|Year : 2022 | Volume
| Issue : 4 | Page : 364-370
Tuberculin test versus interferon gamma release assay in pregnant women with household contacts of tuberculosis patients
Maisuri Tadjuddin Chalid1, Dian Puspawaty1, Andi Mardiah Tahir1, Hidayah Najdah2, Muhammad Nasrum Massi3
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University Hospital, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
2 Postgraduate Program, Faculty of Medicine, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
3 Department of Clinical Microbiology, Faculty of Medicine, Hasanuddin University Hospital, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
|Date of Submission||16-Jul-2022|
|Date of Decision||16-Aug-2022|
|Date of Acceptance||20-Sep-2022|
|Date of Web Publication||10-Dec-2022|
Maisuri Tadjuddin Chalid
Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University Hospital, Universitas Hasanuddin, Perintis Kemerdekaan Street Km. 10, Tamalanrea, Makassar 90245, South Sulawesi
Source of Support: None, Conflict of Interest: None
Background: Pregnant women who live in tuberculosis (TB)-affected households are more likely to develop latent TB infection (LTBI), which often escapes treatment. This study aims to determine if Interferon-gamma release (IGRA) is reliable in screening for LTBI in pregnant women, compare to the tuberculin skin test (TST). Methods: It was a cross-sectional study that involved 60 pregnant women with TB contact history as a proxy for LTBI and 30 pregnant women without contact history. Latent TB was detected using the TST 5 tuberculin units and IGRA using the QuantiFERON Gold Plus TB Test kit (QFT-Plus). The sensitivity and specificity of the two diagnostic methods and the agreement between them were estimated using SPSS version 20.0. Results: The sensitivity 95% (95% confidence interval [CI]: 86.08%–98.96%) and specificity 26.7% (95% CI: 12.28%–45.89%) of TST were compared to that of the IGRA with 60% (95% CI: 46.54%–72.44%) and 73.3% (95% CI: 54.11%–87.72%) sensitivity and specificity, respectively in detecting LTBI in pregnancy. Although there was a significant difference (P < 0.05) between TST and IGRA, the agreement was fair (kappa 0.39; 95% CI: 0.24–0.45). Conclusion: TST assay is more sensitive than IGRA; however, the specificity of IGRA was superior to the TST method. In this study, a fair agreement of TST and IGRA was observed for detecting latent TB infection in pregnant women with household contact with TB patients.
Keywords: Interferon-gamma release assay, latent tuberculosis, pregnancy, tuberculin test
|How to cite this article:|
Chalid MT, Puspawaty D, Tahir AM, Najdah H, Massi MN. Tuberculin test versus interferon gamma release assay in pregnant women with household contacts of tuberculosis patients. Int J Mycobacteriol 2022;11:364-70
|How to cite this URL:|
Chalid MT, Puspawaty D, Tahir AM, Najdah H, Massi MN. Tuberculin test versus interferon gamma release assay in pregnant women with household contacts of tuberculosis patients. Int J Mycobacteriol [serial online] 2022 [cited 2023 Jan 31];11:364-70. Available from: https://www.ijmyco.org/text.asp?2022/11/4/364/363148
| Introduction|| |
Worldwide, tuberculosis (TB) remains a health problem. TB is the leading cause of a single infectious agent, which rank above HIV/AIDS and is the tenth leading cause of death globally. The incidence of new TB cases is estimated at 10 million cases globally in 2019. Indonesia ranks third highest worldwide and contributes to 8.4% of global TB cases after India. Individuals with active TB whose sputum is smear-positive are the main source of Mycobacterium tuberculosis transmission in communities through respiratory droplets released into the air., A condition in which individuals are infected with M. tuberculosis without clinical manifestations of active TB called latent TB infection (LTBI). These individuals are at risk for developing active TB disease, pregnant women are particularly at high risk of developing TB.
Pregnant women with LTBI are more likely to progress developing the active tuberculous disease than men. It has long been observed by obstetricians that pregnancy is associated with a higher risk of active TB and also the more rapid progression of TB disease compared with the non-pregnant state.
Pregnancy may increase susceptibility to the risk of contracting infectious diseases including TB due to changes in cell-mediated (Th1) immunity that protects against TB and antibody-mediated (Th2) immunity that leads to changes in the levels of pro-inflammatory cytokines. Transmission, infection, and clinical manifestations of TB during pregnancy is similar to that in its counterpart despite some typical symptoms of TB. In addition, pregnant women who develop TB are more difficult to diagnose because TB symptoms are physiologically similar to pregnancy symptoms. If left untreated, or if the diagnosis is late, TB during pregnancy may lead to poor outcomes for both mother and child. An increased risk of preeclampsia, vaginal bleeding, early pregnancy loss, and pre-term labour are the complications faced by infected pregnant women, whereas low birth weight and small gestational age are faced by neonates. Therefore, TB antenatal screening for pregnant women is an important strategy to identify and diagnose LTBI for improved pregnancy outcomes and reduction of TB transmission.
