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T-Spot.TB outperforms tuberculin skin test in predicting development of active tuberculosis among household contacts.
Leung, Chi Chiu; Yam, Wing Cheong; Ho, Pak Leung; Yew, Wing Wai; Chan, Chi Kuen; Law, Wing Sze; Lee, Shuk Nor; Chang, Kwok Chiu; Tai, Lai Bun; Tam, Cheuk Ming.
  • Leung CC; Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, China.
Respirology ; 20(3): 496-503, 2015 Apr.
Article en En | MEDLINE | ID: mdl-25689894
ABSTRACT
BACKGROUND AND

OBJECTIVE:

In Hong Kong, neonatal Bacillus Calmette-Guerin (BCG) vaccination is practiced with 99% coverage. This study was to compare the performance of T-Spot.TB and tuberculin skin test (TST) in predicting tuberculosis (TB) among household contacts.

METHODS:

From 1 March 2006 to 31 July 2010, 1049 asymptomatic household contacts of smear-positive patients were simultaneously tested with T-Spot.TB and TST, and then followed for up to 5 years for development of TB. Attending clinicians and subjects were blinded to the results of T-Spot.TB.

RESULTS:

T-Spot.TB gave a significantly higher positive rate (32.7% vs 22.1%) and better association with exposure time than TST at the 15 mm cut-off. Agreement between T-Spot.TB and TST using cut-offs of 5, 10 and 15 mm were relatively poor (kappa 0.25-0.41) irrespective of presence or absence of BCG scar. Only T-Spot.TB positivity was negatively associated with BCG scar. Both T-Spot.TB (incidence rate ratio between test-positive and test-negative subjects, IRR 8.2) and TST (IRR 4.1, 6.1 and 2.8, using cut-offs of 5 mm, 10 mm and 15 mm, respectively) helped to predict TB. Using a TST cut-off of 15 mm, 56% of future TB cases and 62.5% of bacteriologically confirmed cases were missed. Lowering the TST cut-off to 10 mm or 5 mm could achieve sensitivity comparable with that of T-Spot.TB, but at the expense of lower specificities, with more positive tests (thus requiring treatment) per case of TB predicted.

CONCLUSIONS:

T-Spot.TB outperformed TST in predicting TB among household contacts in a high-income area with widespread BCG vaccination coverage.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Tuberculosis / Prueba de Tuberculina Tipo de estudio: Incidence_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male / Middle aged País como asunto: Asia Idioma: En Año: 2015 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Tuberculosis / Prueba de Tuberculina Tipo de estudio: Incidence_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male / Middle aged País como asunto: Asia Idioma: En Año: 2015 Tipo del documento: Article