TY - JOUR

T1 - A comparison of interferon-γ and IP-10 for the diagnosis of tuberculosis

AU - Holm, Line Lindebo

AU - Rose, Michala Vaaben

AU - Kimaro, Godfather

AU - Bygbjerg, Ib C

AU - Mfinanga, Sayoki G

AU - Ravn, Pernille

AU - Ruhwald, Morten

N1 - Copyright © 2014 by the American Academy of Pediatrics.

PY - 2014/12

Y1 - 2014/12

N2 - OBJECTIVE: Interferon-γ and IP-10 release assays are diagnostic tests for tuberculosis infection. We have compared the accuracy of IP-10 and QuantiFERON-TB Gold In-tube [QFT-IT] in Tanzanian children suspected of having active tuberculosis (TB).METHODS: Hospitalized Tanzanian children with symptoms of TB were tested with the QFT-IT and IP-10 tests and retrospectively classified into diagnostic groups. Adults with confirmed TB were assessed in parallel.RESULTS: A total of 203 children were included. The median age was 3.0 years (interquartile range: 1.2-7.0), 38% were HIV infected, 36% were aged <2 years, and 58% had a low weight-for-age. IP-10 and QFT-IT test performance was comparable but sensitivity was low: 33% (1 of 3) in children with confirmed TB and 29% (8 of 28) in children with probable TB. Rates of indeterminate responders were high: 29% (59 of 203) for IP-10 and 26% (53 of 203) for QFT-IT. Age <2 years was associated with indeterminate test outcome for both IP-10 (adjusted odds ratio [aOR]: 2.2; P = .02) and QFT-IT (aOR: 2.4; P = .01). TB exposure was associated with positive IP-10 test outcome (aOR: 3.6; P = .01) but not with positive QFT-IT outcome (aOR 1.4; P = .52). In 102 adults, test sensitivity was 80% for both tests (P = .248).CONCLUSIONS: Although IP-10 and QFT-IT performed well in Tanzanian adults, the tests exhibited an equally poor performance in diagnosing active TB in children. Test performance was especially compromised in young children. Neither test can be recommended for use in hospitalized children in high-burden settings.

AB - OBJECTIVE: Interferon-γ and IP-10 release assays are diagnostic tests for tuberculosis infection. We have compared the accuracy of IP-10 and QuantiFERON-TB Gold In-tube [QFT-IT] in Tanzanian children suspected of having active tuberculosis (TB).METHODS: Hospitalized Tanzanian children with symptoms of TB were tested with the QFT-IT and IP-10 tests and retrospectively classified into diagnostic groups. Adults with confirmed TB were assessed in parallel.RESULTS: A total of 203 children were included. The median age was 3.0 years (interquartile range: 1.2-7.0), 38% were HIV infected, 36% were aged <2 years, and 58% had a low weight-for-age. IP-10 and QFT-IT test performance was comparable but sensitivity was low: 33% (1 of 3) in children with confirmed TB and 29% (8 of 28) in children with probable TB. Rates of indeterminate responders were high: 29% (59 of 203) for IP-10 and 26% (53 of 203) for QFT-IT. Age <2 years was associated with indeterminate test outcome for both IP-10 (adjusted odds ratio [aOR]: 2.2; P = .02) and QFT-IT (aOR: 2.4; P = .01). TB exposure was associated with positive IP-10 test outcome (aOR: 3.6; P = .01) but not with positive QFT-IT outcome (aOR 1.4; P = .52). In 102 adults, test sensitivity was 80% for both tests (P = .248).CONCLUSIONS: Although IP-10 and QFT-IT performed well in Tanzanian adults, the tests exhibited an equally poor performance in diagnosing active TB in children. Test performance was especially compromised in young children. Neither test can be recommended for use in hospitalized children in high-burden settings.

KW - Chemokine CXCL10

KW - Child

KW - Child, Preschool

KW - Developing Countries

KW - Female

KW - HIV Infections

KW - Humans

KW - Infant

KW - Interferon-gamma

KW - Interferon-gamma Release Tests

KW - Male

KW - Opportunistic Infections

KW - Predictive Value of Tests

KW - Tanzania

KW - Tuberculosis

U2 - 10.1542/peds.2014-1570

DO - 10.1542/peds.2014-1570

M3 - Journal article

C2 - 25422019

VL - 134

SP - e1568-75

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 6

ER -