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Use of T Cell-Based Diagnosis of Tuberculosis Infection to Optimize Interpretation of Tuberculin Skin Testing for Child Tuberculosis Contacts.
(Bakir, Mustafa.) |
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Bibliographical information (record 266473) |
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- Background. Treatment of recent tuberculosis infection in children aged ! 2 years is essential, because of high risk of progression to disease, but diagnosis is hindered by the inaccuracy of the tuberculin skin test (TST). More-accurate T cell-based tests of infection could enhance diagnosis by optimizing interpretation of the TST results.
Methods. A total of 979 child tuberculosis contacts in Istanbul underwent the TST and enzyme-linked immunospot assay. Using enzyme-linked immunospot test results as a reference standard, we assessed the effect of age and bacille Calmette-Guerin ( BCG) vaccination on the sensitivity and specificity of the TST, and we computed the optimal TST cutoff points, using receiver operating characteristic curves.
Results. With a TST cutoff point of >= 10 mm, the sensitivity of the TST was 66% for children aged <2 years, which was lower than that for older children (P = .006). Specificity was 75% for BCG-vaccinated children, Pp. 006 compared with 92% for unvaccinated children (P = .001). Optimal cutoff points improved TST specificity for children with 1 BCG scar, with little loss of sensitivity. Despite the use of optimal cutoff points, TST sensitivity remained <70% for children aged <2 years, specificity remained <87% for BCG-vaccinated children aged >= 2 years, and overall accuracy was low for children with 1 BCG scar.
Conclusions. Negative results of the TST cannot exclude tuberculosis infection for child tuberculosis contacts aged <2 years, which supports the use of preventive therapy regardless of the TST results for this age group. In children aged >= 2 years, the accuracy of the TST can be improved by adjustment of cutoff points for BCG-vaccinated children but remains poor for children with >1 BCG scar. This methodology can define optimal TST cutoff points for diagnosis of tuberculosis infection tailored to target populations.
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EOL-1379
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Item available
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NEU Grand LibraryOnline (QW504 .U84 2009)
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Online electronic |
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