Positive QuantiFERON-TB Gold Research Articles

Quantiferon-TB Gold Test in Diagnosis of Tubercular Uveitis

Background: Tuberculosis can occur in eye as a result of an active infection or immunological reaction to the tuberculosis antigen. One of the most accurate tests for suspected ocular tuberculosis is the Quantiferon TB Gold (QFT-G) test, which has a higher specificity than the Tuberculin Skin Test (TST) especially among persons vaccinated with bacillus Calmette-Guérin (BCG) and the fact that most environmental mycobacteria give TST positive results. Methods: We retrospectively reviewed thirty nine presumed ocular tuberculosis cases who had both TST and QFT-G test prior to anti-tuberculosis treatment (ATT) in the National Institute of Ophthalmology and Hospital and Vision Eye Hospital, Dhaka from January, 2019 to December, 2021. Patients who had concomitant pulmonary or other extra pulmonary tuberculosis were excluded from the study. Results: The most common anatomical type of uveitis was posterior uveitis 24(61.5%) and vasculitis retinae 8(20.5%) was the commonest form of specific pattern of uveitis. MT test was positive in 18(46.2%) and QFT-G test was positive in 17 (43.6%) patients. Multifocal choroiditis was commonest form of QFT-G positive uveitis 5(29.5%). There was no significant association of positive QFT-G test with any subset of uveitis (p>0.05). Conclusion: As our study found no significant association of positive QFT-G in patients with any anatomical variety of uveitis or specific variety of uveitis we should advice QFT-G judicially to patients of suspected TBU who have positive TST.

Patient navigator’s role in latent tuberculosis infection at a New York City Health Department Chest Clinic

BackgroundPhilippines is one of the top ten countries of birth among individuals with tuberculosis in New York City (NYC). The NYC Health Department (HD) screened Filipino-born New Yorkers for latent TB infection (LTBI), but few of those tested positive completed evaluation and treatment. ObjectiveTo increase the proportion of Filipinos with a positive QuantiFeron-TB Gold Plus (QFT-Plus) complete LTBI evaluation and treatment. MethodsNine community-based LTBI screening events were conducted during September-December 2021. Patients with positive QFT-Plus results were offered no-cost LTBI evaluation and treatment at HD Chest Clinic. The HD engaged culturally- and linguistically-competent Filipino patient navigators (PN) to facilitate LTBI evaluation and treatment. ResultsOf 77 Filipinos screened, 17 (22%) tested positive. Fourteen (82%) were evaluated for LTBI; eight of the 14 (57%) completed LTBI treatment. ConclusionsPairing patients with culturally- and linguistically- competent Filipino PNs contributed to an increase in the proportion of Filipinos with a positive QFT-Plus who completed LTBI evaluation and treatment. TB prevention programs may wish to consider PNs in LTBI patient care.

A-170 Investigation of High Rate of Low Positive Quantiferon-TB Gold Plus Results

Abstract Background Tuberculosis (TB) is a communicable disease, transmitted almost exclusively by cough aerosols carrying pathogens of the M. tuberculosis complex. TB continues to be a major public health threat, causing an estimated 10.4 million new cases and 1.3 million deaths from TB globally in 2016. Many more people may have latent tuberculosis infection (LTBI), which may go undetected without further laboratory investigation. The Quantiferon-TB Gold Plus (QFT-Plus) is an Interferon Gamma Release Assay (IGRA) for the identification of LTBI. It detects the cellular immune response to antigens of M. tuberculosis and represents an indirect marker of M. tuberculosis exposure. In January of 2021, the NorthShore University HealthSystem Core Laboratory transitioned from a reference laboratory ELISA-based QFT-Plus test to an in-house DiaSorin LIAISON® QuantiFERON®-TB Gold Plus test. After implementation, we noticed a higher rate of low positive QFT-Plus results (1.3%–5.4%) in our patient population that we regard as a mixed risk population. The expected percent of low positive results in a mixed risk population is 2%–3%. Objective To determine the potential causes of a higher rate of low positive Quantiferon-TB Gold Plus Results. Methods Forty specimens with Antigen-Nil results between 0.35–1.00 IU/mL using LIAISON® QuantiFERON®-TB Gold Plus reagent from 8/2022–10/2022 were collected for this study. All forty specimens were re-tested using ELISA-based methodology. Patient demographics and medical history were reviewed for any factor that may be responsible for the low positive results. Results Results from the two different methodologies were compared: 28/40 (70%) specimens showed positive results on the DiaSorin LIAISON®-XL platform, but negative results on the ELISA platform. Review of medical history showed that 92% of the sample population had received more than 2 doses of COVID-19 vaccine and 12.5 % had previous COVID-19 infection. 30% had an underlying autoimmune disease, with psoriasis and rheumatoid arthritis being the most common. However, no correlation was found between medical or vaccination history and the QFT-Plus results. Conclusion LIAISON® QuantiFERON®-TB Gold Plus is a Chemiluminescence immunoassay which is more sensitive than ELISA, resulting in an increased number of low positive QFT-Plus results. Physicians need to correlate clinical findings and TB exposure history to the QFT-Plus results when making clinical decisions.

