Recombinant Tuberculosis Allergen Research Articles

ТЕХНОЛОГИЧЕСКИЙ ЗАМЫСЕЛ ГАММА-ИНТЕРФЕРЕНОВЫХ ТЕСТОВ IN VITRO ПО ВЫЯВЛЕНИЮ ЭФФЕКТОРНЫХ T-КЛЕТОК, РЕАГИРУЮЩИХ НА СТИМУЛЯЦИЮ АНТИГЕНОМ MYCOBACTERIUM TUBERCULOSIS, У ДЕТЕЙ

Objective: To define the test place of T-Spot.TB gamma-interferon release in the algorithm of diagnosing and diagnostics of different onsets of tuberculosis infection among children and adloscents. Methods : T-Spot.TB test results among children under 17 years old were examined as an alternative screening method (n=4096), in VI dispensary observation group (n=645) and among patients suffering tuberculosis (n=15). Results : T-Spot.TB effectiveness as a screening test was 2.8 %. Matching this test’s results and the skin test with tuberculosis recombinant allergen (TRA) in a year of observation demonstrated negative result in 90.7 % of cases in the event of uncertain or weakly positive TRA reaction. Conclusions: Child population tuberculosis screening under 7 years old should be held using Mantoux reaction, but from 8 to 17 years old – using TRA test. Gamma-interferon T-Spot. TB test can be held on a contract basis as an alternative child screening method if the legal representative refused to make recommended skin tests. Immunosuppression of various origins, allergies and obesity can be considered as medical indicators to prescribe this test for children and adolescents.

Значимость эпидемиологических факторов риска развития туберкулеза у детей и подростков в современных условиях

Objective : To estimate epidemiological factors of the tuberculosis progression among children and teenagers under current conditions. Methods: Epidemiological indicators on tuberculosis in Moscow region for the period from 2014 to 2019 have been analyzed according to the forms of Federal Statistic Survey. Results: There is a decrease of tuberculosis disease rate in Moscow region among children and teenagers. The increase of preventive examination coverage by 1.6 times when tuberculosis was identified allowed to take timely preventive measures and to reduce the morbidity among children and adults living in the outbreaks of the infection by 11.8 times. The enhance of the effectiveness of preventive measures is due to the introduction of the sample of tuberculosis recombinant allergen. It increased the commitment of the parents to the preventive treatment of the children and teenagers up to 92.9 %. Conclusions: Early and timely detection of tuberculosis and working in the outbreaks of tuberculosis infection preserve relevance under the conditions of tuberculosis disease. High risks of tuberculosis progression among children and adults defined contacts with a person discharging bacteria, also multiple drug resistance of the mycobacteria and the availability of the outbreak formed by patients having co-infection HIV+tuberculosis.

Efficiency of screening for tuberculosis infection in children and adolescents in Moscow in 2019 based on the new procedure for using the intradermal test with tuberculosis recombinant allergen (ESAT-6/CFP-10)

The objective of the study : to compare two approaches to mass screening for tuberculosis infection in children and adolescents in Moscow. Subjects and methods . Two periods have been assessed. Period 1 (2014), when a pilot screening project was implemented in two stages: Stage 1 -all children and adolescents had Mantoux test with 2 TU PPD-L (1,429,395 people were tested), Stage 2 - a skin test with TRA (tuberculosis recombinant allergen - ESAT protein-6/CFP-10) was used in those with increasing induration as a response to Mantoux test (219,888 people were tested). Period 2 (2019): children from 0 to 7 years old (711,869 children were tested) were screened by the same two-stage scheme, and those 8-17 years old (904,757 people were tested) had the test with TRA only. Results . It has been demonstrated that the test with TRA can be used as a screening tool and effectively identify patients with a high risk of tuberculosis development. At the same time, the rate of detection of tuberculosis patients, persons with post-tuberculosis changes and latent infection is tens times higher among persons with positive reactions to TRA test versus Mantoux test. The preventive therapy received by those positively responding to TRA test resulted in almost no disease in them. Over the past 7 years, the number of people newly diagnosed with tuberculosis, latent tuberculosis infection (LTBI) and post-tuberculosis changes has decreased. Preventive therapy in those with a positive result of TRA test helps to stop the progression of tuberculosis infection and reduce the pool of LTBI among children and adolescents. TRA test versus Mantoux test, allows more effective selection patients with a high risk of developing tuberculosis, thus it is possible to carry out additional examination only of this target group and save resources.

