Impact of Targeted Testing for Latent Tuberculosis Infection Using Commercially Available Diagnostics
Background. The interferon-γ release assays (IGRAs) are increasingly being used as an alternative to the tuberculin skin test (TST). Although IGRAs may have better specificity and certain logistic advantages to the TST, their use may contribute to overtesting of low-prevalence populations if testing...
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| Veröffentlicht in: | Clinical infectious diseases 2011-08, Vol.53 (3), p.234-244 |
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| creator | Mancuso, James D. Tribble, David Mazurek, Gerald H. Li, Yuanzhang Olsen, Cara Aronson, Naomi E. Geiter, Lawrence Goodwin, Donald Keep, Lisa W. |
| description | Background. The interferon-γ release assays (IGRAs) are increasingly being used as an alternative to the tuberculin skin test (TST). Although IGRAs may have better specificity and certain logistic advantages to the TST, their use may contribute to overtesting of low-prevalence populations if testing is not targeted. The objective of this study was to evaluate the accuracy of a risk factor questionnaire in predicting a positive test result for latent tuberculosis infection using the 3 commercially available diagnostics. Methods. A cross-sectional comparison study was performed among recruits undergoing Army basic training at Fort Jackson, South Carolina, from April through June 2009. The tests performed included: (1) a risk factor questionnaire; (2) the QuantiFERON Gold In-Tube test (Cellestis Limited, Carnegie, Victoria, Australia); (3) the T-SPOT.TB test (Oxford Immunotec Limited, Abingdon, United Kingdom); and (4) the TST (Sanofi Pasteur Ltd., Toronto, Ontario, Canada). Prediction models used logistic regression to identify factors associated with positive test results. RFQ prediction models were developed independently for each test. Results. Use of a 4-variable model resulted in 79% sensitivity, 92% specificity, and a c statistic of 0.871 in predicting a positive TST result. Targeted testing using these risk factors would reduce testing by >90%. Models predicting IGRA outcomes had similar specificities as the skin test but had lower sensitivities and c statistics. Conclusions. As with the TST, testing with IGRAs will result in false-positive results if the IGRAs are used in low-prevalence populations. Regardless of the test used, targeted testing is critical in reducing unnecessary testing and treatment. Clinical Trial Registration. NCT00804713. |
| doi_str_mv | 10.1093/cid/cir321 |
| format | Article |
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The interferon-γ release assays (IGRAs) are increasingly being used as an alternative to the tuberculin skin test (TST). Although IGRAs may have better specificity and certain logistic advantages to the TST, their use may contribute to overtesting of low-prevalence populations if testing is not targeted. The objective of this study was to evaluate the accuracy of a risk factor questionnaire in predicting a positive test result for latent tuberculosis infection using the 3 commercially available diagnostics. Methods. A cross-sectional comparison study was performed among recruits undergoing Army basic training at Fort Jackson, South Carolina, from April through June 2009. The tests performed included: (1) a risk factor questionnaire; (2) the QuantiFERON Gold In-Tube test (Cellestis Limited, Carnegie, Victoria, Australia); (3) the T-SPOT.TB test (Oxford Immunotec Limited, Abingdon, United Kingdom); and (4) the TST (Sanofi Pasteur Ltd., Toronto, Ontario, Canada). Prediction models used logistic regression to identify factors associated with positive test results. RFQ prediction models were developed independently for each test. Results. Use of a 4-variable model resulted in 79% sensitivity, 92% specificity, and a c statistic of 0.871 in predicting a positive TST result. Targeted testing using these risk factors would reduce testing by >90%. Models predicting IGRA outcomes had similar specificities as the skin test but had lower sensitivities and c statistics. Conclusions. As with the TST, testing with IGRAs will result in false-positive results if the IGRAs are used in low-prevalence populations. Regardless of the test used, targeted testing is critical in reducing unnecessary testing and treatment. Clinical Trial Registration. NCT00804713.