP  - 11
DP  - 2012 Nov
TI  - Screening for latent tuberculosis infection: performance of tuberculin skin test 
      and interferon-gamma release assays under real-life conditions.
PG  - 1791-5
LID - 10.1136/annrheumdis-2011-200941 [doi]
AB  - OBJECTIVES: To characterise optimal screening strategies for latent tuberculosis 
      infection (LTBI) prior to the initiation of anti-tumour necrosis factor therapy. 
      METHODS: Patients in 62 German rheumatology centres were evaluated for LTBI. Each 
      patient was screened with a tuberculin skin test (TST) and one form of an 
      interferon-gamma release assay (IGRA), either TSPOT.TB (TSPOT) or Quantiferon TB Gold 
      (QFT). RESULTS: A total of 1529 patients with rheumatological disease were tested 
      with a TST, 844 with TSPOT and 685 with QFT. TST was positive in 11.3% (n=173). 
      The prevalence of LTBI was 8.0% when defined as a positive TST and no previous 
      Bacille Calmette-Guerin (BCG) vaccination and 7.9% when based on a positive IGRA. 
      Combining both estimates increased the prevalence of LTBI to 11.1%. Clinical risk 
      factors for LTBI were found in 122 patients (34 with a history of prior TB, 81 
      close contacts and 27 with suggestive chest x-ray lesions). A compound risk 
      factor (CRF) was defined as the presence of at least one of these three risk 
      factors. Statistical analyses were conducted to examine the association between 
      CRF and LTBI test outcomes. In multivariate analysis, TST was influenced by CRF 
      (OR 6.2; CI 4.08 to 9.44, p<0.001) and BCG vaccination status (OR 2.9; CI 2.00 to 
      4.35, p<0.001). QFT and TSPOT were only influenced by CRF (QFT: OR 2.6; CI 1.15 
      to 5.98, p=0.021; TSPOT: OR 8.7; CI 4.83 to 15.82, p<0.001). ORs and the 
      agreement of TST and IGRA test results varied by rheumatological disease. 
      CONCLUSION: LTBI test results in an individual patient need to be considered in 
      the context of prior BCG vaccination and clinical risk factors. In patient 
      populations with low rates of TB incidence and BCG vaccination, the use of both 
      TST and IGRA may maximise sensitivity in detecting LTBI but may also reduce 
      specificity.
FAU - Kleinert, S
AU  - Kleinert S
AD  - Rheumatology/Clinical Immunology, University Hospital of Wuerzburg, Wuerzburg, 
      Germany. Kleinert_S@klinik.uni-wuerzburg.de
FAU - Tony, H-P
AU  - Tony HP
FAU - Krueger, K
AU  - Krueger K
FAU - Detert, J
AU  - Detert J
FAU - Mielke, F
AU  - Mielke F
FAU - Rockwitz, K
AU  - Rockwitz K
FAU - Schwenke, R
AU  - Schwenke R
FAU - Burmester, G R
AU  - Burmester GR
FAU - Diel, R
AU  - Diel R
FAU - Feuchtenberger, M
AU  - Feuchtenberger M
FAU - Kneitz, C
AU  - Kneitz C
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20120514
PL  - England
TA  - Ann Rheum Dis
JT  - Annals of the rheumatic diseases
JID - 0372355
RN  - 82115-62-6 (Interferon-gamma)
SB  - IM
CIN - Ann Rheum Dis. 2012 Nov;71(11):1757-60. PMID: 22975752
MH  - Female
MH  - Humans
MH  - Interferon-gamma/blood
MH  - *Interferon-gamma Release Tests
MH  - Latent Tuberculosis/blood/*diagnosis
MH  - Male
MH  - Mass Screening/*methods
MH  - Middle Aged
MH  - Professional Practice
MH  - Prospective Studies
MH  - Secondary Prevention
MH  - *Tuberculin Test
EDAT- 2012/05/16 06:00
MHDA- 2012/12/21 06:00
CRDT- 2012/05/16 06:00
PHST- 2012/05/16 06:00 [entrez]
PHST- 2012/05/16 06:00 [pubmed]
PHST- 2012/12/21 06:00 [medline]
AID - annrheumdis-2011-200941 [pii]
AID - 10.1136/annrheumdis-2011-200941 [doi]
PST - ppublish
SO  - Ann Rheum Dis. 2012 Nov;71(11):1791-5. doi: 10.1136/annrheumdis-2011-200941. Epub 
      2012 May 14.