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Original Research |

Challenges of Interferon-γ Release Assay Conversions in Serial Testing of Health-care Workers in a TB Control ProgramChallenge of Interferon-03B3 Release Assay Conversion

Kimberlee S. Fong, DO; J. Walton Tomford, MD; Lucileia Teixeira, MD; Thomas G. Fraser, MD; David van Duin, MD, PhD; Belinda Yen-Lieberman, PhD; Steve M. Gordon, MD; Cyndee Miranda, MD
Author and Funding Information

From the Department of Infectious Disease (Drs Fong, Tomford, Teixeira, Fraser, van Duin, Gordon, and Miranda) and Department of Pathology (Dr Yen-Lieberman), Cleveland Clinic, Cleveland, OH.

Correspondence to: Kimberlee S. Fong, DO, Department of Infectious Disease, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: fongk2@ccf.org

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


For editorial comment see page 10

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


Chest. 2012;142(1):55-62. doi:10.1378/chest.11-0992
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Background:  Clinical data with use of serial interferon-γ release assay (IGRA) testing in US health-care workers (HCWs) are limited.

Methods:  A single-center, retrospective chart review was done from 2007 to 2010 of HCWs who underwent preemployment QuantiFERON-TB Gold In-Tube testing. Demographic data, bacille Calmette-Guérin history, prior tuberculin skin test result if done, and baseline and serial IGRA values were obtained. The number of IGRA converters and reverters and their subsequent management by infectious disease physicians were reviewed. Quantitative IGRA-negative values were not available.

Results:  A total of 7,374 IGRAs were performed on newly hired HCWs. Of these tests, 486 (6.6%) were positive at baseline, 305 (4.1%) were indeterminate, and 6,583 (89.3%) were negative. From 2007 to 2010, 52 of 1,857 HCWs (2.8%) with serial IGRA tests were identified as converters, with a serial IGRA median value of 0.63 IU/mL. Seventy-one percent of HCWs with IGRA conversion had values ≤ 1 IU/mL. None of the converters had active TB or were part of an outbreak investigation.

Conclusions:  Clinical significance of most QuantiFERON-TB Gold In-Tube conversions in serial testing remains a challenging task for clinicians. The use of a single cutoff point criterion for IGRA may lead to overdiagnosis of new TB infections. Clinical assessment and evaluation may help to prevent unnecessary therapy in these cases. The criteria for defining conversions and reversions by establishing new cutoffs needs to be evaluated further, especially in HCWs.

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