Risk Assessment of Tuberculosis in Immunocompromised Patients A TBNET Study

• Type: Article in International Scientific Journal
• Date: 2014

Authors

Sester, M (Author) Other; Van Leth, F (Author) Other; Bruchfeld, J (Author) Other; Bumbacea, D (Author) Other; Cirillo, DM (Author) Other; Dilektasli, AG (Author) Other; Dominguez, J (Author) Other; Duarte R (Author) FMUP; Ernst, M (Author) Other; Eyuboglu, FO (Author) Other; Gerogianni, I (Author) Other; Girardi, E (Author) Other; Goletti, D (Author) Other; Janssens, JP (Author) Other; Julander, I (Author) Other; Lange, B (Author) Other; Latorre, I (Author) Other; Losi, M (Author) Other; Markova, R (Author) Other; Matteelli, A (Author) Other; Milburn, H (Author) Other; Ravn, P (Author) Other; Scholman, T (Author) Other; Soccal, PM (Author) Other; Straub, M (Author) Other; Wagner, D (Author) Other; Wolf, T (Author) Other; Yalcin, A (Author) Other; Lange, C (Author) Other; TBNET, (Author) Other

Journal

Title: American Journal of Respiratory and Critical Care Medicine

Vol. 190

Pages: 1168-1176

ISSN: 1073-449X

Publisher: American Thoracic Society

Indexing

ISI Web of Knowledge - 158 Citations

Scopus - 170 Citations

Other information

Authenticus ID: P-00A-1SB

DOI: 10.1164/rccm.201405-0967oc

Abstract (EN): Rationale: In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency. Objectives: This study compared the performance of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis. Methods: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT. TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up. Measurements and Main Results: Frequencies of positive test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15.2% in immunocompetent control subjects (n = 211). Eleven patients (10 with HIV infection and one solid-organ transplant recipient) developed tuberculosis during a median follow-up of 1.8 (interquartile range, 0.2-3.0) years. Six of the 11 patients had a negative or indeterminate test result in all three tests at the time of screening. Tuberculosis incidence was generally low, but higher in HIV-infected individuals with a positive TST (3.25 cases per 100 person-years) than with a positive ELISA (1.31 cases per 100 person-years) or enzyme-linked immunospot result (1.78 cases per 100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy. Conclusions: Among immunocompromised patients evaluated in this study, progression toward tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9