Concurrent syphilis, gonorrhea, and monkeypox: A case report.

Documented cases of monkeypox virus outside of Africa are rare, but as of August 22, 2022, the CDC was tracking 18,101 cases in the United States. Monkeypox rash can easily mimic other sexually transmitted infections, which may occur concurrently. This case report describes a 36-year old Caucasian man who has sex with men. The patient came in for a routine history and physical examination and disclosed a perianal rash. The patient had a medical history significant for undertreated HIV, ankylosing spondylitis, and homelessness. On examination, he had multiple perianal deep-seated ulcers that were swabbed for monkeypox and herpes simplex virus 1 and 2. Samples were also collected for syphilis, chlamydia, and gonorrhea. The swabs were positive for monkeypox and pharyngeal gonorrhea. At subsequent blood draw, he was found to have elevated titers for syphilis and a positive QuantiFERON-TB gold test. In summary, this case is a clear example of an individual with concurrent monkeypox virus and other sexually and nonsexually transmitted infections, highlighting the importance of careful identification of risk factors and testing for monkeypox virus even when the clinical presentation may depict a common sexually transmitted infection, such as the herpes simplex virus.

Diffuse anterior scleritis following micropulse transscleral laser

We report a case of scleritis following micropulse transscleral laser therapy (TLT) in an elderly female with medically uncontrolled primary open-angle glaucoma. She had completed antitubercular treatment (ATT) for pulmonary tuberculosis 20 years ago. Along with scleritis, there were vitritis and macular edema post laser. Systemic blood investigations for connective tissue disorders were negative. She had latent tuberculous infection with positive Mantoux test and quantiferon TB gold. She responded favorably to topical steroids with no vision loss. Though TLT, with its pulsed laser delivery, is considered safe, caution must be exercised in patients susceptible to inflammation.

Influence of Vitamin D Supplementation on Growth, Body Composition, and Pubertal Development Among School-aged Children in an Area With a High Prevalence of Vitamin D Deficiency

Vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] <20 ng/mL) is prevalent among children living in temperate climates and has been reported to associate independently with stunting, obesity, and early activation of the hypothalamic-pituitary-gonadal axis. Phase 3 randomized clinical trials to investigate the influence of long-term vitamin D replacement on growth, body composition, and pubertal development of school-aged children with vitamin D deficiency are lacking. To determine whether weekly oral vitamin D supplementation influences linear growth, body composition, or pubertal development in school-aged children living in a setting where vitamin D deficiency is highly prevalent. This secondary analysis of a double-blind, placebo-controlled randomized clinical trial was conducted from June 2016 to June 2019 at 18 grade schools in Ulaanbaatar, Mongolia. School-aged children (6 to 13 years at baseline) attending participating schools were included. Exclusion criteria included a positive QuantiFERON-TB Gold in-tube assay result, conditions or medications associated with altered vitamin D metabolism, use of vitamin D supplements, signs of rickets, or intention to move from Ulaanbaatar within 4 years. Of 11 475 children invited to participate in the study, 9814 underwent QFT testing, and 8851 with negative results were included in the study. All but 1 participant in the placebo group completed follow-up and were included in the present analysis. Data were analyzed from November 2021 to February 2022. Weekly oral doses of vitamin D3, 14 000 IU, (n = 4418), or placebo (n = 4433) for 3 years. Mean z scores for height for age, body mass index for age, and waist-to-height ratio; mean percentage body fat, fat mass, and fat-free mass; and mean Tanner scores for pubertal development. Of 8851 participants, 4366 (49.3%) were female, and 8165 (92.2%) were of Khalkh ethnicity; the mean (SD) age was 9.4 (1.6) years. A total of 8453 participants (95.5%) were vitamin D deficient at baseline, and mean end-of-study 25(OH)D concentrations among participants randomized to vitamin D vs placebo were 31.0 vs 10.7 ng/mL (mean difference, 20.3; 95% CI; 19.9-20.6). However, vitamin D supplementation did not influence mean height for age, body mass index for age, waist-to-height ratio, percentage body fat, fat mass, fat-free mass, or Tanner scores, either overall or within subgroups defined by baseline 25(OH)D concentration less than 10 ng/mL vs 10 ng/mL or greater, estimated calcium intake less than 500 mg/d vs 500 mg/d or greater, or male vs female sex. In school-aged children in this study with low baseline vitamin D status, oral vitamin D3 supplementation at a dose of 14 000 IU per week for 3 years was effective in elevating 25(OH)D concentrations but did not influence growth, body composition, or pubertal development. ClinicalTrials.gov Identifier: NCT02276755.

