Tüberkülozlu hastalar, yakın temaslıları, sağlık çalışanları ve tüberküloz laboratuvarı personelinde Quantıferon-TB gold ve tüberkülin cilt testinin değerlendirilmesi
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Dosyalar
Tarih
2010
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ankara Microbiology Soc
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Tüberkülin cilt testi (TCT), uzun bir süredir duyarlılık ve özgüllük değerlerindeki sınırlamalara rağmen etkin bir şekilde kullanılmaktadır. Aktif tüberkülozu olmaksızın TCT pozitif olan hastalar, latent tüberküloz enfeksiyonu (LTBE) olarak tanımlanır. LTBE olan hastaların TCT ile tanımlanması, hastalığın kontrolünde önemli bir aşamadır. Plazma interferon gamma (IFN-γ) düzeyini belirleyen Quantiferon-TB Gold Testi (QTG, Cellestis, Austuralya) latent tüberküloz (TB) enfeksiyonu tanısında TCT’ye göre avantajları olan in vitro tanısal bir testtir. Bu test Mycobacterium tuberculosis’e özgül ESAT-6 ve CFP-10 antijenlerini içerir. Bu çalışmanın amacı, TB’li hastalar, yakın temaslıları, sağlık çalışanları ve TB laboratuvarı personelinde QTG ve TCT testi sonuçlarının karşılaştırılmasıdır. Çalışmaya, 26 aktif akciğer TB’li hasta, 6 hasta yakını, 11 hasta teması olan sağlık çalışanı ve 8 TB laboratuvarı personeli dahil edilmiştir. TCT uygulanmadan önce QTG testi için kan örnekleri alınmıştır. Tüm bireyler BCG aşılaması yönünden sorgulanmış ve BCG skarı yönünden incelenmiştir. Çalışmaya katılanların tümünde BCG aşılaması öyküsü ve muayenede BCG skarı tespit edilmiştir. QTG testi plazma örneklerinde üretici firmanın önerileri doğrultusunda çalışılmıştır. TCT ile QTG testi arasındaki uyum kappa istatistiği ile ölçülmüştür. Aktif TB’li hastalarda (gerçek enfekte bireyler) TCT (PPD) pozitifliği %34.6 (9/26), QTG pozitifliği %65.3 (17/26) olarak belirlenmiş; pozitiflik oranı QTG testinde daha yüksek tespit edilmiş olmasına rağmen aradaki fark istatistiksel olarak anlamlı bulunmamıştır (p> 0.001). Diğer çalışma gruplarına bakıldığında; sağlık çalışanları, TB’li hastanın yakın temaslıları ve TB laboratuvarı çalışanlarında TCT ve QTG pozitiflik oranları sırasıyla; %36 (4/11) ve %27 (3/11); %16.6 (1/6) ve %83 (5/6); %37.5 (3/8) ve %75 (6/8) olarak tespit edilmiştir. PPD testi sonucu, QTG negatif grupta ortalama 11 mm iken, QTG pozitif grupta ortalama 14 mm olarak saptanmış ve aradaki fark istatistiksel olarak anlamlı bulunmuştur (p< 0.001). QTG pozitif ve negatif gruplar arasında yaş (p≥ 0.05) ve cinsiyet (p< 0.001) yönünden istatistiksel olarak anlamlı farklılık saptanmamıştır. QTG testi, latent ve aktif TB enfeksiyonunu saptamada BCG aşısından etkilenmemesi, TB dışı (atipik) mikobakterilere bağlı yanıtları ayırt etmesi ve TCT’nin uygulanması ve değerlendirilmesiyle ilişkili değişkenlik ve birey- sel farklılıklardan etkilenmemesi nedeniyle TCT’den üstündür. Ayrıca, QTG testinin değerlendirilmesi için hastanın sağlık merkezine tekrar gelme zorunluluğu olmaması ve sonuçların daha erken alınabilmesi de avantajları arasındadır. Buna karşın TCT’den daha pahalı olması, test için özel ekipmanlara ve iyi yetişmiş laboratuvar personeline gereksinim duyulması, QTG testinin dezavantajları arasında sayılabilir.
