PMID- 25318864
OWN - NLM
STAT- MEDLINE
DCOM- 20151028
LR  - 20220331
IS  - 1432-1750 (Electronic)
IS  - 0341-2040 (Linking)
VI  - 193
IP  - 1
DP  - 2015 Feb
TI  - Diagnosis of latent tuberculosis infection with T-SPOT((R)).TB in a predominantly 
      immigrant population with rheumatologic disorders.
PG  - 3-11
LID - 10.1007/s00408-014-9655-9 [doi]
AB  - PURPOSE: The objective of this study is to compare how likely positive tuberculin 
      skin test (TST) and T-SPOT((R)).TB (TSPOT) results predict risk factors for 
      tuberculosis in a predominantly immigrant patient population at risk of latent TB 
      infection (LTBI) and with rheumatologic conditions requiring immunomodulatory 
      therapy (IMT). METHODS: Prospective study conducted at a referral rheumatology 
      clinic. Inclusion criteria included patients on various IMT, including 
      immunosuppressive drugs that could predispose to TB progression. We studied risk 
      factors associated with LTBI, test results, and tests' agreement. RESULTS: We 
      studied 101 patients. Eighty (79.2 %) were from countries where TB is prevalent 
      and Bacille Calmette-Guerin vaccination is placed routinely. Seventy-four (73.3 
      %) had rheumatoid arthritis and 92 (90.7 %) were on IMT. Among patients with both 
      TST and TSPOT results, 25 (30.9 %) were TST(+) and 20 (24.7 %) had TSPOT(+) 
      results. Fifteen patients (18.5 %) had TST(+)/TSPOT(+) results, and 51 (63.0 %) 
      had TST(-)/TSPOT(-) results (agreement = 81.5 %; kappa = .54 [95 % CI, .34-.74; P 
      < .001]). Each TSPOT(+) and TST(+) results were independently associated with 
      immigrant status and prior residence in a TB prevalent country after adjustment 
      for immunosuppressive therapy: Adjusted OR(TSPOT+)=6.6 (95 % CI, 1.2-123.3; P = 
      .027); and adjusted OR(TST+)=11.2 (95 % CI, 2.0-209.5; P = .003). Seven out of 10 
      TST(+)/TSPOT(-) cases had a TST >/=15 mm induration, including three cases with 
      history of TST conversion. CONCLUSIONS: TST(+) and TSPOT(+) results predict risk 
      factors associated with LTBI independent of immunosuppressive IMT. Some 
      TST(+)/TSPOT(-) results were unlikely to be false-negatives. The combined use of 
      TST and TSPOT appears to be a reasonable diagnostic strategy to evaluate for LTBI 
      in this population.
FAU - Escalante, Patricio
AU  - Escalante P
AD  - Division of Pulmonary and Critical Care Medicine and Mayo Clinic Center for 
      Tuberculosis, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, 
      escalante.patricio@mayo.edu.
FAU - Kooda, Kirstin J
AU  - Kooda KJ
FAU - Khan, Rizwana
AU  - Khan R
FAU - Aye, San San
AU  - Aye SS
FAU - Christianakis, Stratos
AU  - Christianakis S
FAU - Arkfeld, Daniel G
AU  - Arkfeld DG
FAU - Ehresmann, Glenn R
AU  - Ehresmann GR
FAU - Kort, Jens J
AU  - Kort JJ
FAU - Jones, Brenda E
AU  - Jones BE
LA  - eng
GR  - UL1 TR000135/TR/NCATS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20141016
PL  - United States
TA  - Lung
JT  - Lung
JID - 7701875
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - *Emigrants and Immigrants
MH  - *Enzyme-Linked Immunospot Assay
MH  - False Negative Reactions
MH  - Humans
MH  - Immunocompromised Host
MH  - Immunosuppressive Agents/adverse effects/*therapeutic use
MH  - Latent Tuberculosis/*diagnosis/epidemiology/immunology
MH  - Minnesota/epidemiology
MH  - Predictive Value of Tests
MH  - Prevalence
MH  - Prospective Studies
MH  - Rheumatic Diseases/diagnosis/*drug therapy/epidemiology/immunology
MH  - Risk Assessment
MH  - Risk Factors
MH  - Tuberculin Test
EDAT- 2014/10/17 06:00
MHDA- 2015/10/29 06:00
CRDT- 2014/10/17 06:00
PHST- 2014/03/17 00:00 [received]
PHST- 2014/10/07 00:00 [accepted]
PHST- 2014/10/17 06:00 [entrez]
PHST- 2014/10/17 06:00 [pubmed]
PHST- 2015/10/29 06:00 [medline]
AID - 10.1007/s00408-014-9655-9 [doi]
PST - ppublish
SO  - Lung. 2015 Feb;193(1):3-11. doi: 10.1007/s00408-014-9655-9. Epub 2014 Oct 16.