ISOLATED RETINAL VASCULITIS: Prognostic Factors and Expanding the Role of Immunosuppressive Treatment in Retinal Vasculitis Associated With Positive QuantiFERON-TB Gold Test.

To identify prognostic factors for poor visual outcomes in patients with isolated retinal vasculitis and to elucidate the outcome of immunosuppressive treatment without the use of antituberculosis drugs for patients with retinal vasculitis associated with a positive QuantiFERON-TB Gold In-Tube (QFT) test. A retrospective chart review was performed of patients presenting with retinal vasculitis. After the diagnosis of active retinal vasculitis had been confirmed by fluorescein angiography and other possible causes of retinal vasculitis had been excluded, patients were categorized into two groups by their QFT result. Potential associated factors between the poor and good visual outcome groups were statistically analyzed by the chi-square test and logistic regression model with generalized estimating equations. Seventy-three eyes (48 patients) were enrolled in this study. After univariate analysis, multivariate logistic regression analysis was performed and revealed that logMAR visual acuity at the initial visit ( P = 0.01) and outer retinal disruption ( P = 0.03) were the two factors significantly associated with poor visual outcomes. Systemic corticosteroids were administered without the use of antituberculosis drugs to all 16 cases of presumed tuberculous retinal vasculitis associated with positive QFT (26 eyes), 10 (63%) of whom were given nonsteroidal immunosuppressive drugs and achieved inflammatory control and treatment success. Risk factors leading to poor visual outcome in patients with isolated retinal vasculitis have been identified. Immunosuppressive treatment without antituberculosis drugs seems to be a promising regimen for selected patients with presumed tuberculous retinal vasculitis under vigilant care.

Presumed tuberculosis-related scleritis

AimsTo evaluate the clinical characteristics and therapeutic outcome of patients with recurrent scleritis of unknown demonstrable aetiology and positive QuantiFERON-TB Gold In-Tube test (QFT).MethodsRetrospective chart review of the demographic, clinical,...

Prevalence of hepatitis B surface antigen and hepatitis B core antibody among adults with latent tuberculosis infection.

To evaluate the prevalence of hepatitis B surface antigen (HBsAg) positive or hepatitis B core antibody total (anti-HBc) among adults with latent tuberculosis infection (LTBI) in the USA. Using data from the National Health and Nutrition Examination Survey 1999-2000 and 2011-2012 cycles, US adults with LTBI (identified by positive tuberculin skin test or positive QuantiFERON-TB Gold In-Tube test) were evaluated to determine prevalence HBsAg and anti-HBc. Survey-weighted data was used to determine prevalence estimates of HBsAg or anti-HBc, which were further stratified by sex, race/ethnicity, country of birth and age. Trends were analyzed by regressing the outcome over time. Between-group comparisons used chi-squared testing. Overall prevalence of LTBI was 4.2% [95% confidence interval (CI), 3.5-5.1]. Among individuals with LTBI, HBsAg prevalence was 0.9% (95% CI, 0.4-2.1) and anti-HBc prevalence was 12.9% (95% CI, 9.8-16.8), both of which remained stable between 1999-2000 and 2011-2012. While no significant differences in HBsAg prevalence were observed by sex, race/ethnicity, country of birth, age, anti-HBc prevalence was significantly higher in men vs. women (16.8 vs. 7.9%, P < 0.05), blacks vs. non-Hispanic whites (22.9 vs. 5.9%, P < 0.05), non-US born vs. US-born (15.9 vs. 7.2%, P = 0.01) and highest in the oldest age group (age ≥65 years: 17.5%, 95% CI, 10.5-27.8). Among US adults with LTBI, overall prevalence of HBsAg was 0.9%. One in eight individuals with LTBI had prior HBV exposure. Effective HBV screening among individuals with LTBI may allow changes in clinical practice to prevent drug-induced liver injury from anti-TB therapies.