Сложности диагностики туберкулезного остеомиелита ребер у ребенка младшего школьного возраста

Diagnosis of tuberculosis in children is challenging because of variable clinical symptoms and no specific signs. We report a case of tuberculous osteomyelitis of the ribs, which demonstrates difficulties associated with the diagnosis of generalized tuberculosis in an 8-year-old child (correct diagnosis was established after 1.3 years). Diagnostic procedures included: Mantoux test, skin test with recombinant tuberculosis allergen, computed tomography, pathomorphological and bacterioscopic testing. The patient presented with disease progression and lesions to the lung tissue, pleura, and ribs and did not respond to antibacterial therapy, hormones, and cytostatics. This required repeated diagnosis revision. The diagnosis of tuberculosis of the right 4th and 5th ribs was confirmed after surgery using bacterioscopic and immunohistochemical examinations. The child received comprehensive treatment in a specialized tuberculosis hospital and had positive dynamics. Despite the correct routing, low suspicion for tuberculosis in primary and secondary healthcare institutions has led to an insufficient use of currently available diagnostic methods and late diagnosis of tuberculosis in a child residing in a megapolis. Key words: generalized tuberculosis, children, tuberculosis of the rib, immunodiagnostics, diagnosis of tuberculosis, immunohistochemistry

ИННОВАЦИОННЫЕ РЕКОМБИНАНТНЫЕ ТЕХНОЛОГИИ ВЫЯВЛЕНИЯ И ДИАГНОСТИКИ ТУБЕРКУЛЕЗА У ДЕТЕЙ И ПОДРОСТКОВ: ДОСТИЖЕНИЯ И ПРОБЛЕМЫ

Objective of the research: to assess the effect of recombinant tuberculosis allergen (RTA) in tuberculosis infection (TI) screening in children and adolescents on the epidemiological indicators of tuberculosis (TB) and to study the economic efficiency of using RTA in a large industrial region. Materials and methods: according to medical records, two periods were analyzed, 2011–2015 and 2016–2019, before and after the RTA screening introduction, respectively. Results: it was found that using RTA test in practice for the differential diagnosis of infectious and post-vaccination allergies led to an improvement in the epidemic situation among the child population and a significant economic effect – the savings during the year amounted to 12 385 407,84 rubles. RTA allows to reveal latent TI and develop scientific approaches to studying predictors of the clinically expressed TB, which is extremely important in modern conditions.

Changes in the lungs of a child with Gaucher disease: differential diagnosis with disseminated tuberculosis

The article describes a clinical case of a rare combination of hereditary pathology – Gaucher disease and latent tuberculosis infection in an 8-y ea r-o ld child. The child was examined for tuberculosis due to disseminated small foci and calcination in the lung tissue detected by chest computed tomography. The particular parameter of latent tuberculosis infection of this case was the positive results of IGRA tests ( T- S POT TB and Quanti FERON ) with a negative response to the intradermal test with recombinant tuberculosis allergen. According to the examination results, the disseminated tuberculosis was not confirmed, diffuse lung damage was regarded as a manifestation of Gaucher disease, which was a rare sign of this pathology according to the published data.