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/cir321</identifier><identifier>PMID: 21765072</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adolescent ; Adult ; and Commentaries ; ARTICLES AND COMMENTARIES ; Bacterial diseases ; Biological and medical sciences ; Clinical Laboratory Techniques - methods ; Cross-Sectional Studies ; Cutaneous tuberculosis ; Diagnostic tests ; Female ; Human bacterial diseases ; Humans ; Immunoassay - methods ; Infections ; Infectious diseases ; Interferon ; Latent tuberculosis ; Latent Tuberculosis - diagnosis ; Male ; Medical sciences ; Military recruitment ; Modeling ; Mycobacterium tuberculosis ; Predictive Value of Tests ; Predisposing factors ; Risk Assessment - methods ; Risk factors ; Sensitivity and Specificity ; Skin tests ; South Carolina ; Surveys and Questionnaires ; Tuberculin ; Tuberculosis ; Tuberculosis and atypical mycobacterial infections ; Young Adult</subject><ispartof>Clinical infectious diseases, 2011-08, Vol.53 (3), p.234-244</ispartof><rights>Copyright © 2011 Oxford University Press on behalf of the Infectious Diseases Society of America</rights><rights>Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. 2011</rights><rights>2015 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Aug 1, 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c519t-b2adfe3cc6df09ac512a0d194cb0ae83ebd662a7839de4e494cf95fbb438aac13</citedby><cites>FETCH-LOGICAL-c519t-b2adfe3cc6df09ac512a0d194cb0ae83ebd662a7839de4e494cf95fbb438aac13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/23053198$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/23053198$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,776,780,799,881,1578,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24462152$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21765072$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mancuso, James D.</creatorcontrib><creatorcontrib>Tribble, David</creatorcontrib><creatorcontrib>Mazurek, Gerald H.</creatorcontrib><creatorcontrib>Li, Yuanzhang</creatorcontrib><creatorcontrib>Olsen, Cara</creatorcontrib><creatorcontrib>Aronson, Naomi E.</creatorcontrib><creatorcontrib>Geiter, Lawrence</creatorcontrib><creatorcontrib>Goodwin, Donald</creatorcontrib><creatorcontrib>Keep, Lisa W.</creatorcontrib><title>Impact of Targeted Testing for Latent Tuberculosis Infection Using Commercially Available Diagnostics</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Background. The interferon-γ release assays (IGRAs) are increasingly being used as an alternative to the tuberculin skin test (TST). Although IGRAs may have better specificity and certain logistic advantages to the TST, their use may contribute to overtesting of low-prevalence populations if testing is not targeted. The objective of this study was to evaluate the accuracy of a risk factor questionnaire in predicting a positive test result for latent tuberculosis infection using the 3 commercially available diagnostics. Methods. A cross-sectional comparison study was performed among recruits undergoing Army basic training at Fort Jackson, South Carolina, from April through June 2009. The tests performed included: (1) a risk factor questionnaire; (2) the QuantiFERON Gold In-Tube test (Cellestis Limited, Carnegie, Victoria, Australia); (3) the T-SPOT.TB test (Oxford Immunotec Limited, Abingdon, United Kingdom); and (4) the TST (Sanofi Pasteur Ltd., Toronto, Ontario, Canada). Prediction models used logistic regression to identify factors associated with positive test results. RFQ prediction models were developed independently for each test. Results. Use of a 4-variable model resulted in 79% sensitivity, 92% specificity, and a c statistic of 0.871 in predicting a positive TST result. Targeted testing using these risk factors would reduce testing by >90%. Models predicting IGRA outcomes had similar specificities as the skin test but had lower sensitivities and c statistics. Conclusions. As with the TST, testing with IGRAs will result in false-positive results if the IGRAs are used in low-prevalence populations. Regardless of the test used, targeted testing is critical in reducing unnecessary testing and treatment. Clinical Trial Registration. NCT00804713.