The Association between QuantiFERON-TB Gold Test and Clinical Manifestations of Uveitis in the United States

To report the prevalence of QuantiFERON-TB Gold (QFT-G) positivity among uveitis patients compared to general population and to evaluate the differences in clinical features of uveitis. Retrospective cohort study. SETTING: Institutional. 418 consecutive new uveitis patients, regardless of clinical suspicion, were tested for QFT-G. Demographics, TB risk factors, clinical characteristics of uveitis were collected. The frequency of QFT-G positivity among uveitis patients and characteristic clinical features among QFT-G positive patients. QFT-G positivity was found in 60/418 patients with uveitis (14.4%, 95% CI: 11.18 - 18.14) higher than the general US population (5%, 95% CI: 4.2 - 5.8, p<.001). Age, gender and residence were similar between QFT-G positive and negative groups. Uveitis patients with positive QFT-G were more likely to be foreign born or have a recent travel history (OR:5.84; 95% CI: 2.83 - 12.05; p<.001). QFT-G positive patients were more likely to present with granulomatous uveitis (OR 2.90; 95%CI 1.36 - 6.21; p=.006). No significant association was found with specific clinical features such as choroiditis, retinal vasculitis, occlusive vasculitis, and serpiginoid choroiditis (p>.05 for each). Prevalence of TB-uveitis based on treatment response was 1.19%. Our study demonstrates significantly higher prevalence of QFT-G positivity among uveitis patients compared to average US population. Characteristic signs of TB uveitis reported in endemic countries were not seen in this cohort. Implications of higher prevalence of QFT-G positivity among uveitis patients require further investigation.

Association between latent tuberculosis and ischemic heart disease: a hospital-based cross-sectional study from Saudi Arabia.

Introductionatherosclerosis could be a sequela of long-term activation of cell-mediated immunity as the case of latent tuberculosis infection. Atherosclerosis is the main pathological event in ischemic heart disease. The present study aimed to assess the prevalence of Latent tuberculosis infection (LTBI) among patients with ischemic heart disease (IHD) and to detect the association between both diseases.Methodsthis cross-sectional study included 98 patients with a history of previously diagnosed ischemic heart disease who did a multi-detector computed tomography coronary angiogram (MDCTCA). Detailed clinical examination and investigations as chest X-ray and sputum examination were done for those with positive QuantiFERON-TB Gold test (QFT) to exclude active tuberculosis (TB). Participants having positive QFT results but with no evidence of active TB were considered as LTBI positive.Resultsthe prevalence of LTBI in patients with IHD was 19.3% as only nineteen of the ninety-eight patients were diagnosed with latent tuberculosis infection using the QuantiFERON serum test. Eighty-four percent (84.2%) of patients with LTBI had coronary artery atherosclerosis (CAA) compared to only 55.6% in patients without LTBI with a statistically significant difference. In multivariable analysis, Diabetes Mellitus (DM) (AOR 0.179, 95% C.I.: 0.03-0.967), and LTBI (AOR 1.024, 95% C.I.: 1.002-1.736) were significantly associated with coronary artery atherosclerosis (p=0.0001, and p= 0.003 respectively).Conclusionthe prevalence of latent tuberculosis infection among patients with ischemic heart diseases is high. Among different factors that are already well known to precipitate ischemic heart disease, latent tuberculosis should be considered.

Diagnostic Approach and Successful Treatment of Ocular Tuberculosis

Introduction: The prevalence of ocular tuberculosis (TB) are 1% in patients with pulmonary TB and 20% in patients with extrapulmonary TB. The definitive diagnosis and its management are still challenging. This case highlights the diagnostic approach and successful management of ocular tuberculosis Purpose: To report the diagnostic approach and successful management of ocular tuberculosis.Case Presentation: A-15-Years-old-Girl, presented to outpatient clinic due to blurred vision on both eyes since 6 month ago. She was suffered from fever and solitaire mass along the neck lymph node 2 weeks before. The best corrected visual acuity (BCVA) of the right eye was 0.2 and the left eye 0.3. The ophthalmology examination of both eyes revealed mutton fat, 2+ flare, and 1+ cell, posterior synechia, koeppe and bussaca nodule, 4+ vitreous cells. Funduscopy were unremarkable due to vitritis. There was an elevation of erythrocyte sedimentation rate, positive mantoux test and Quantiferon-TB Gold. Chest radiograph showed fibrosis of the right lung. Fine needle aspiration biopsy of neck mass showed fibrotic tissue. Patient was diagnosed with tuberculous granulomatous panuveitis. She received anti-tuberculous therapy (ATT) along with high dose methylprednisolone 0.5 mg/BW/days on tapered dose. At 3 weeks follow up, vitritis was subsided and we revealed snowball, snowbanking, and optic disc swelling of both eyes that showed improvement at 11 weeks follow up. The BCVA become 1.0 at week-17 of therapy and remains stable until 8 months follow up. Conclusion: Diagnosis of ocular tuberculosis diagnose was made based on symptoms and signs of granulomatous panuveitis and supporting evidence of pulmonary TB ancillary tests. Significant clinical improvement was achieved after administration of ATT along with high dose oral steroid.

