Interferon-gamma release assay clarifies the effect of bacille Calmette-Guérin vaccination in Greek army recruits
Abstract: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.
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: May 1, 2010
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