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Original Research: RESPIRATORY INFECTIONS |

Performance of Tests for Latent Tuberculosis in Different Groups of Immunocompromised Patients

Luca Richeldi, MD, PhD; Monica Losi, PhD; Roberto D'Amico, PhD; Mario Luppi, MD; Angela Ferrari, MD; Cristina Mussini, MD; Mauro Codeluppi, MD; Stefania Cocchi, MD; Francesca Prati, MD; Valentina Paci, MD; Marisa Meacci, BS; Barbara Meccugni, BS; Fabio Rumpianesi, MD; Pietro Roversi, MD; Stefania Cerri, MD; Fabrizio Luppi, MD; Giovanni Ferrara, MD; Irene Latorre, MSc; Giorgio E. Gerunda, MD; Giuseppe Torelli, MD; Roberto Esposito, MD; Leonardo M. Fabbri, MD, FCCP
Author and Funding Information

From University of Modena and Reggio Emilia (Drs. Richeldi, Losi, D'Amico, M. Luppi, Ferrari, Mussini, Codeluppi, Cocchi, Prati, Paci, Roversi, Cerri, F. Luppi, Ferrara, Gerunda, Torelli, Esposito, and Fabbri, and Ms. Latorre), Modena, Italy; and Policlinico Hospital (Dr. Rumpianesi, Ms. Meacci, and Ms. Meccugni), Modena, Italy.

Correspondence to: Luca Richeldi, MD, PhD, Section of Respiratory Diseases, Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Italy; e-mail: luca.richeldi@unimore.it

*Presently at the University of Perugia, Perugia, Italy.

†Presently at Servei de Microbiologia, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Instituto de Salud Carlos III, Badalona, Spain.


This work was supported in part by the Azienda Ospedaliero-Universitaria Policlinico di Modena (Italy). Ms. Latorre is an Formación Profesorado Universitario (FPU) predoctoral student and the recipient of a grant from the Ministerio de Educación y Ciencia (Spain). T-SPOT.TB kits were kindly provided by Oxford Immunotec Ltd. and Nanogen Advanced Diagnostics Italy. Neither company had a role in the design or conduct of the study, collection, management, analysis, or interpretation of the data, preparation, review, or approval of this article.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):198-204. doi:10.1378/chest.08-2575
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Background:  Immunocompromised persons infected with Mycobacterium tuberculosis (MTB) have increased risk of tuberculosis (TB) reactivation, but their management is hampered by the occurrence of false-negative results of the tuberculin skin test (TST). The T-cell interferon (IFN)-γ release blood assays T-SPOT.TB (TS.TB) [Oxford Immunotec; Abingdon, UK] and QuantiFERON-TB Gold In-Tube (QFT-IT) [Cellestis Ltd; Carnegie, VIC, Australia] might improve diagnostic accuracy for latent TB infection (LTBI) in high-risk persons, although their performance in different groups of immunocompromised patients is largely unknown.

Methods and results:  Over a 1-year period, we prospectively enrolled patients in three different immunosuppressed groups, as follows: 120 liver transplantation candidates (LTCs); 116 chronically HIV-infected persons; and 95 patients with hematologic malignancies (HMs). TST, TS.TB, and QFT-IT were simultaneously performed, their results were compared, and intertest agreement was evaluated. Overall, TST provided fewer positive results (10.9%) than TS.TB (18.4%; p < 0.001) and QFT-IT (15.1%; p = 0.033). Significantly fewer HIV-infected individuals had at least one positive test (9.5%) compared with LTCs (35.8%; p < 0.001) and patients with HMs (29.5%; p < 0.001). Diagnostic agreement between tests was moderate (κ = 0.40 to 0.65) and decreased in the HIV-infected group when the results of the TS.TB were compared with either TST (κ = 0.16) or QFT-IT (κ = 0.19). Indeterminate blood test results due to low positive control values were significantly more frequent with QFT-IT (7.2%) than with TS.TB (0.6%; p < 0.001).

Conclusions:  Blood tests identified significantly more patients as being infected with MTB than TST, although diagnostic agreement varied across groups. Based on these results, we recommend tailoring application of the new blood IFN-γ assays for LTBI in different high-risk groups and advise caution in their current use in immunosuppressed patients.

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