1649. Characterizing Factors Associated with Pediatric Latent Tuberculosis Infection in an Urban Health System to Improve Screening Practices

BackgroundThe epidemiology and risk factors informing current American Academy of Pediatrics (AAP) guidelines on screening for pediatric latent tuberculosis infection (LTBI) have evolved over the past decade. To improve pediatric LTBI screening efficiency, we sought to reevaluate characteristics associated with positive QuantiFERON-TB Gold Plus (QFT-Plus) at Denver Health (DH), an urban health system that includes a network of primary care clinics, a refugee clinic and a tuberculosis clinic.MethodsWe retrospectively analyzed all QFT-Plus tests performed on children aged 2-18 years from 1/2019 to 9/2019. To obtain additional variables we conducted chart review on all positive and indeterminate results, and a random 10% sample of negatives. Characteristics (age range, sex, region of birth, clinic setting, primary language) of patients with positive and negative QFT-Plus were compared using Chi2 or Fisher’s exact tests (Table 1). Using the 10% negative controls, we calculated odds ratios for each variable and included important or significant variables in a multivariable logistic regression model.ResultsOf 1063 QFT-Plus tests performed, 29 (2.7%) were positive. 76% of all positive tests and 83% of positive tests in primary care clinics occurred in patients age ≥10. 51.7% of all positive patients were born in the US. Among factors analyzed by logistic regression including birth region, reason for screening, sex, age, ordering location, insurance status, and language, only Spanish language (OR 5.0, CI 1.6-15.8) and non-English, non-Spanish language (OR 6.4, CI 1.4-28.5) were significant risk factors for positive testing.Characteristics of Denver Health Patients with Positive and Negative QFT-Plus, January-September 2019. ConclusionLanguage was the only predictor of LTBI in this study, and may be a proxy for high risk travel and family exposure. Region of birth was not predictive, as half of positive tests occurred in US-born children. The majority of positive tests occurred in older children, suggesting they should be prioritized in screening programs, though occasional detection among younger children reinforces the importance of LTBI detection in ages where risk of progression to active TB is higher. Further studies are needed to better elucidate the details behind positive testing, including more detailed characterization of travel and potential family exposures.Disclosures All Authors: No reported disclosures