The individual that is known to have close household contacts with pulmonary TB or are suspected to have active TB are particularly at high risk to develop latent TB in medium to high TB burden countries, where most of the cases result from a recent transmission., There is a large ongoing risk of developing TB after initial contact, particularly during the first year. In low and middle-income countries, the prevalence of TB in household contacts is 3.1%. Screening TB patients from close household contacts are expected to reach a 2% decrease in TB prevalence every year. Active screening among household contacts is an effective way to improve TB case detection. Diagnosis and treatment of LTBI are the most effective strategy to control TB transmission. This strategy prevents the risk of the progression of active TB disease that may otherwise accelerate the eradication of TB. Until recently, the available methods to predict the progression of active TB from LTBI are the tuberculin skin test (TST) and interferon-gamma (IFN-γ) release assays (IGRAs).
For more than a century, TST is the main diagnostic tool for TB which relies on delayed-type hypersensitivity response to purified protein derivative (PPD) and is often used to estimate the average burden of TB infection in a population. However, false-positive TST results can occur due to nontuberculous mycobacterial infection and Bacille Calmette–Guerin (BCG) vaccination,,,, particularly if the BCG is received after infancy. Active TB, HIV infection, malnutrition, impaired immunity, immunosuppressant drugs such as prednisolone and methotrexate therapy also affect skin test sensitivity.,, The immunocompromised person, children under five years, and older people may result in false negatives.
The IGRA test is based on the production of IFN-γ, a key cytokine involved in cellular immunity,,, released by T-cells and natural killer (NK) cells as a specific response to M. tuberculosis, while absent in BCG and most other mycobacteria, and thus, makes the IGRA assay more accurate than TST. This assay requires costly equipment and consumables. The IGRA positive rate for household contacts of TB patients ranges from 42 to 65%.,,, Most of the TST or IGRA-positive LTBI patients remain not reactivated after latent infection, and the TB risk was not significantly different between the two groups. In this study, we evaluate TST and IGRA in detecting latent TB infection in pregnant women with household contact history to TB patients.
| Methods|| |
Study population and design
Between July and November 2018, a cross-sectional study was conducted at Makassar city, South Sulawesi Province of Indonesia. Pregnant women which have a household contact history with TB patients were traced through interviews with 271 TB patients who regularly seek treatment at the Pulmonary Hospital and several primary health cares and recruited consecutively 79 pregnant women who are their family members, and only 70 agreed to be subject in this study.
Pregnant women with a contact history with TB patients for more than three months or who exhibit clinical symptoms of TB and did not suffer from any other lung diseases such as bronchial asthma, bronchitis, or lung tumours were considered eligible for this study. Pregnant women were excluded if they had a severe reaction to TST; underwent treatment against TB before or during the current pregnancy; experienced shortness and chest pain; their physical examination results showed a decrease in the sound of breathing; and their blood samples were spilt during collection, experienced cell lysis, or were not sufficient in volume for further analysis.
In the same period, 57 pregnant women were recruited consecutively for the no contact history group in the parallel primary health centers, which finally reached 40 subjects eligible to be enrolled.
All pregnant women were screened by clinical and laboratory examination and were questioned regarding their history of exposure to TB patients and BCG vaccination. All pregnant women were tested for HIV and excluded if they were positive. Nutritional status of pregnant women was categorised according to pre-pregnancy body mass index which was computed as reported weight (kg) divided by square of measured height (m) and categorized into four groups as underweight (<18.5 kg/m2), normal (≥18.5 and <25 kg/m2), overweight (≥25 and <30 kg/m2) and obese (≥30 kg/m2).
Tuberculin skin test
The TST was performed using 5 tuberculin units (TU) of PPDRT23 (Staten Serum Institute, Copenhagen, Denmark) in a total volume of 0.1 ml injected intradermally. The diameter of skin induration was measured 72 hours after injection. To minimize imprecise reading of TST, the BCG scar result was measured by the same person who has have attended standardized training. The mean diameter of scar size was calculated from diameters perpendicular to each other. Induration size ≥5–15 mm was considered positive.
