Performance of interferon-γ release assay for the diagnosis of active or latent tuberculosis in children in the first 2 years of age: A multicenter study of the Italian society of pediatric infectious diseases

Silvia Garazzino, Luisa Galli, Elena Chiappini, Michele Pinon, Barbara Maria Bergamini, Salvatore Cazzato, Paola Dal Monte, Icilio Dodi, Laura Lancella, Susanna Esposito, Lorenzo Iughetti, Carlotta Montagnani, Maurizio De Martino, Pier Angelo Tovo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The diagnosis of latent or active tuberculosis in children is often challenging. Recently, interferon-γ release assays have been licensed, but their diagnostic accuracy in young children remains questionable as frequent false-negative or indeterminate results have been reported. Methods: We performed a multicenter, retrospective study in children 0-24 months of age who were tested at least once with QuantiFERON-TB Goldin-tube (QTF-IT) ± tuberculin skin test (TST), to analyze its use and performance in clinical practice. Results: Eight-hundred and twenty-three children (449 males, median age 13.5 months) were enrolled. QTF-IT sensitivity and specificity for active tuberculosis were 92.4% and 98.6%, respectively. Indeterminate tests (4.2 %) were not related to age (P = 0.838) or gender (P = 0.223); 32 children (91.4 %) with an indeterminate QTF-IT ultimately resulted uninfected. In the 616 subjects with valid paired results of QTF-IT and TST, sensitivity and specificity were comparable (91.1% vs. 85.1% and 98.1% vs. 97.9%, respectively). Diagnostic concordance between tests was higher in Bacillus Calmétte-Guerin nonvaccinated children (κ = 0.802). A high rate of discordant tests was observed in latent infections. Conclusions: QTF-IT showed good sensitivity and specificity, and a low rate of indeterminate results in the first 2 years of life, supporting its use at this age. However, considering costs and the similar performance between QTF-IT and TST, it is reasonable to suggest the latter as first-line testing in young children. The complementary use of TST and interferon-γ release assays may be considered in selected cases to improve the accuracy of testing.

Original languageEnglish
Pages (from-to)E226-E231
JournalPediatric Infectious Disease Journal
Volume33
Issue number9
DOIs
Publication statusPublished - 2014

Keywords

  • Children
  • Infants
  • Interferon-γ release assay
  • QuantiFERON
  • Tuberculin skin testing
  • Tuberculosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

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