</description><subject>Adolescent</subject><subject>Adult</subject><subject>and Commentaries</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Clinical Laboratory Techniques - methods</subject><subject>Cross-Sectional Studies</subject><subject>Cutaneous tuberculosis</subject><subject>Diagnostic tests</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Immunoassay - methods</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Interferon</subject><subject>Latent tuberculosis</subject><subject>Latent Tuberculosis - diagnosis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Military recruitment</subject><subject>Modeling</subject><subject>Mycobacterium tuberculosis</subject><subject>Predictive Value of Tests</subject><subject>Predisposing factors</subject><subject>Risk Assessment - methods</subject><subject>Risk factors</subject><subject>Sensitivity and Specificity</subject><subject>Skin tests</subject><subject>South Carolina</subject><subject>Surveys and Questionnaires</subject><subject>Tuberculin</subject><subject>Tuberculosis</subject><subject>Tuberculosis and atypical mycobacterial infections</subject><subject>Young Adult</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90c1rFDEYB-Agiq3Vi3clCKIIo_mcyVyEstp2YcHL9hzeySRrlsxkTWYK_e_Nsms_PPQQEvI-_PLxIvSWkq-UtPyb8X0ZiTP6DJ1SyZuqli19XtZEqkoork7Qq5y3hFCqiHyJThhtakkadorsctiBmXB0eA1pYyfb47XNkx832MWEVzDZccLrubPJzCFmn_FydNZMPo74Ou_dIg5DqXoI4Raf34AP0AWLf3jYjLFEmfwavXAQsn1znM_Q9cXP9eKqWv26XC7OV5WRtJ2qjkHvLDem7h1poWwyID1thekIWMVt19c1g0bxtrfCilJwrXRdJ7gCMJSfoe-H3N3cDbY35eoJgt4lP0C61RG8flwZ_W-9iTeaM8I4VSXg0zEgxT9z-Qc9-GxsCDDaOGetGkW4YLUo8vOTkjYNV6zQutAP_9FtnNNYPmKfJ4USnBT05YBMijkn6-5uTYnet1mXNutDmwt-__Cdd_RfXwv4eASQDQSXYDQ-3zshakblAxfn3dMHvju4bZ5ius_hRHLaKv4XZb_JUg</recordid><startdate>20110801</startdate><enddate>20110801</enddate><creator>Mancuso, James D.</creator><creator>Tribble, David</creator><creator>Mazurek, Gerald H.</creator><creator>Li, Yuanzhang</creator><creator>Olsen, Cara</creator><creator>Aronson, Naomi E.</creator><creator>Geiter, Lawrence</creator><creator>Goodwin, Donald</creator><creator>Keep, Lisa W.</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110801</creationdate><title>Impact of Targeted Testing for Latent Tuberculosis Infection Using Commercially Available Diagnostics</title><author>Mancuso, James D. ; 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The interferon-γ release assays (IGRAs) are increasingly being used as an alternative to the tuberculin skin test (TST). Although IGRAs may have better specificity and certain logistic advantages to the TST, their use may contribute to overtesting of low-prevalence populations if testing is not targeted. The objective of this study was to evaluate the accuracy of a risk factor questionnaire in predicting a positive test result for latent tuberculosis infection using the 3 commercially available diagnostics. Methods. A cross-sectional comparison study was performed among recruits undergoing Army basic training at Fort Jackson, South Carolina, from April through June 2009. The tests performed included: (1) a risk factor questionnaire; (2) the QuantiFERON Gold In-Tube test (Cellestis Limited, Carnegie, Victoria, Australia); (3) the T-SPOT.TB test (Oxford Immunotec Limited, Abingdon, United Kingdom); and (4) the TST (Sanofi Pasteur Ltd., Toronto, Ontario, Canada). Prediction models used logistic regression to identify factors associated with positive test results. RFQ prediction models were developed independently for each test. Results. Use of a 4-variable model resulted in 79% sensitivity, 92% specificity, and a c statistic of 0.871 in predicting a positive TST result. Targeted testing using these risk factors would reduce testing by >90%. Models predicting IGRA outcomes had similar specificities as the skin test but had lower sensitivities and c statistics. Conclusions. As with the TST, testing with IGRAs will result in false-positive results if the IGRAs are used in low-prevalence populations. Regardless of the test used, targeted testing is critical in reducing unnecessary testing and treatment. Clinical Trial Registration. NCT00804713.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21765072</pmid><doi>10.1093/cid/cir321</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult and Commentaries ARTICLES AND COMMENTARIES Bacterial diseases Biological and medical sciences Clinical Laboratory Techniques - methods Cross-Sectional Studies Cutaneous tuberculosis Diagnostic tests Female Human bacterial diseases Humans Immunoassay - methods Infections Infectious diseases Interferon Latent tuberculosis Latent Tuberculosis - diagnosis Male Medical sciences Military recruitment Modeling Mycobacterium tuberculosis Predictive Value of Tests Predisposing factors Risk Assessment - methods Risk factors Sensitivity and Specificity Skin tests South Carolina Surveys and Questionnaires Tuberculin Tuberculosis Tuberculosis and atypical mycobacterial infections Young Adult |
| title | Impact of Targeted Testing for Latent Tuberculosis Infection Using Commercially Available Diagnostics |
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