Seval ÖZEN, Fatih ÜÇKARDEŞ, Hatice UYGUN, Nurettin ERDEM, Nevzat AKGÜL, Mehmet TURĞUT

Çocuklarda Tüberkülin Deri Testi ve QuantiFERON-TB Gold testinin Karşılaştırılması

Amaç: İnterferon-γ salınım testleri (IGRA’lar) ve tüberkülin deri testi (TST) çocuklarda tüberküloz (TB) hastalığının teşhisi için önemli yardımcı testlerdir. Bu çalışmada, TB ve latent tüberküloz enfeksiyonu (LTBI) olan çocuklarda kullanılan QuantiFERON-TB Gold In-tube testi (QFT) ile tüberkülin deri testinin (TST) duyarlılığının ve uyumunun karşılaştırılması amaçlandı. Gereç ve Yöntemler: Eylül 2018-Ocak 2020 tarihleri arasında testlerin performansıyla ilişkili vaka özelliklerini belirlemek ve testlerin duyarlılığını ölçmek için 118 hasta prospektif olarak çalışmaya dahil edildi. TST ve QFT testleri eşzamanlı yapıldı. Bulgular: Çalışmaya 118 hasta dahil edildi. Pnömoni semptom ve bulguları ile başvuran 13 (%11), aktif TB temaslı taramasında 7 (%6) hasta TB tanısı aldı. TB tanısı %20 mikrobiyolojik, %80 klinik olarak konuldu. Semptomatik hastalık nedeniyle 50 (%42.3) çocuktan açlık mide sıvısında tüberküloz belirteçleri çalışıldı. Mycobacterium tuberculosis kültür pozitifliği ise %10’du. Hiçbir hastamızda asidorezistan basil pozitifliği saptanmadı. Çalışmamızda erkek / kadın oranı 74/44’dı. Ortanca hasta yaşı erkeklerde 14 yıl (1.17-19.2 yıl), kızlarda ise 12 yıl (0.33 -17.9 yıl)’dı. LTBI grubunun yaş ortalaması TB grubundan anlamlı olarak yüksekken (p<0.05) enfekte olmayan grup ile benzerdi (p>0.05). Hastaların % 53.5’inde tüberkülozlu biriyle karşılaşma öyküsü vardı ve % 82.2’sinde BCG aşısı yapılmıştı. Saptanan en sık radyolojik bulgu konsolidasyondu. TB tanılı hastalarda TST ile IGRA testi arasında orta düzeyde (kappa =0.50, p=0.025) uyum saptanırken LTBI hastalarında testler arasında uyum saptanamadı. TB ve LTBI tanılı hastalarda TST’nin sensitivitesi %51.1 (%95 CI,36.7-65.3), QFT’nın sensitivitesi %60.4 (%95 CI,45.5-73.6)’dı. Sonuç: Maliyet ve teknik hususlar, sınırlı kaynaklara ve zayıf laboratuvar altyapısına sahip kırsal bölgelerde tanıda TST en çok tercih edilen yöntem olarak devam edecek gibi gözükmektedir.

Anahtar Kelimeler:

Tüberküloz, İnterferon gama salım testi, Latent tüberküloz, Tüberkülin deri testi

Comparison of Tuberculin Skin Test and QuantiFERON-TB Gold Test in Children

Objective: Interferon-γ release tests (IGRAs) and tuberculin skin testing (TST) are important helpful tests for diagnosing tuberculosis (TB) disease in children. It was aimed to compare the sensitivity and compatibility of QuantiFERON-TB Gold In-tube test (QFT) and TST used in children with TB and Latent tuberculosis infection (LTBI). Material and Methods: A total of 118 patients between September 2018 and January 2020 were included in the study prospectively to determine the case characteristics related to the performance of the tests, and to measure the sensitivity of these tests. Results: A total of 118 patients were included in the study; and 13 (11%) patients presented with pneumonia symptoms and 7 (6%) patients were diagnosed with TB in active TB Contact Screening. TB diagnosis was made 20% microbiologically. Mycobacterium tuberculosis culture positivity was found to be 10%. None of the patients had acid-resistant bacilli positivity. The male / female rate was 74/44 in our study (p = 0.006). The median age was found to be 14 (1.17-19.2 years) in males, and 12 (0.33 -17.9 years) in females. The mean age of the LTBI Group was higher than the TB Group at significant levels (p <0.05), and was similar to the non-infected group (p>0.05). A total of 53.5% of the patients had a history of meeting someone with tuberculosis, and 97 children were vaccinated with BCG (82.2%). TST and QFT positivities were 19.5% and 22%, respectively. The most common radiological finding that was detected was consolidation areas. While there was moderate compliance between TST and IGRA test in patients with TB diagnosis (kappa =0.50, p=0.025), no compliance was found between tests in LTBI patients. In patients who were diagnosed with TB and LTBI, the sensitivity of TST was found to be 51.1%, and the sensitivity of QFT was found to be 60.4%. Conclusion: TST seems to continue as the most preferred method of diagnosis in rural areas with limited resources and poor laboratory infrastructure due to the costs and technical considerations.

