Accuracy of QuantiFERON-TB Gold Test for Tuberculosis Diagnosis in Children.

Michela Sali,Giovanni Fadda,Pamela D’Alfonso,Antonella Zumbo,Danilo Buonsenso,Delia Goletti,Piero Valentini,Maurizio Sanguinetti,Giovanni Delogu,Lei Gao

doi:10.1371/journal.pone.0138952

Abstract

ObjectivesTo evaluate the accuracy of the QuantiFERON-TB Gold assay (QFT-IT) in children with suspected active or latent TB infection (LTBI).MethodsA retrospective study was conducted on 621 children (0–14 years old) evaluated for TB infection or disease. Following clinical assessment, children were tested with the QFT-IT assay.ResultsAmong the 140 active TB suspects, we identified 19 cases of active disease. The overall sensitivity for active TB was 87.5%, ranging from 62.5% in children 25–36 months old to 100% in children older than 49 months. The overall specificity for active TB was 93.6%. Among the 481 children tested for LTBI screening, 38 scored positive and all but 2 had at least one risk factor for TB infection. Among the 26 children with indeterminate results, bacterial, viral or fungal pneumonia were later diagnosed in 11 (42.3%) cases and non-TB related extra-pulmonary infections in 12 (46.1%).ConclusionsOur results indicate that the children's response to QFT-IT associates to active TB and risk factors for LTBI. Moreover, we show that mitogen response is also found in children of 1 year of age, providing support for QFT-IT use also in young children.

Highlights

Children bear a substantial part of the tuberculosis (TB) epidemic at a global level
Among the 481 children tested for latent TB infection (LTBI) screening, 38 scored positive and all but 2 had at least one risk factor for TB infection
Our results indicate that the children's response to QuantiFERON-TB GoldIn-Tube (QFT-IT) associates to active TB and risk factors for LTBI

Summary

Introduction

Children bear a substantial part of the tuberculosis (TB) epidemic at a global level. The main risk factor for infection is exposure to adults with pulmonary TB, which, in children under the age of 2, is very likely to progress to active disease within the first year of primary infection [3]. Young children are more likely to develop the most severe forms of disseminated and meningeal TB, characterized by high mortality rate [4]. For these reasons, children under the age of 5 with no signs of TB disease but who have close contact with a contagious adult TB patient should receive isoniazid preventive therapy (IPT), which is known to drastically reduce the risk of developing active TB [4]. IPT should only be administered to truly infected children, but the lack of effective diagnostic tools prevents this approach

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Conclusion