Interferon-gamma release assay
IFN-γ IGRA by using QuantiFERON Gold Plus TB Test kit (QFT-Plus). Six ml of venous blood was obtained from participants and transferred to 0.8-1.2 uL of QFT Plus in 4 tubes (Nil, TB1, TB2, Mitogen). Four tubes were simultaneously shaken until covered in blood. These four tubes were incubated at 37°C for 16-24 h, followed by a 15-minute centrifugation to separate the plasma. Plasma samples were stored at −20°C until employed in the IFN-γ enzyme-linked immunosorbent assay (ELISA) procedure, according to manufacture protocols. The Optical Density (OD) was measured using an ELISA reader with a 450 nm filter and 620 nm to 650 nm reference filter. QuantiFERON-TB Gold Plus Analysis Software ver. 2.71 (Qiagen) was used to calculate IFN-γ from OD readings. All tested samples had a Nil value ≤8 IU/mL and a Mitogen-Nil difference ≥0.5 IU/mL indicating that all samples were valid. The difference value of Tb1-Nil and/or Tb2-Nil ≥0.35 IU/mL was considered positive.
The sensitivity and specificity TST and IGRA were measured and having contact history as a proxy for having LTBI. The sensitivity and specificity of the two diagnostic methods and the agreement between them were estimated using SPSS version 20.0 (SPSS Inc., Armonk, NY, USA). Categorical data were compared using the Chi-squared test or Fischer-exact test. The agreement between those TST and IGRA was measured by Kappa (κ) test. κ test was interpreted as poor (κ ≤0.2), fair (0.21≤ κ ≤0.4), moderate 0.41≤ κ ≤0.6), good (0.61≤ κ ≤0.8), and very good (0.81≤ κ ≤1). A P value less than 0.05 was considered significant. The confidence interval (95% CI) was estimated according to the binomial distribution.
Written informed consent was obtained from each pregnant woman in this study and ethics approval of the study was obtained from the Health Research Ethics Committee of Faculty of Medicine, University of Hasanuddin, Makassar (No. 517/H184.108.40.206.31./PP36-KOMETIK/2018, July 27, 2018).
Patient declaration of consent statement
The authors confirmed that they have collected all necessary consent papers from patients. All subjects have consented to the publication of their clinical information in the journal, are aware that their names and initials will not be published, and that all reasonable attempts will be done to protect their anonymity.
| Results|| |
Initially, we interviewed 271 TB patients, whether they have pregnant women who lived in their house for more than 3 months, then we consecutively recruited 79 pregnant women, but only 70 subjects agreed to participate in this study. We searched for no contact subjects in the parallel primary health centers. From 65 subjects, only 57 subjects agreed, but through further interviews, we found that the “true” no contact subjects narrowed to 40 pregnant women [Figure 1]. Nine women were lost in the follow-up process, which consisted of five women with contact history to TB patients and four women without contact history to TB patients. Five blood samples from the contact history group and six blood samples from the no contact history group experienced cell lysis and therefore were not eligible for further analysis. Thus, this study enrolled 60 pregnant women with a history of household contact with TB patients and 30 women without contact history.
Of these 90 women, 31.1% (28/90) were aged 25-28 years, 62.2% (56/90) were multiparous, 47.8% (43/90) were in the second trimester of pregnancy, and 70% (63/90) had normal body mass index (BMI). There was 43.3% (39/90) of the participants in this study whose TB patient contact were their parents and 44.4% (40/90) of participants have duration of exposure ranged from 4 – 6 months [Figure 1]. Characteristics of the samples are shown in [Table 1].
|Table 1: Pregnant women characteristics based on contact history with tuberculosis patients|
Click here to view
[Table 2] shows a significant correlation of both TST and IGRA with the duration of exposure to TB contacts and with history of TB (all P < 0.05), whereas nutritional status and trimester of pregnancy were not significant. There were 87.8% (79/90) of the pregnant women tested in this study had positive TST results, while only 48.8% (44/90) of them had positive IGRA results. Pregnant women with a contact history with TB patients in this study had 95% (57/60) positive results with TST, which is higher compared to 60% (36/60) positive results in the IGRA. However, our results also show that pregnant women without any contact history to TB patients were also detected as positive by both TST 73.3% (22/30) and IGRA 26.7% (8/30). We obtained a 95% (confidence interval [CI]: 86.08%–98.96%) sensitivity and a 26.7% (CI: 12.28%–45.89%) specificity for TST with positive predictive value (PPV) and negative predictive value (NPV) were 72.15% (CI: 67.45%-76.41%) and 72.73% (CI: 43.25%-90.32%), respectively. While for IGRA, we obtained a 60% sensitivity (CI: 46.54%-72.44%) and 73.3% (CI: 54.11%-87.72%) specificity with PPV and NPV were 81.82% (CI: 70.59%-89.40%) and 7.83% (CI: 38.59%-57.21%), respectively.
