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Free Content Interferon-gamma release assay clarifies the effect of bacille Calmette-Guérin vaccination in Greek army recruits

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OBJECTIVE: To compare the most recent commercial interferon-gamma release assay (IGRA), the QuantiFERON®-TB Gold In-Tube (QFT-GIT), with the tuberculin skin test (TST) in Greek army recruits who were bacille Calmette-Guérin (BCG) vaccinated during childhood and had no history of tuberculosis (TB) exposure.

METHOD: We conducted a cross-sectional comparison study of 1750 young army recruits. TST was performed on all participants, while QFT-GIT was performed in all subjects with TST > 0 mm and in 18 TST-negative controls (TST = 0 mm).

RESULTS: Among the study subjects, 5.4% (96/1750) had TST indurations of ≥10 mm, and 3.4% (59/1750) had indurations of ≥15 mm. Among subjects with a positive TST, 11.4% (11/96) tested positive on QFT-GIT. All those with QFT-GIT positivity had TST indurations of ≥15 mm, and none of those with TST indurations of 10–14 mm were positive by QFT-GIT. The overall agreement between TST and QFT-GIT was poor (κ = 0.02).

CONCLUSION: We found a significant discordance between TST and QFT-GIT in BCG-vaccinated Greek army recruits consistent with previous studies showing that BCG received after infancy produces false-positive TST reactions. Our findings underline the need for a two-step approach in diagnosing latent TB infection in all BCG-vaccinated individuals: initial TST screening, followed by an IGRA to confirm TST positivity.
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Keywords: BCG; IGRA; QuantiFERON; latent tuberculosis infection; tuberculin skin test

Document Type: Regular Paper

Affiliations: 1: Department of Pneumonology, University Hospital of Ioannina, Ioannina, Greece 2: Department of Microbiology, University Hospital of Ioannina, Ioannina, Greece 3: Department of Family Medicine, University Hospital of Ioannina, Ioannina, Greece

Publication date: 01 May 2010

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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