Immunological skin tests in differential diagnostics disseminated processes in the lungs

Diseases that manifest as Х-ray syndrome of pulmonary dissemination are one of the most complex differential diagnostic problems in pulmonology and Phthisiology. Literature data on the effectiveness of using a new intradermal test with tuberculosis recombinant allergen (ATR, Diaskintest®) for disseminated processes in the lungs are single and contradictory.The aim. Тo study the diagnostic capabilities of intradermal test with tuberculosis recombinant allergen in disseminated lung processes of various etiologies.Methods. The analysis of archival materials of 204 patients with disseminated lung processes of various etiologies who were admitted to diagnostic departments of the N.S.Pokhvisneva Voronezh regional anti-tuberculosis dispensary in 2011 – 2019 was carried out. There were 85 (41.67%) women and 119 (58.33%) men aged 19 to 87 years. The data of im mu no - logical examination of patients using intradermal Mantoux samples with 2 TE PPD-L and with ATR were studied, and their comparative analysis was performed.Results. In disseminated pulmonary processes in tuberculosis, the proportion of individuals who respond positively to the Mantoux test was greater only in comparison with the group of people with sarcoidosis (p < 0.01) and did not significantly differ from the results in other groups of patients (p > 0.05). At the same time, the proportion of people who respond positively to a test with ATR in tuberculosis was greater than in patients with pneumonia, sarcoidosis (p < 0.01) and, to some extent, with a tumor. In healthy individuals, a lower proportion of positive reactions to ATR was established compared to the Mantoux test (p < 0.01). With active disseminated pulmonary tuberculosis, a hyperergic reaction (11.9%) was observed in the sample with ATR, which was not observed with the Mantoux test. In non-specific processes in the lungs, less often than negative reactions (p < 0.05) were detected on the sample with ATR less often than on the Mantoux test with 2 TE.Conclusion. The ATR sample compared to the Mantoux test indicates that it is appropriate to use it in the differential diagnosis of tuberculosis and non-specific lung diseases in adult patients with radiological dissemination syndrome.

Immunodiagnostics of tuberculosis infection <i>in vitro</i> in solving the issue of prescribing preventive chemotherapy

For the immunodiagnosis of tuberculosis infection, in addition to standard skin tests (Mantoux test with 2 TU PPD-L and Diaskintest), in vitro tests are currently used, one of which is the T-spot.TB test. Purpose of research . Evaluate the T-SPOT test as a method of early detection of tuberculosis infection in children and adolescents and its role as an additional method in solving the problem of the need for chemoprophylaxis. Materials and methods. The analysis of the results of T-SPOT.TB in 794 children aged 2 to 17 years inclusive in the period from 2016 to 2019 was carried out. Two groups were allocated: 1 group (n = 596) — children who underwent T-SPOT.TB as the main methodology; Group 2 — 198 children with positive skin test results for a recombinant tuberculosis allergen after screening. The results of T-SPOT.TB were evaluated taking into account the data of previous immunodiagnostics and associated pathology. Results. It is established that T-SPOT.TB. can be used as an independent method in case of rejection of skin tests. The level of latent tuberculosis infection is higher among children with concomitant pathology according to the results of T-SPOT.TB twice. Conclusion. T-SPOT.TB can be an alternative method for diagnosing tuberculosis infection during screening. In children with concomitant pathology of the T-SPOT.TB can serve as the leading method of tuberculosis immunodiagnosis. A positive T-SPOT.TB can serve as an additional method for deciding on the appointment of preventive chemotherapy.

Recombinant tuberculosis allergen (Diaskintest®) in tuberculosis diagnostic in Russia (meta-analysis).