|Table 2: The relationship of pregnant women characteristic with tuberculin skin test and interferon-gamma release assay|
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Seventy-nine of the pregnant women tested had positive TST results. Among these women, 39 (49.4%) tested positive and 40 (50.6%) tested negative with the IGRA. However, there were 5 (45.5%) cases where the women who tested as positive with the IGRA, tested negative with TST in contrast. The difference in the results of TST and IGRA were significant (P < 0.05), and the agreement between those two diagnostic tests was fair (kappa 0.39; 95% CI 0.24–0.45) [Table 3].
|Table 3: Agreement between the results of tuberculin skin test and interferon-gamma release assay|
Click here to view
| Discussion|| |
There is no gold-standard diagnostic method for detecting latent TB infection that can be used as a basis to determine whether the TST or the IGRA were better in detecting LTBI. We assumed that having contact history as a proxy for having LTBI. A few studies have evaluated the use of IGRA for latent TB infection during pregnancy in both low,, and high-burden areas.,, In this study, we evaluated the TST and IGRA to detect LTBI in pregnant women who had a history of household contact with TB patients. As a novel assay for detecting latent TB infection, the IGRA has been reported to show higher sensitivity and higher specificity than TST.,, However, even though we found similar results with previously reported studies regarding a higher specificity of IGRA compared to TST, our results indicated that the sensitivity of IGRA was lower than TST, and the agreement between the two methods was fair (kappa 0.39). Assuming that having a contact history as a proxy for LTBI is a limitation of this study. This implies that the definition of sensitivity and specificity was slightly different from the actual one. Studies in high-burden areas were a challenge in itself, because misclassification occurred in determining contact history and without contact history, although efforts have been made to minimize it by finding family members with active TB patients who were pregnant and have lived for more than 3 months, which means that the subject actually have contact history. However, determining the true non-contact history was quite difficult in high-burden areas.
In high-burden countries, such as Indonesia, BCG vaccination is a prevention strategy that has been included in the national immunization program for infants aged 4 weeks, but the protection of this vaccine declines in adolescence., The vaccination effects reduce ten years after injection, and therefore, would then no longer influence TST results. TST has a low specificity and a low sensitivity due to BCG vaccination and non-tuberculous mycobacteria, particularly amongst HIV-positive patients and pregnant women., Findings from PRACHITi, a cohort study in Pune, India revealed the both IGRA and TST were impacted by the phases of pregnancy, which demonstrated the influence of immunological alterations during pregnancy. This result may indicate that immune suppression reduces the tuberculin sensitivity test (TST) and IGRA sensitivity (IGRA). Although the study reported a low concordance between IGRA and TST, it was unable to conclusively compare these two tests since it only investigated patients with positive IGRAs and did not compare them with subjects with negative IGRAs.(Bhosale 2020, utk ganti no 41).
Compared to TST, the IGRA has a very high specificity and is unaffected by prior BCG vaccination or non-tuberculous mycobacteria. This assay is more sensitive to detect M. tuberculosis infections in immunosuppressive patients than TST. However, the absence of a gold standard results in the difficulty of concluding as to whether the IGRA outperforms TST, or if there are higher false-positive results., A study of adult (non-pregnant) patients in Zambia reported the sensitivity of IGRA (Quantiferon-TB Gold Plus) among people living with HIV was comparable to that of HIV-negative individuals (85%, 95% CI: 75–93, and 80%, 95% CI: 64–91. Moreover, the fair agreement between TST and IFN-γ IGRA results were also reported by other previous studies.,,, In several studies comparing IGRA (Quantiferon-TB Gold (QFT-G), the T SPOT-TB (SPOT), and TST results for latent TB in pregnancy, the range of kappa values were from 0.2 to 0.93.,,,,, Birku et al. found that the concordance of TST and QFT-G results in pregnant women varies according to the presence of HIV infection. Other reports on non-pregnant cases also report varying agreements, for example, in screening LTBI in children, the kappa value of both tests in the range of 0.46–0.74.,,
In the present study, the number of pregnant women that were TST-positive was higher than the number of those who were IGRA-positive. Our findings are contrary to the previous study in high-burden areas who observed that the number of IGRA positives were higher than that of TST positives,, but in concordance to another recent report. Cases that were TST-positive but were IGRA-negative in the present study may occur due to impaired IGRA performance in pregnancy. Unfortunately, this study did not show that the pregnancy trimester had any significant effect on IGRA results. On the other hand, the different results between the two methods may also indicate false positives or false negatives in TST results. Various factors such as age, impaired immunity, the coexisting disease may interfere with its interpretation. False-negative TST may result in very young age <6 months and patients with cutaneous anergy, recent TB (8-10 weeks of exposure) or chronic TB infection, protein malnutrition and imprecise reading of induration or incorrect method of administration. Some nutritional studies in Indonesia showed a low average protein intake in pregnant mothers was associated with poor pregnancy outcomes., However, this condition might not be directly related to the false-negative TST result. False-positive TST results is an increasingly observed phenomenon, which may be due to cross-reaction with non-tuberculous mycobacteria and prior administration of BCG vaccination. Besides, there is also the possibility of positive TST results due to pathergic reactions.
