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Performance of two commercial blood IFN-γ release assays for the detection of Mycobacterium tuberculosis infection in patient candidates for anti-TNF-α treatment

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Abstract

The reactivation of latent tuberculosis (TB) is a major complication of tumor necrosis factor (TNF)-α inhibitors. Screening for TB infection is recommended before anti-TNF therapy is initiated; however, the use of tuberculin skin testing (TST) is controversial, due to the high rate of false-negative results in patients receiving immunosuppressive treatment. To compare the performance of two commercial interferon (IFN)-γ release assays (IGRA), T-SPOT.TB (TS-TB) and QuantiFERON-TB Gold “In-tube” (QFT-GIT), with TST for the detection of TB infection in patients due to start anti-TNF therapy, 69 human immunodeficiency virus (HIV)-negative Italian patients (mean age: 45.2 ± 12.6 years; male=39) were enrolled between September 2005 to August 2006. Patients affected by rheumatoid arthritis (n = 18), psoriatic arthritis (n = 26), ulcerous rectocolitis (n = 6), and Crohn’s disease (n = 19) were tested simultaneously with TST, TS-TB, and QFT-GIT. Overall, 26% of patients were positive by TST, 30.4% by TS-TB, and 31.8% by QFT-GIT. Agreement with TST was similar (κ = 0.21, p = 0.0002 and κ = 0.26, p < 0.001, respectively). In 11 TST-negative cases, IFN-γ release assays were positive. In addition, in seven Mantoux-positive cases with no TB risk factors, TST result agreement was achieved with at least one blood test. Indeterminate results were detected in 5.8% and 2.8% of cases, respectively, with TS-TB and with QFT-GIT (p = not significant [ns]). In conclusion, our results suggest that IGRAs may be helpful for screening purposes in patient candidates for anti-TNF therapy to confirm positive TST results and in selected cases when false-negative results are suspected. The utility of blood tests in patients with low or no TB risk remains to be assessed.

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Authors and Affiliations

  1. TB Infection Screening Unit, Department of Clinical and Experimental Medicine, University of Naples “FEDERICO II”, Monaldi Hospital, Via L. Bianchi, 5, 80131, Naples, Italy

    M. Bocchino, A. Matarese, B. Bellofiore, P. Giacomelli, F. Perna, D. Galati, A. Ponticiello & A. Sanduzzi

  2. Microbiology and Virology Service, Monaldi Hospital, Via L. Bianchi, 5, 80131, Naples, Italy

    G. Santoro

  3. Division of Dermatology, Department of Systematic Pathology, University of Naples “FEDERICO II”, Via S. Pansini, 5, 80131, Naples, Italy

    N. Balato

  4. Division of Gastroenterology, Department of Clinical and Experimental Medicine, University of Naples “FEDERICO II”, Via S. Pansini, 5, 80131, Naples, Italy

    F. Castiglione

  5. Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Naples “FEDERICO II”, Via S. Pansini, 5, 80131, Naples, Italy

    R. Scarpa

  6. Statistics Unit, Department of Medicine and Public Health, Second University of Naples, Via L. Armanni, 5, 80138, Naples, Italy

    G. Signoriello

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  1. M. Bocchino
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Bocchino, M., Matarese, A., Bellofiore, B. et al. Performance of two commercial blood IFN-γ release assays for the detection of Mycobacterium tuberculosis infection in patient candidates for anti-TNF-α treatment. Eur J Clin Microbiol Infect Dis 27, 907–913 (2008). https://doi.org/10.1007/s10096-008-0519-1

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