Immunological testing for tuberculosis has been one of the most rapidly developing areas in the last decade. A new-generation immunological skin test, Diaskintest (DST), has been developed in the Russian Federation and successfully implemented into clinical practice since 2009. This article presents the results of a meta-analysis of publications reporting data on the use of the recombinant tuberculosis allergen DST (n = 121) from 2009 to 2019 included in Russian and international databases. The analysis included a total of 61 papers consistent with the study design, which cumulatively presented the results of 3,777,083 patients tested with DST (83.0%). The obtained data showed that the overall diagnostic sensitivity of the test in this population, regardless of age, was 86.0%, with 98.0% negative results. It was found that the intensity of the immune response of tuberculosis patients to specific ESAT-6 and CFP-10 antigens of DST may depend on the biological properties of the pathogen characteristic to various Mycobacterium tuberculosis genotypes, tuberculosis severity, and the presence of concomitant diseases. These factors are more prevalent in the adult population. In children, however, the test sensitivity reaches 100%. The proportion of positive DST results in HIV-positive patients tested for tuberculosis was 60.0%. The analysis showed that the accuracy (overall validity) of DST was 95.1% in the total studied population (95% confidence interval [CI]: 95.06-95.1) and 92.4% in HIV-positive patients (95% CI: 91.9-92.7).

Screening for tuberculosis infection in children and adolescents in Russia – past, present, future

The article presents a brief overview of the establishment and development of screening system in the pediatric population for tuberculosis and latent tuberculosis infection - from Koch alt-tuberculin to modern recombinant tuberculosis allergens for intradermal administration and in vitro laboratory tests. It gives extensive data on clinical research and the introduction into practical public health of the Russian Federation of the test with recombinant tuberculosis allergen as a screening method for tuberculosis in children from 8 to 14 years old inclusively.

Comparative performance of QuantiFERON-TB Gold versus skin test with tuberculosis recombinant allergen (Diaskintest) among patients with suspected pulmonary tuberculosis in Russia

BackgroundThe early identification of Mycobacterium tuberculosis infection can prevent tuberculosis (TB) transmission. A skin test with a tuberculosis recombinant allergen (Diaskintest) is a new method for identification that has been implemented in Russia. This study was performed to compare the performances of Diaskintest and QuantiFERON-TB Gold (QFT) in adults and children with suspected TB in Moscow, Russia. MethodsAdults (n=85) and children (n=96) were tested using Diaskintest and QFT. Concordance and comparative analyses were performed. ResultsDiaskintest and QFT were concordant in 84% of adults and 90% of children (overall concordance 87%, κ>0.6, Kc>0.5). The concordance between QFT, Diaskintest, and the final diagnosis was good in adults (86% and 81%, respectively) and moderate in children (77% and 79%, respectively). In adults, QFT had a higher sensitivity for detecting TB than Diaskintest (82% and 68%, respectively); in children, Diaskintest was more sensitive (73% and 65%, respectively). In patients with a confirmed TB diagnosis, negative Diaskintest/QFT results were associated with low disease activity. Combined Diaskintest/QFT results identified TB patients with higher sensitivity and specificity than each test separately. ConclusionsDiaskintest is a low-cost diagnostic tool that shows a test positivity rate similar to QFT and can be used in combination with QFT as an adjunctive test for TB diagnosis.

METHODS OF SCREENING FOR TB INFECTION IN CHILDREN AND THEIR ROLE IN THE FORMATION OF RISK GROUPS AND DIAGNOSIS OF THE DISEASE

In the review there are presented possibilities of the application of skin immunological tests -Mantoux test (MT) 2TE, as a specific diagnostic test - intradermal Mantoux tuberculin test with two tuberculin units; PPD-L - injectable form of purified tuberculin in standard dilution. L-tuberculin by Linnikova (MT with 2 TE PPD-L = MT) and samples with recombinant tuberculosis allergen (RTA) for the formation of high-risk groups and diagnosis of TB infection in children. Screening investigations with the use of MT have a high sensitivity (95-98%), which is an advantage of MT as the evidence base. The insufficient sensitivity of the Diaskintest® skin test (DST) preparation has been established by independent researchers (78-85% of cases of active TB are missed). The special attention was shown to have to assess the cost effectiveness of screening tests with RTA. 98% of negative results in the screening with RTA were revealed to be very expensive unreasonably. These patients failed to come in sight of health professionals, although among them there may be cases with different stages of latent TB infections requiring medical supervision by phthisiatrician. To solve the issue concerning mass application of RTA test its safety profile should be studied.