It has been suggested that nutrition plays a major role in developing the innate and Th1 immune responses that are appropriate for TB. Low-protein diets result in decreased lymphocyte proliferation, higher levels of immunoglobulin G, and decreased cytokines such as IL-2, TNF-α, and IFN-γ and other mycobactericidal substances that may impair the cell-mediated response important for the immune system to eliminate TB infection. Patients with TB typically experience weight loss or malnutrition due to poor protein intake, muscle catabolism generated by inflammation during infection, and gastrointestinal symptoms induced by acute-phase proteins, such as elevated TNF levels., Malnutrition may decrease immunity and increase the risk of the development of active TB and primary progressive disease. Active TB increases the risk of malnutrition and makes malnutrition worse. However, nutritional status was not associated with positivity for either test.
| Conclusion|| |
This study showed that both contact history and duration of exposure of pregnant women to TB patients affect TST and IGRA results. The sensitivity of the TST was higher than IGRA, while the specificity of IGRA was higher than TST. The agreement between the two methods was fair for detecting LTBI in pregnant women with household contacts. A rapid and affordable diagnostic tool is required to detect LTBI, particularly for high-risk person in high-burden areas.
We are aware of the limitations of this study as there is no gold standard diagnostic test in detecting latent TB to date, so in this case, we used contact history as a proxy for having LTBI. Another limitation of this study was the insufficient information on the BCG vaccination during the childhood of pregnant women. Some of these women did not have a BCG vaccination record and could not confirm either whether they had BCG vaccination during their childhood or not. Therefore, we could not assess the influence of BCG vaccination on false-negative results in the present study.
Financial support and sponsorship
This study was supported by grant from the Research and Community Service Institution of Hasanuddin University (Grant No. UNHAS-LP2M 1754/UN4.21/PL.01.00/2018).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Churchyard G, Kim P, Shah NS, Rustomjee R, Gandhi N, Mathema B, et al.
What we know about tuberculosis transmission: An overview. J Infect Dis 2017;216:S629-35.
Turner RD, Bothamley GH. Cough and the transmission of tuberculosis. J Infect Dis 2015;211:1367-72.
Meermeier EW, Lewinsohn DM. Early clearance versus control: What is the meaning of a negative tuberculin skin test or interferon-gamma release assay following exposure to Mycobacterium tuberculosis
? F1000Res 2018;7:v1000-664.
Jonsson J, Kühlmann-Berenzon S, Berggren I, Bruchfeld J. European Respiratory Journal 2020;55:1901886; DOI: 10.1183/13993003.01886-2019.
Bates M, Ahmed Y, Kapata N, Maeurer M, Mwaba P, Zumla A. Perspectives on tuberculosis in pregnancy. Int J Infect Dis 2015;32:124-7.
Jasenosky LD, Scriba TJ, Hanekom WA, Goldfeld AE. T cells and adaptive immunity to Mycobacterium tuberculosis
in humans. Immunol Rev 2015;264:74-87.
Mnyani CN, McIntyre JA. Tuberculosis in pregnancy. BJOG 2011;118:226-31.
Mathad JS, Gupta A. Tuberculosis in pregnant and postpartum women: Epidemiology, management, and research gaps. Clin Infect Dis 2012;55:1532-49.
Lin HC, Lin HC, Chen SF. Increased risk of low birthweight and small for gestational age infants among women with tuberculosis. BJOG 2010;117:585-90.
