Value of the tuberculin skin testing and of an interferon-gamma release assay in haemodialysis patients after exposure to M. tuberculosis

We assessed the value of the tuberculin skin test (TST) and of an interferon-gamma release assay (Quantiferon[REGISTERED SIGN]-TB Gold in-Tube, QFT) for diagnosing LTBI in ESRD patients, after prolonged exposure to a highly contagious TB case in a haemodialysis unit. As a high number of patients presented erythema without induration in the TST response, this type of reaction was also analysed.MethodThe TST and QFT were simultaneously performed twelve weeks after the last possible exposure to a bacilliferous TB patient.

If the first TST (TST-1) was negative, a second TST (TST-2) was performed 15 days later to detect a booster response. A comparison was made between the TST responses (including those cases with erythema without induration) and those for the QFT.

The correlation with risk of infection and the concordance between tests were both analysed.

Results: A total of 52 patients fulfilled the inclusion criteria. Overall, 11 patients (21.2%) had a positive TST response: 3 for TST-1 and 8 for TST-2, and 18 patients (34.6%) showed a positive QFT response (p = 0.065).

Erythema without induration was found in 3 patients at TST-1 and in a further 9 patients at TST-2. The three patients with erythema without induration in TST-1 had a positive TST-2 response.

Concordance between TST and QFT was weak for TST-1 (kappa = 0.21); it was moderate for overall TST (kappa = 0.49); and it was strong if both induration and erythema (kappa = 0.67) were considered.

Conclusions: In patients with ESRD, erythema without induration in the TST response could potentially be an indicator of M. tuberculosis infection.

Source :      2012/9/4

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