Tuberculin skin test (TST) has been used effectively for a long time, despite inherent sensitivity and specificity limitations. Patients with a positive TST without active tuberculosis are identified as having latent tuberculosis infection. Identifying patients with latent tuberculosis infection with this test is an important part of control of the disease. A whole-blood inferferon gamma (IFN-gamma) assay, the Quantiferon TB Gold test (QTG; Cellestis, Australia) which is a promising in vitro diagnostic test for the identification of latent tuberculosis infection (LTBI), has potential advantages over the TST. This test includes Myobacterium tuberculosis specific ESAT- 6 and CFP-10 antigens. The aim of this study was to compare the results obtained by QTG and TST in active tuberculosis (TB) patients, close contacts of patients, health care workers and tuberculosis laboratory personel. Twenty-six patients with active pulmonary TB, 6 close contacts of those patients, 11 health care workers with contact to TB patients and 8 TB reference laboratory personnel were included in the study. Prior to administration of the TST, blood samples were drawn from each participant for QTG test. All subjects were asked for BCG vaccination history and examined for a BCG scar. All individuals had a BCG scar. The QTG assay was performed in whole blood samples according to manufacturer's instructions. The agreement between TST and QTG was measured with kappa statistical analysis. In active TB patients (true-infected cases) TST (PPD) positivity was found 34.6% (9/26) while QTG positivity was 65.3% (17/26). Although the positivity rate was higher in QTG test, this difference was not found statistically significant (p> 0.001). TST and QTG positivity rates for health care workers, close house contact of TB patients and TB laboratory staff were as follows, respectively; 36% (4/11) and 27% (3/11); 16.6% (1/6) and 83% (5/6); 37.5% (3/8) and 75% (6/8). The mean PPD diameter was 11 mm in QTG negative group and 14 mm in QTG positive group with a statistically significant difference (p< 0.001). However, there was no statistical significance between QTG positive and negative groups by means of age (P >= 0.05) and gender (p< 0.001). In conclusion, QTG assay was superior to TST in its ability to detect LTBI and active TB infection, not to be affected with BCG vaccination, to discriminate responses due to non-tuberculous mycobacteria, and to avoid variability and subjectivity associated with application and reading the TST. Besides, QTG assay needs only one visit to the test unit. However, its being expensive than TST and requirement for special equipments and skilled laboratory personnel, are among the disadvantages of QTG assay.
Tuberculin skin test (TST) has been used effectively for a long time, despite inherent sensitivity and specificity limitations. Patients with a positive TST without active tuberculosis are identified as having latent tuberculosis infection. Identifying patients with latent tuberculosis infection with this test is an important part of control of the disease. A whole-blood inferferon gamma (IFN-gamma) assay, the Quantiferon TB Gold test (QTG; Cellestis, Australia) which is a promising in vitro diagnostic test for the identification of latent tuberculosis infection (LTBI), has potential advantages over the TST. This test includes Myobacterium tuberculosis specific ESAT- 6 and CFP-10 antigens. The aim of this study was to compare the results obtained by QTG and TST in active tuberculosis (TB) patients, close contacts of patients, health care workers and tuberculosis laboratory personel. Twenty-six patients with active pulmonary TB, 6 close contacts of those patients, 11 health care workers with contact to TB patients and 8 TB reference laboratory personnel were included in the study. Prior to administration of the TST, blood samples were drawn from each participant for QTG test. All subjects were asked for BCG vaccination history and examined for a BCG scar. All individuals had a BCG scar. The QTG assay was performed in whole blood samples according to manufacturer's instructions. The agreement between TST and QTG was measured with kappa statistical analysis. In active TB patients (true-infected cases) TST (PPD) positivity was found 34.6% (9/26) while QTG positivity was 65.3% (17/26). Although the positivity rate was higher in QTG test, this difference was not found statistically significant (p> 0.001). TST and QTG positivity rates for health care workers, close house contact of TB patients and TB laboratory staff were as follows, respectively; 36% (4/11) and 27% (3/11); 16.6% (1/6) and 83% (5/6); 37.5% (3/8) and 75% (6/8). The mean PPD diameter was 11 mm in QTG negative group and 14 mm in QTG positive group with a statistically significant difference (p< 0.001). However, there was no statistical significance between QTG positive and negative groups by means of age (P >= 0.05) and gender (p< 0.001). In conclusion, QTG assay was superior to TST in its ability to detect LTBI and active TB infection, not to be affected with BCG vaccination, to discriminate responses due to non-tuberculous mycobacteria, and to avoid variability and subjectivity associated with application and reading the TST. Besides, QTG assay needs only one visit to the test unit. However, its being expensive than TST and requirement for special equipments and skilled laboratory personnel, are among the disadvantages of QTG assay.
Açıklama
Birengel, Serhat/0000-0002-5599-6488; Annakkaya, Ali Nihat N/0000-0002-7661-8830
WOS: 000284385400003
PubMed: 21063967
WOS: 000284385400003
PubMed: 21063967
Anahtar Kelimeler
Active tuberculosis, latent tuberculosis, tuberculin skin test, Quantiferon TB Gold test
Kaynak
Mikrobiyoloji Bulteni
WoS Q Değeri
N/A
Scopus Q Değeri
Q4
Cilt
44
Sayı
4