Kasaie P, Andrews JR, Kelton WD, Dowdy DW. Timing of tuberculosis transmission and the impact of household contact tracing. An agent-based simulation model. Am J Respir Crit Care Med 2014;189:845-52.
Fox GJ, Barry SE, Britton WJ, Marks GB. Contact investigation for tuberculosis: A systematic review and meta-analysis. Eur Respir J 2013;41:140-56.
Dheda K, Barry CE 3rd
, Maartens G. Tuberculosis. Lancet 2016;387:1211-26.
Nair D, Rajshekhar N, Klinton JS, Watson B, Velayutham B, Tripathy JP, et al.
Household contact screening and yield of tuberculosis cases-a clinic based study in Chennai, South India. PLoS One 2016;11:e0162090.
Paton NI, Borand L, Benedicto J, Kyi MM, Mahmud AM, Norazmi MN, et al.
Diagnosis and management of latent tuberculosis infection in Asia: Review of current status and challenges. Int J Infect Dis 2019;87:21-9.
Zellweger JP, Sotgiu G, Corradi M, Durando P. The diagnosis of latent tuberculosis infection (LTBI): Currently available tests, future developments, and perspectives to eliminate tuberculosis (TB). Med Lav 2020;111:170-83.
Gualano G, Mencarini P, Lauria FN, Palmieri F, Mfinanga S, Mwaba P, et al.
Tuberculin skin test – Outdated or still useful for Latent TB infection screening? Int J Infect Dis 2019;80:S20-2.
Barcellini L, Borroni E, Brown J, Brunetti E, Campisi D, Castellotti PF, et al.
First evaluation of Quantiferon-TB gold plus performance in contact screening. Eur Respir J 2016;48:1411-9.
Seddon JA, Paton J, Nademi Z, Keane D, Williams B, Williams A, et al.
The impact of BCG vaccination on tuberculin skin test responses in children is age dependent: Evidence to be considered when screening children for tuberculosis infection. Thorax 2016;71:932-9.
Shah I, Kathwate J, Shetty NS. Comparison of tuberculin skin test and Quantiferon-TB gold in-tube test in bacillus calmette-guerin-vaccinated children. Lung India 2020;37:24-9.
] [Full text]
Mancuso JD, Mody RM, Olsen CH, Harrison LH, Santosham M, Aronson NE. The long-term effect of bacille calmette-guérin vaccination on tuberculin skin testing: A 55-year follow-up study. Chest 2017;152:282-94.
Arias-Guillén M, Sánchez Menéndez MM, Alperi M, Riestra S, González Budiño MT, García-Clemente MM, et al.
High rates of tuberculin skin test positivity due to methotrexate therapy: False positive results? Semin Arthritis Rheum 2018;48:538-46.
Siqueira RC, Oréfice F. The potential of the IGRA (Interferon Gamma Release Assay) test for the diagnosis of ocular tuberculosis. Review and comparative analysis with the tuberculosis skin test. Rev Bras Oftalmol 2019;78:202-9.
Boddu D, Verghese VP, Michael JS, Chacko A, Jeyaseelan V. Utility of quantiferon®-TB gold in-tube test compared with tuberculin skin test in diagnosing tuberculosis in Indian children with malnutrition. Indian J Med Microbiol 2019;37:433-7.
] [Full text]
Primaturia C, Reniarti L, Nataprawira HMN. Comparison between the Interferon γ Release Assay-QuantiFERON Gold Plus (QFT-Plus)-and Tuberculin Skin Test (TST) in the Detection of Tuberculosis Infection in Immunocompromised Children. Pulm Med 2020;2020:7159485. doi: 10.1155/2020/7159485. PMID: 32455014; PMCID: PMC7238328.
Ghanavi J, Farnia P, Farnia P, Velayati AA. The role of interferon-gamma and interferon-gamma receptor in tuberculosis and nontuberculous mycobacterial infections. Int J Mycobacteriol 2021;10:349-57.
] [Full text]
Priyanka, Sharma M, Sharma S. Ethnicity based comprehensive evaluation of polymorphism in interferon-gamma gene and its association with pulmonary and extra-pulmonary tuberculosis risk: An updated trial sequential meta-analysis. Int J Mycobacteriol 2021;10:243-54.
Waghmare PJ, Lende T, Goswami K, Gupta A, Gupta A, Gangane N, et al
. Immunological host responses as surveillance and prognostic markers in tubercular infections. Int J Mycobacteriol 2019;8:190-5.
] [Full text]
Januarie KC, Uhuo OV, Iwuoha E, Feleni U. Recent advances in the detection of interferon-gamma as a TB biomarker. Anal Bioanal Chem 2022;414:907-21.