MYCOBACTERIUM PORCINUM CAUSING A FALSE-POSITIVE QUANTIFERON TB-GOLD TEST

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Mycobacterium (M.) porcinum is a rapidly growing nontuberculous mycobacterium that is genetically related to M. Fortuitum. It has been detected in drinking water and fresh vegetables. In isolation, M. porcinum is considered to be commensal; however, true infections such as cellulitis, peritonitis, catheter-related infection and rarely pneumonitis have been reported secondary to M. Porcinum. We discuss the case of a 69 year old male who was infected with M. Porcinum and tested positive for Quantiferon TB-Gold (QFT). This case report brings to attention that despite the increased reliance on QFT for tuberculosis (TB) diagnosis, it is important to be mindful of its limitations and the possibility of an underlying non-tuberculous mycobacterium infection. CASE PRESENTATION: A 69-year-old male, with a history of COPD and long-term smoking presented with a persistent cough and shortness of breath for the past three months. He was treated for bronchitis without improvement. He denied any fever, chills, rigors or weight loss. CT scan of the chest showed a tree in bud appearance, raising concern for an atypical mycobacterial infection. Sputum for AFB stains were negative along with the Mycobacterium tuberculosis PCR assay. However, the QFT was positive. Further, after two weeks of incubation, AFB cultures were positive for M. Porcinum. The patient was subsequently started on rifampin, clarithromycin and amikacin with symptomatic improvement. DISCUSSION: The QFT gold is an ELISA measuring IFN-γ specific to M. tuberculosis peptides such as ESAT6, CFP-10, and TB7.7. These are present in M. tuberculosis but absent in BCG and other non-tuberculous mycobacterium. Unlike the tuberculin skin test, which measures a delayed hypersensitive reaction to the purified protein derivative present in M. tuberculosis and many atypical mycobacteria, the QFT gold test is an in vitro test that is more specific to M. tuberculosis. However, some tuberculous mycobacterium including M. Fortuitum and M. bovis also harbor ESAT 6, CFP 10, and TB7.7 and can produce falsely-positive QFT gold tests. As demonstrated in our patient, we consider M. porcinum to be a true pathogen. He had concomitant advanced COPD and showed evidence of a tree-in-bud appearance that is typically seen in an atypical Mycobacterium infection. After completing treatment with antibiotics, repeat sputum cultures have been negative. Infections from M. Porcinum have only been reported in a few case reports; however, false positive QFT tests secondary to M. porcinum have yet to be reported in literature. CONCLUSIONS: Although M. porcinum is usually considered commensal, it was regarded as a true pathogen in our patient, as evidenced by the tree in bud appearance on CT, positive M. Porcinum cultures, and a negative Mycobacterium tuberculosis PCR assay. Thus, we consider the QFT in our patient to be falsely-positive. Reference #1: Brown-Elliott BA, Wallace RJ, Tichindelean C, et al. Five-year outbreak of community- and hospital-acquired Mycobacterium porcinum related to public water supplies. J Clin Microbiol 2011;49:4231–8. DISCLOSURES: No relevant relationships by Joseph Leon, source=Web Response No relevant relationships by Mohan Rudrappa, source=Web Response No relevant relationships by Sanket Shah, source=Web Response No relevant relationships by Kunal Shah, source=Web Response

Genital tuberculosis screening at an academic fertility center in the United States

Infertility is a common presentation of female genital tuberculosis in endemic areas. Female genital tuberculosis-related maternal and neonatal complications have increased in recent years after assisted reproductive technology treatments. Despite rising emigration rates to the United States, guidelines to identify those with latent tuberculosis or female genital tuberculosis in fertility centers do not exist. This study aimed to characterize the prevalence of female genital tuberculosis in infertile patients at our academic fertility center. This is a prospective cohort study. All patients presenting for infertility evaluation between January 2014 and January 2017 were assessed for risk factors for latent tuberculosis. Patients at risk for latent tuberculosis underwent screening using QuantiFERON-TB Gold serum assay. QuantiFERON-TB Gold-positive patients underwent further testing for female genital tuberculosis consisting of endometrial biopsy with histopathologic examination by a clinical pathologist, polymerase chain reaction for tuberculosis, and culture for acid-fast Mycobacterium tuberculosis. Twenty-five of 323 infertility patients (7.7%) screened for latent tuberculosis had positive QuantiFERON-TB Gold results. A greater number of patients with a positive test result for QuantiFERON-TB Gold were foreign born than those with a negative test result for QuantiFERON-TB Gold (92% vs 29%; P<.001). Of note, the QuantiFERON-TB Gold-positive population had a higher incidence of both recurrent pregnancy loss (28% vs 7%; P=.003) and Asherman syndrome (8% vs 0.3%; P<.001). Among those with a positive test result for QuantiFERON-TB Gold, chest x-ray was abnormal in only 2 patients (8.0%). Endometrium evaluation revealed abnormalities in 2 patients (8.0%), in whom chest x-ray was normal, with 1 showing evidence of female genital tuberculosis. This was indicated by histology consistent with chronic granulomatous endometritis and positive endometrial testing for tuberculosis by polymerase chain reaction, acid-fast bacilli smear, and culture for Mycobacterium tuberculosis. Although the prevalence of female genital tuberculosis in infertile women in the United States seems to be low, this study indicates that it can be underdiagnosed without utilization of multiple diagnostic modalities including endometrial sampling. Given the potential for serious maternal and neonatal morbidity in affected patients utilizing assisted reproductive technology, we propose that all at-risk women seeking infertility care in the United States be screened for latent tuberculosis. In patients who screen positive, endometrial biopsy should be obtained for evaluation by histology, polymerase chain reaction, and culture for Mycobacterium tuberculosis to rule out female genital tuberculosis before infertility treatments are initiated.