Keywords:

Tuberculosis, Interferon Gamma Release Test, Latent Tuberculosis, Tuberculin Skin Test,

PDF

___

1. World Health Organization Global Tuberculosis report 20th.edition,Geneva;2015. 2. Kay AW, Islam SM, Wendorf K, Westenhouse J, Barry PM. Interferon-γ release assay performance for tuberculosis in childhood. Pediatrics. 2018 Jun 1;141(6).
3. Graham SM, Cuevas LE, Jean-Philippe P, et. al. Clinical case definitions for classification of intrathoracic tuberculosis in children: an update. Clinical Infectious Diseases. 2015 Oct 15;61(suppl_3):S179-87.
4. Chiang SS, Starke JR. Mycobacterium Tuberculosis. In: Long SS, Prober CG, Fischer M (eds). Principles and Practice of Pediatric Infectious Disease. 5th ed. Philadelphia: Elsevier, 2018:4026-4081.
5. T.C. Ministry of Health Tuberculosis Diagnosis and Treatment Guide Akdağ R. (eds) Ankara 2011
6. MazureGH, Jereb J, LoBue P, Iademarco MF, Vernon A. Guidelines for Using the QuantiFERON®-TB G Test for Detecting Mycobacterium tuberculosis Infection, United States.MMWR 2005;15: 49-55.
7. Starke JR. Diagnosis of tuberculosis in children. Pediatr Infect Dis J 2000; 19: 1095–1096.
8. Starke JR. Interferon release assay for diagnosis of tuberculosis infection and disease in children. Pediatrics 2014; 134:1763-73
9. Ahmed A, Feng PJ, Gaensbauer JT.et al. Interferon-γ release assays in children< 15 years of age. Pediatrics. 2020 Jan 1;145(1)
10. Connell TG, Ritz N, Paxton GA, Buttery JP, Curtis N, Ranganathan SC. A three-way comparison of tuberculin skin testing, QuantiFERON-TB gold and T-SPOT. TB in children. PloS one. 2008 Jul 9;3(7):e2624.
11. Tavast E, Salo E, Seppälä I, Tuuminen T. IGRA tests perform similarly to TST but cause no adverse reactions: pediatric experience in Finland. BMC research notes. 2009 Dec;2(1):1-9.
12. Rangaka MX, Wilkinson KA, Glynn JR, et al. Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis. The Lancet infectious diseases. 2012 Jan 1;12(1):45-55.
13. Togun TO, Egere U, Gomez MP.et al. No added value of interferon-γ release to a prediction model for childhood tuberculosis. European Respiratory Journal. 2016 Jan 1;47(1):223-32.
14. Kampmann B, Whittaker E, Williams A, et.al. Interferon-γ release assays do not identify more children with active tuberculosis than the tuberculin skin test. European Respiratory Journal. 2009 Jun 1;33(6):1374-82.
15. Chen SC, Chen KL, Chen KH, Chien ST, Chen KT. Updated diagnosis and treatment of childhood tuberculosis. World Journal of Pediatrics. 2013 Feb;9(1):9-16.
16. Schepisi MS, Motta I,Dore S, Costa C,Satgiu G, Giordi E. Tuberculosis transmission among children and adolescents in schools and other congreate settings: a systemic rewiew. New microbiologica;2018;41;4,282-290.
17. Kim D, Lee S, Kang SH, et al. A contact investigation after exposure to a child with disseminated tuberculosis mimicking inflammatory bowel disease. Korean journal of pediatrics. 2018 Nov;61(11):366.
18. Pai M, Denkinger CM, Kik SV, .et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clinical microbiology reviews. 2014 Jan 1;27(1):3-20.