Zhou G, Luo Q, Luo S, Teng Z, Ji Z, Yang J, et al.
Interferon-γ release assays or tuberculin skin test for detection and management of latent tuberculosis infection: A systematic review and meta-analysis. Lancet Infect Dis 2020;20:1457-69.
Mensah GI, Sowah SA, Yeboah NY, Addo KK, Jackson-Sillah D. Utility of Quantiferon tuberculosis gold-in-tube test for detecting latent tuberculosis infection among close household contacts of confirmed tuberculosis patients in Accra, Ghana. Int J Mycobacteriol 2017;6:27-33.
] [Full text]
Hidayah N, Djaharuddin I, Ahmad A, Bukhari A, Patellongi I, Tabri NA, et al.
Expression of vitamin D receptor (VDR) gene and VDR polymorphism rs11574113 in pulmonary tuberculosis patients and their household contacts. Gene Rep 2022;27:101581.
Gurjav U, Ankhbat M, Ganbaatar G, Batjarga K, Ochirbat B, Baigal D, et al.
Vitamin D deficiency is associated with tuberculosis infection among household contacts in Ulaanbaatar, Mongolia. Int J Tuberc Lung Dis 2019;23:919-23.
Eom JS, Kim I, Kim WY, Jo EJ, Mok J, Kim MH, et al.
Household tuberculosis contact investigation in a tuberculosis-prevalent country: Are the tuberculin skin test and interferon-gamma release assay enough in elderly contacts? Medicine (Baltimore) 2018;97:e9681.
Abubakar I, Drobniewski F, Southern J, Sitch AJ, Jackson C, Lipman M, et al.
Prognostic value of interferon-γ release assays and tuberculin skin test in predicting the development of active tuberculosis (UK PREDICT TB): A prospective cohort study. Lancet Infect Dis 2018;18:1077-87.
Sun Y, Shen Z, Zhan Y, Wang Y, Ma S, Zhang S, et al.
Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications. BMC Pregnancy Childbirth 2020;20:390.
Siegel SA, Cavanaugh M, Ku JH, Kawamura LM, Winthrop KL. Specificity of Quantiferon-TB plus, a new-generation interferon gamma release assay. J Clin Microbiol 2018;56:e00629-18.
Dettori JR, Norvell DC. Kappa and beyond: Is there agreement? Global Spine J 2020;10:499-501.
Worjoloh A, Kato-Maeda M, Osmond D, Freyre R, Aziz N, Cohan D. Interferon gamma release assay compared with the tuberculin skin test for latent tuberculosis detection in pregnancy. Obstet Gynecol 2011;118:1363-70.
König Walles J, Tesfaye F, Jansson M, Tolera Balcha T, Winqvist N, Kefeni M, et al.
Performance of Quantiferon-TB gold plus for detection of latent tuberculosis infection in pregnant women living in a tuberculosis-and HIV-endemic setting. PLoS One 2018;13:e0193589.
Chehab BM, Kallail KJ, El Fakih RO, Zackula RE, Minns GO. Use of the Quantiferon®-TB gold assay in pregnant patients. Kans J Med 2010;3:24-30.
Birku M, Desalegn G, Kassa G, Tsegaye A, Abebe M. Effect of pregnancy and HIV infection on detection of latent TB infection by tuberculin skin test and Quantiferon-TB gold in-tube assay among women living in a high TB and HIV burden setting. Int J Infect Dis 2020;101:235-42.
Bhosale R, Alexander M, Deshpande P, Kulkarni V, Gupte N, Gupta A, et al.
Stages of pregnancy and HIV affect diagnosis of tuberculosis infection and Mycobacterium tuberculosis
(MTB)-induced immune response: Findings from prachiti, a cohort study in Pune, India. Int J Infect Dis 2021;112:205-11.
LaCourse SM, Cranmer LM, Matemo D, Kinuthia J, Richardson BA, Horne DJ, et al.
Effect of pregnancy on interferon gamma release assay and tuberculin skin test detection of latent TB infection among HIV-infected women in a high burden setting. J Acquir Immune Defic Syndr 2017;75:128-36.
Auguste P, Tsertsvadze A, Pink J, Court R, Seedat F, Gurung T, et al.
Accurate diagnosis of latent tuberculosis in children, people who are immunocompromised or at risk from immunosuppression and recent arrivals from countries with a high incidence of tuberculosis: Systematic review and economic evaluation. Health Technol Assess 2016;20:1-678.