SUN-166 Primary Adrenal Insufficiency Caused by Underlying Tuberculosis

IntroductionPrimary adrenal insufficiency (AI) is a rare endocrine disorder affecting 1 in 100,000 people. Primary AI is a gradual destruction of the adrenal cortex. Etiology includes autoimmune, tuberculosis, histoplasmosis, blastomycosis, adrenal metastases, primary adrenal tumors, and opportunistic infections of HIV. Since aggressive treatment of TB, the incidence of TB adrenalitis has significantly declined, now accounting for 20% of reported cases where as autoimmune causes of AI account for 70%. Most common symptoms are non-specific, and diagnosis is often delayed, with patient initially presenting with a life-threatening adrenal crisis.CasePatient is an incarcerated 65 y/o African American male with PMHx of hypothyroidism who was admitted to the hospital for AMS after being found unresponsive in his prison cell. On admission, patient was febrile, hypotensive and tachycardic. He looked disheveled, confused, and lethargic. Other exam findings were negative.Lab results revealed WBC 11.7/μL, serum sodium 116 mmol/L, serum potassium 5.2 mmol/L, serum glucose 68 mg/dL, serum osmolality 237mOsm/kg, TSH 26.3mIU/L, and random cortisol 1.6ug/dL. ACTH stimulation test revealed pre-challenge cortisol levels 5.1ug/dL, 30-minute 4.9ug/dL and 60-minute 4.5ug/dL. ACTH 1271 pg/mL (normal range 7.2-63.3pg/mL). A normal response is a stimulated cortisol level > 18ug/dl. Chest x-ray revealed left lower lobe pneumonia.Clinical signs/symptoms and labs were consistent with primary AI. Adrenal crisis was most likely precipitated by underlying pneumonia. Workup was negative for 21-Hydrolase Antibodies, HIV, CMV, and histoplasmosis. However, QuantiFERON-TB Gold Test was positive. Abdominal CT revealed bilateral enlarged non-enhancing adrenal nodules with coarse calcifications. Biopsy of right adrenal gland revealed necrotizing caseating granulomatous inflammation. Biopsy was negative for isolated aerobic, anerobic, fungal organisms, AFB, and mycobacterium PCR.Due to current findings and high suspicion of TB adrenalitis, patient is currently being treated as culture-negative tuberculosis along with PO hydrocortisone for underlying AI.DiscussionAdrenal tuberculosis is a rare cause of primary adrenal insufficiency in developed countries. There should be high suspicion for AI when a patient presents with hypotension, hyponatremia, hyperkalemia and/or hypoglycemia. In this case, although patient did not have a positive AFB culture, he did have a positive QuantiFERON-TB Gold Test along with consistent findings on CT and biopsy. Thus, case was concluded to have high suspicion of primary AI secondary to underlying untreated tuberculosis. Prompt treatment with antituberculosis medication, appropriate steroid therapy, along with monitoring of adrenal function, underlying adrenal insufficiency may be reversible if detected in early stages and decrease mortality.

Treatment of latent tuberculosis infection with short-course regimens in potential living kidney donors.

Treatment data for latent tuberculosis infection (LTBI) among potential living kidney donors are scarce. This retrospective study was performed to evaluate the prevalence of positive QuantiFERON-TB Gold In-Tube (QFT-GIT) among potential living kidney donors that were screened from 2009 to 2017. We investigated if there was any difference in the time to donation between QFT-GIT-positive and QFT-GIT-negative donors. We assessed the regimens used to treat LTBI and whether the recipients of QFT-GIT-positive donors developed active tuberculosis (TB). Forty out of 427 (9%) potential living kidney donors had a positive QFT-GIT. QFT-GIT-positive donors were as likely as negative donors to undergo donation (30 [75%] vs 315 [81%], P=.33). The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors (median 221days [range: 4-1139] vs 86days [range: 3-1887], P=.001). Twelve-week rifapentine (RPT)/Isoniazid (INH) was the most common treatment used and was not associated with significant adverse reactions. There was a trend toward longer time to donation among QFT-GIT-positive donors who were treated for LTBI compared with QFT-GIT-positive donors who were not (252days [range: 88-1139] vs 95days [range: 4-802], P=.05). Twenty-nine recipients of QFT-GIT-positive living kidney donors were evaluated. Eleven of these recipients received kidneys from donors that were not treated for LTBI. Two of these recipients were treated with INH post-transplantation. The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors. The short-course regimens appear to be excellent options for LTBI treatment among living kidney donors and avoid delaying organ donation further.

