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Comparing interferon-gamma release assays with tuberculin skin test for identifying latent tuberculosis infection that progresses to active tuberculosis : systematic review and meta-analysis
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Auguste, Peter, Tsertsvadze, Alexander, Pink, Joshua, Court, Rachel A., McCarthy, Noel D., Sutcliffe, P. (Paul) and Clarke, Aileen (2017) Comparing interferon-gamma release assays with tuberculin skin test for identifying latent tuberculosis infection that progresses to active tuberculosis : systematic review and meta-analysis. BMC Infectious Diseases, 17 (1). doi:10.1186/s12879-017-2301-4 ISSN 1471-2334.
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Official URL: http://dx.doi.org/10.1186/s12879-017-2301-4
Abstract
Background
Timely and accurate identification of people with latent tuberculosis infection (LTBI) is important for controlling Mycobacterium tuberculosis (TB). There is no gold standard for diagnosis of LTBI. Screening tests such as interferon gamma release assays (IGRAs) and tuberculin skin test (TST) provide indirect and imperfect information. This systematic review compared two types of IGRAs QuantiFERON®-TB Gold In-Tube test (QFT-GIT) and T-SPOT.TB with TST for identification of LTBI by predicting progression to a diagnosis of active TB in three subgroups: children, immunocompromised people, and those recently arrived from countries with high TB burden.
Methods
Cohort studies were eligible for inclusion. We searched MEDLINE, EMBASE, the Cochrane Library and other databases from December 2009 to June 2015. One reviewer screened studies, extracted data, and assessed risk of bias with cross checking by a second reviewer. Strength of association between test results and incidence of TB was summarised using cumulative incidence ratios (CIRs with 95% CIs). Summary effect measures: the ratio of CIRs (R-CIR) with 95% CIs. R-CIRs, were pooled using a random-effects model. Heterogeneity was assessed using Chi-squared and I2 statistics.
Results
Seventeen studies, mostly of moderate or high risk of bias (five in children, 10 in immunocompromised people, and two in those recently arrived) were included. In children, while in two studies, there was no significant difference between QFT-GIT and TST (≥5 mm) (pooled R-CIR = 1.11, 95% CI: 0.71, 1.74), two other studies showed QFT-GIT to outperform TST (≥10 mm) in identifying LTBI. In immunocompromised people, IGRA (T-SPOT.TB) was not significant different from TST (≥10 mm) for identifying LTBI, (pooled R-CIR = 1.01, 95% CI: 0.65, 1.58). The forest plot of two studies in recently arrived people from countries with high TB burden demonstrated inconsistent findings (high heterogeneity; I2 = 92%).
Conclusions
Prospective studies comparing IGRA testing against TST on the progression from LTBI to TB were sparse, and these results should be interpreted with caution due to uncertainty, risk of bias, and unexplained heterogeneity. Population-based studies with adequate sample size and follow-up are required to adequately compare the performance of IGRA with TST in people at high risk of TB.
Item Type: | Journal Article | ||||||||
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Subjects: | Q Science > QR Microbiology R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Latent virus diseases, Tuberculosis , Interferon inducers, Gamma ray sources , Tuberculin test , Tuberculosis--Diagnosis | ||||||||
Journal or Publication Title: | BMC Infectious Diseases | ||||||||
Publisher: | BioMed Central Ltd. | ||||||||
ISSN: | 1471-2334 | ||||||||
Official Date: | 9 March 2017 | ||||||||
Dates: |
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Volume: | 17 | ||||||||
Number: | 1 | ||||||||
Number of Pages: | 13 | ||||||||
DOI: | 10.1186/s12879-017-2301-4 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Date of first compliant deposit: | 5 March 2018 | ||||||||
Date of first compliant Open Access: | 5 March 2018 | ||||||||
Funder: | National Institute for Health Research Health Technology Assessment (Great Britain) (NIHR HTA) | ||||||||
Grant number: | 13/178/01 |
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