Moliva JI, Turner J, Torrelles JB. Immune responses to bacillus calmette-guérin vaccination: Why do they fail to protect against Mycobacterium tuberculosis
? Front Immunol 2017;8:407.
SAGE Working Group. Report on BCG Vaccine use for Protection Against Mycobacterial
Infections Including Tuberculosis, Leprosy, and other Nontuberculous Mycobacteria
(NTM) Infections. Geneva, Switzerland: SAGE Working Group; 2017.
Mathad JS, Bhosale R, Sangar V, Mave V, Gupte N, Kanade S, et al.
Pregnancy differentially impacts performance of latent tuberculosis diagnostics in a high-burden setting. PLoS One 2014;9:e92308.
Chkhartishvili N, Kempker RR, Dvali N, Abashidze L, Sharavdze L, Gabunia P, et al.
Poor agreement between interferon-gamma release assays and the tuberculin skin test among HIV-infected individuals in the country of Georgia. BMC Infect Dis 2013;13:513.
Gray J, Reves R, Johnson S, Belknap R. Identification of false-positive Quantiferon-TB gold In-tube assays by repeat testing in HIV-infected patients at low risk for tuberculosis. Clin Infect Dis 2012;54:e20-3.
Quintana-Ortega C, Mendez-Echevarria A, Del Rosal T, Gonzalez-Muñoz M, Baquero-Artigao F. False-positive results of quantiferon-tb-gold assay in children. Pediatr Infect Dis J 2020;39:620-3.
Telisinghe L, Amofa-Sekyi M, Maluzi K, Kaluba-Milimo D, Cheeba-Lengwe M, Chiwele K, et al.
The sensitivity of the Quantiferon®-TB gold plus assay in zambian adults with active tuberculosis. Int J Tuberc Lung Dis 2017;21:690-6.
Mathad JS, Bhosale R, Balasubramanian U, Kanade S, Mave V, Suryavanshi N, et al.
Quantitative IFN-γ and IL-2 response associated with latent tuberculosis test discordance in HIV-infected pregnant women. Am J Respir Crit Care Med 2016;193:1421-8.
Lighter-Fisher J, Surette AM. Performance of an interferon-gamma release assay to diagnose latent tuberculosis infection during pregnancy. Obstet Gynecol 2012;119:1088-95.
Benachinmardi K, Sampath S, Rao M. Evaluation of a new interferon gamma release assay, in comparison to tuberculin skin tests and quantiferon tuberculosis goldplus for the detection of latent tuberculosis infection in children from a high tuberculosis burden setting. Int J Mycobacteriol 2021;10:142-8. [Full text]
Thomas L, Verghese VP, Chacko A, Michael JS, Jeyaseelan V. Accuracy and agreement of the tuberculin skin test (TST) and the Quantiferon-TB gold in-tube test (QFT) in the diagnosis of tuberculosis in Indian children. Indian J Med Microbiol 2022;40:109-12.
Lapphra K, Srinuchasart P, Senawong S, Rungpanich U, Umrod P, Maleesatharn A, et al.
Performance and correlation of Quantiferon-TB gold, T-SPOT.TB and tuberculin skin test in young children with tuberculosis exposure or tuberculosis disease. Asian Pac J Trop Med 2020;13:423-5. [Full text]
Madanijah S, Briawan D, Rimbawan R, Zulaikhah Z, Andarwulan N, Nuraida L, et al.
Nutritional status of pre-pregnant and pregnant women residing in Bogor district, Indonesia: A cross-sectional dietary and nutrient intake study. Br J Nutr 2016;116 Suppl 1:S57-66.
Hartriyanti Y, Suyoto PS, Muhammad HF, Palupi IR. Nutrient intake of pregnant women in Indonesia: A review. Malays J Nutr 2012;18:113-24.
Pastore S, Naviglio S, Ventura A. Pathergy as a cause of false-positive tuberculin skin test. Pediatr Infect Dis J 2012;31:104.
Jaganath D, Mupere E. Childhood tuberculosis and malnutrition. J Infect Dis 2012;206:1809-15.
Tellez-Navarrete NA, Ramon-Luing LA, Muñoz-Torrico M, Osuna-Padilla IA, Chavez-Galan L. Malnutrition and tuberculosis: The gap between basic research and clinical trials. J Infect Dev Ctries 2021;15:310-9.
Chandrasekaran P, Saravanan N, Bethunaickan R, Tripathy S. Malnutrition: Modulator of immune responses in tuberculosis. Front Immunol 2017;8:1316.
[Table 1], [Table 2], [Table 3]