Interferon-gamma release assays for the detection of Mycobacterium tuberculosis infection in children with cancer
Abstract:SETTING: The paediatric oncology unit at Tygerberg Children's Hospital, South Africa.
OBJECTIVES: To assess the use of the tuberculin skin test (TST) and two commercial interferon-gamma release assays (IGRAs) for the detection of Mycobacterium tuberculosis infection in children with cancer before initiating chemotherapy treatment.
DESIGN: Prospective hospital-based study, including children newly diagnosed with cancer; all underwent TST and IGRA testing.
RESULTS: Of the 34 children enrolled, seven (17.6%) tested positive with either test: TST (3/7, 8.8%), T-SPOT®.TB (n = 6, 17.6%) and QuantiFERON®-TB Gold In-Tube (QFT-G; n = 3, 8.8%). T-SPOT.TB assay results were negative in 17 (50.0%) and indeterminate in four (11.8%) children. Six T-SPOT.TB tests could not be completed due to low cell counts (<100 000 per well), and one clotted. QFT-G results were negative in 26 (76.5%) and indeterminate in five (14.7%).
CONCLUSIONS: TST and IGRAs were frequently discordant, with fewer positive results than expected. T-SPOT.TB produced more positive results, but inadequate cell counts were a particular problem. The sample size was too small to comment with confidence on test accuracy. All latent TB infection tests appear to perform sub-optimally in this group of children, and therefore none of them can be used in isolation to confirm or disprove TB infection.
Document Type: Regular Paper
Affiliations: 1: Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Tygerberg, South Africa 2: Department of Paediatrics and Child Health, Desmond Tutu TB Centre for Research and Education, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
Publication date: June 1, 2010
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