Performance and correlation of interferon gamma release assays and tuberculin skin test in HIV-infected children and adolescents with immune reconstitution

Objective: To evaluate the performance of interferon gamma release assays and tuberculin skin test in HIV-infected children and adolescents with immune reconstitution.Methods: A cross-sectional study was conducted in HIV-infected patients aged 5-18 years receiving antiretroviral treatment with CD4 T-lymphocytes >25% or >500 cells/mm3 for at least 6 months. QuantiFERON-TB Gold, T-SPOT.TB, and tuberculin skin test were performed in each patient.Results: A total of 50 patients were enrolled with median age of 13.7 years, CD4 counts of 753 (IQR: 587-989) cells/mm3. Among 27 patients with tuberculosis (16) or tuberculosis exposure (11), 8 (29.6%) were positive to at least one test, 2 (7.4%) were positive QuantiFERON-TB Gold, 3 (11.1%) positive T-SPOT.TB, and 7 (25.9%) had tuberculin skin test ≥5 mm. Among 23 patients without history of tuberculosis or exposure, all had negative interferon gamma release assays, while 2 (8.7%) had positive tuberculin skin test.Conclusions: All tests had low sensitivity despite immune reconstitution.

The use of GeneXpert Mycobacterium tuberculosis/rifampicin assay in diagnosis of pulmonary tuberculosis in children

Introduction Rapid diagno sis of tuberculosis (TB) is essential for early disease management. GeneXpert (GX) test is a novel rapid diagnostic modality. In this study, we aimed to evaluate the diagnostic role of GX test in diagnosing pulmonary tuberculosis (PTB) in children as well as detection of rifampicin (RIF) resistance. Patients and methods This was a cross-sectional study that included 80 patients suspected to have PTB based on clinical data together with at least one of the followings: a positive tuberculin skin test or QuantiFERON-TB Gold In-Tube test result, a positive blood TB PCR result, or a positive Ziehl–Neelsen staining result. Results PTB was more common in older females. Extrapulmonary manifestations and hilar lymphadenopathy were more frequent in younger age. Both positive tuberculin skin test and positive GX were more frequent in older age. Positive GX was found in 30 (37.5%) cases, and RIF resistance was detected in two (6.6%) of them. Positive GX results were more frequent in sputum than gastric aspirate samples. Positive GX results were more frequent with absent Bacillus Calmette–Guerin scar, and with hemoptysis, failure to thrive, cavitary lung lesions, and lower mean hemoglobin. Conclusion GX detects many more cases than blood PCR and Ziehl–Neelsen stain. GX had 70% sensitivity and 95% specificity in diagnosing PTB, with overall diagnostic accuracy of 86.67%, with better performance in older children who could expectorate. RIF resistance was ∼6.6%.

Prevalence of Positive QuantiFERON-TB Gold In-Tube Test in Uveitis and its Clinical Implications in a Country Nonendemic for Tuberculosis

To report on the prevalence and clinical implications of positive QuantiFERON-Gold (QFT-G) test results in the diagnostic evaluation of a large cohort of consecutive patients with uveitis in the Netherlands. Retrospective cross-sectional study. This study included 710 consecutive patients who all underwent evaluation for uveitis including QFT-G testing. The ocular features, comorbidity, and abnormalities in diagnostic imaging and laboratory tests were registered for QFT-G-positive patients with uveitis. Of all patients, 13% (92/710) were positive for QFT-G. Previously treated tuberculosis (TB) was documented in 2 patients. Of all 92 QFT-G-positive patients, culture-proven active TB was observed in 1 case. The proportion of patients with uveitis of unknown etiology was higher in QFT-G-positive than in the QFT-G-negative patients (54/92, 59% vs 238/618, 39%; P= .0004). The uveitis features of QFT-G-positive patients were mainly nonspecific. Of all QFT-G-positive patients with uveitis, 17 patients had chest imaging changes suggesting either TB or sarcoidosis. Twenty-nine QFT-G-positive patients with otherwise unexplained uveitis completed antituberculous therapy (29/710; 4% of all included patients) with beneficial effect in most cases. The QFT-G tested positive in 13% of patients with uveitis in the Netherlands, whereas only sporadic patients had a documented previous or active TB infection. The proportion of patients with unexplained uveitis was higher in QFT-G-positive patients. Though the association between uveitis and a positive QFT-G test might be coincidental, the majority of treated QFT-G-positive patients with otherwise unexplained severe uveitis cause had a beneficial response to antituberculous therapy.