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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Are interferon-γ release assays useful for diagnosing active tuberculosis in a high-burden setting?
European Respiratory Journal, Volume 38, No. 3, Year 2011
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Description
Although interferon-γ release assays (IGRAs) are intended for diagnosing latent tuberculosis (TB), we hypothesised that in a high-burden setting: 1) the magnitude of the response when using IGRAs can distinguish active TB from other diagnoses; 2) IGRAs may aid in the diagnosis of smear-negative TB; and 3) IGRAs could be useful as rule-out tests for active TB. We evaluated the accuracy of two IGRAs (QuantiFERON®-TB Gold In-tube (QFT-GIT) and T-SPOT®. TB) in 395 patients (27% HIV-infected) with suspected TB in Cape Town, South Africa. IGRA sensitivity and specificity (95% CI) were 76% (68-83%) and 42% (36-49%) for QFT-GIT and 84% (77-90%) and 47% (40-53%) for T-SPOT®.TB, respectively. Although interferon-γ responses were significantly higher in the TB versus non-TB groups (p<0.0001), varying the cut-offs did not improve discriminatory ability. In culture-negative patients, depending on whether those with clinically diagnosed TB were included or excluded from the analysis, the negative predictive value (NPV) of QFT-GIT, T-SPOT®.TB and chest radiograph in smear-negative patients varied between 85 and 89, 87 and 92, and 98% (for chest radiograph), respectively. Overall accuracy was independent of HIV status and CD4 count. In a high-burden setting, IGRAs alone do not have value as rule-in or -out tests for active TB. In smear-negative patients, chest radiography had better NPV even in HIV-infected patients. Copyright©ERS 2011.
Authors & Co-Authors
Ling, Daphne I.
Canada, Montreal
Université Mcgill
Pai, Madhukar
Canada, Montreal
Université Mcgill
Davids, Virginia
South Africa, Cape Town
University of Cape Town
Brunet, Laurence
Canada, Montreal
Université Mcgill
Lenders, Laura M.
South Africa, Cape Town
University of Cape Town
Meldau, Richard
South Africa, Cape Town
University of Cape Town
Calligaro, Gregory L.
South Africa, Cape Town
University of Cape Town
Allwood, Brian William
South Africa, Cape Town
University of Cape Town
van Zyl-Smit, Richard N.
South Africa, Cape Town
University of Cape Town
Peter, Jonathan Grant
South Africa, Cape Town
University of Cape Town
Bateman, E. D.
South Africa, Cape Town
University of Cape Town
Dawson, Rodney
South Africa, Cape Town
University of Cape Town
Dheda, Keertan U.J.
South Africa, Cape Town
University of Cape Town
United Kingdom, London
University College London
Statistics
Citations: 74
Authors: 13
Affiliations: 3
Identifiers
Doi:
10.1183/09031936.00181610
ISSN:
09031936
e-ISSN:
13993003
Research Areas
Infectious Diseases
Study Locations
South Africa