Relation between BCG vaccine scar and an interferon-gamma release assay in immigrant children with "positive" tuberculin skin test (≥10 mm).

BACKGROUND: Immigrants from countries with high incidence of tuberculosis (TB) are usually offered screening when they arrive to low incidence countries. The tuberculin skin test (TST) is often used. The interferon gamma release assays (IGRAs) are more specific and not affected by BCG vaccination. The aims of this study were 1. To see if there if there is a correlation between a positive IGRA (QFT) and presence of a BCG scar in children with TST ≥10 mm, 2. To compare the TST diameter with QFT result, 3. To see if chest X-ray can be omitted in QFT negative children despite TST ≥10 mm. METHODS: 762 healthy children/adolescents (median age 14 years) arriving to Gothenburg and surroundings with TST ≥10 mm were tested with QFT. RESULTS: A total of 163/492 (33 %) children with BCG scar had positive QFT, whereas 205/270 (76 %) without BCG scar had positive QFT (p < 0.0001). The median TST was 12 mm in QFT negative and 18 mm in QFT positive children (p < 0.0001) but with considerable overlap. Median TST was the same (12 mm) in QFT negative children with and without BCG scar. Among the QFT positive children 25/368 had chest X-ray changes compared to 2/393 among the QFT negative children (p < 0.0007). CONCLUSIONS: Previous BCG vaccination had an effect on the TST diameter so an IGRA is recommended to diagnose latent TB. Using only TST for screening of latent TB would lead to overdiagnosis. The TST diameter was larger in QFT positive than in QFT negative children but could not predict QFT in the individual patient. Chest X ray contributes little to the diagnosis of TB in QFT negative children but can not be omitted because of late seroconversion of QFT in some patients. TRIAL REGISTRATION: Not applicable.

[Kingella kingae and osteoarticular infections in children]. / Kingella kingae og skjelettinfeksjon hos barn.

BACKGROUND: In septic arthritis and osteomyelitis in children, the infectious agent is frequently not identified because of failure in obtaining bacterial growth from blood culture or osteoarticular aspirations. MATERIAL AND METHODS: We report a case of septic arthritis caused by Kingella kingae in a two-year-old boy. On the basis of a PubMed literature search, we present an overview of osteoarticular infections with K kingae in childhood. RESULTS AND INTERPRETATION: Over the last ten years there has been an increasing number of reports on osteoarticular infection in children caused by K kingae. The clinical course is usually benign. Direct inoculation of osteoarticular specimens into blood culture bottles is important in order to enhance isolation of K kingae, as this organism will often fail to grow when plated directly on solid media. Improved culture methods and increased awareness are important in order to identify the organism and thus enable targeted antibiotic therapy.