Detection of latent tuberculosis, QuantiFERON-TB Gold test, possibilities and pitfalls of the method
Authors:
V. Vroblová; K. Jankovičová; M. Trojáčková-Kudlová; J. Krejsek
Authors‘ workplace:
Přednosta: prof. RNDr. Jan Krejsek, CSc.
; Lékařská fakulta a Fakultní nemocnice v Hradci Králové
; ÚSTAV KLINICKÉ IMUNOLOGIE A ALERGOLOGIE
; Univerzita Karlova v Praze
Published in:
Prakt. Lék. 2009; 89(4): 204-209
Category:
Diagnostis
Overview
Tuberculosis (TB) is an illness that is found throughout the world and affects both children and adolescents. TB can affect all organs but mainly involves the lungs. Based on individual genetic predisposition, individual immune reactivity, and the characteristics of the particular M. tuberculosis strain, mycobacterial infection is either eliminated or localized, or clinically manifest disease develops. M. tuberculosis, which is present in viable form in granuloma of patients suffering from latent TB infection, is able to survive for decades without any clinical signs of infection. This latent infection can be reactivated, leading to M. tuberculosis multiplying and spreading throughout the body, if the patient’s immune system fails for either natural reasons (e.g. acquired immunodeficiency – AIDS, cancer) or artificial reasons (immunosuppression, cancer therapy). The presence of latent M. tuberculosis infection has to be tested if there is a risk of the development of active TB. This may occur in individuals who are in close contact with active TB or individuals with an increased risk of latent TB reactivation due to immunosuppression. Until now, the Mantoux skin test (MT) was the only approach available to support the suspicion of latent TB but has many limitations.
A new generation of blood tests based on specific cell mediated immune response to M. tuberculosis antigens has now been launched. These tests do not suffer from poor MT test specificity and sensitivity.
The QuantiFERON-TB Gold test is based on ELISA determination of interferon *gamma by antigen specific T cells after in vitro stimulation by specific M. tuberculosis peptidic antigens. QuantiFERON-TB Gold test has been approved for the diagnosis of both latent and active infection by M. tuberculosis. Its application is without any harm for patients. The possible drawback of this test is its price. However, the cost effectiveness of this test is substantial if all the expenditures regarding other tests needed to diagnose latent TB and treatment of incorrectly diagnosed patients with prophylactic therapy are added together. The QuantiFERON-TB Gold test is recommended by NICE guidelines for elimination of active TB. This tests is used to confirm the presence of latent M. tuberculosis infection in patients at risk of TB development especially those undergoing so-called biological treatment by anti TNF-a monoclonals.
Key words:
latent tuberculosis, QuantiFERON-TB Gold test, Mantoux skin test.
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Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2009 Issue 4
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