FORMATION OF RISK GROUPS FOR TUBERCULOSIS DISEASE IN VARIOUS IMMUNOLOGICAL METHODS OF THE EXAMINATION OF CHILDREN POPULATION

When performing mass tuberculin diagnostics in Moscow with coverage of more than 97% of children, the authors evaluated the effectiveness of the formation of risk groups for tuberculosis in children and adolescents with the use of immunological methods such as Mantoux test with 2 TE PPD-L and a test with an tuberculosis recombinant allergen (TRA). There was formed a risk group of cases with altered tuberculin sensitivity (group VI) in which all children underwent a skin test with ATP (Diaskintest preparation) at a dose of 0.2 μg in 0.1 ml. and in the presence of a positive reaction to this test, computed tomography was performed. The low specificity of tuberculin diagnostics in conditions of mass vaccination of children with BCG was found to lead to the fact that the frequency of positive reactions to the Mantoux test is determined primarily by postvaccinal allergy. Accumulation of cases of primary infection, hyperergia and increased reaction is less than 1% per year, and the frequency of positive reactions in the population is above 75%. It was also revealed that only 8.7-11.2% of children and adolescents with a positive reaction to the Mantoux test are examined in an anti-TB dispensary and less than 1% - are to be accounted by phthisiatricians at the risk group. In risk groups selected by the Mantoux sample, in cases with a high threshold of positive response to this test (17 mm and more), the frequency of positive responses to the TRA test is 53.3% in children and 81.4% in adolescents. With age, the proportion of primary infection among all tuberculin-positive Mantoux tests declines from 0.67% in children to 0.06% in adolescents, and the age-related positive responses for the RTA test in risk groups increase from 16.3 to 52.6% respectively. The implementation of the preventive therapy only for children with a high risk of the development of the disease (with a positive RTA test) increases the effectiveness of this therapy and excludes its unreasonable realization.

ПРОЯВЛЕНИЯ ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ У ДЕТЕЙ ПРИ ПОЛОЖИТЕЛЬНОЙ ПРОБЕ С АЛЛЕРГЕНОМ ТУБЕРКУЛЕЗНЫМ РЕКОМБИНАНТНЫМ

The objective : to study manifestations of tuberculous infection in children with a positive result of the test with TRA and determine the tactics for their follow-up. Subjects and methods . In 217 children with a positive result of the test with tuberculosis recombinant allergen (TRA) followed up in a TB dispensary, the results of clinical and radiological (multispiral computed tomography MSCT) examinations were studied and the response to the test with TRA during monitoring (within 3 years) was evaluated to justify terms of dispensary follow-up. Results . It was found that the test with TRA and MSCT allows diagnosing both latent tuberculous infection and detecting minimal post-tuberculous changes (calcifications). Monitoring was performed in 2 groups: Group 1 (n = 112) included patients with newly detected calcifications in the lungs and chest lymph nodes, Group 2 (n = 105) consisted of patients without detected changes in the lungs and chest lymph nodes. The frequency of hyperergic reactions to the test with TRA recorded in patients of both groups was the same (46.7 ± 4.4 and 48.2 ± 4.7%). Results of the test with TRA in children without radiological changes stabilized two years, and in case of calcifications - in three years of follow-up, which allowed predicting the terms of follow-up for such children as belonging to tuberculosis risk group.

ВОЗМОЖНОСТИ ИММУНОЛОГИЧЕСКИХ ТЕСТОВ В ДИАГНОСТИКЕ ЛАТЕНТНОЙ ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ И ТУБЕРКУЛЕЗА

The article assesses existing immunological tests aimed to detect tuberculosis infection (tuberculin skin test, IGRA, skin test with a recombinant tuberculosis allergen). The latest inventions in the development of immunological tests that can differentiate latent tuberculosis infection and active tuberculosis have been analyzed. The difficulties encountered when developing such a test and conducting clinical trials have been demonstrated. The article presents the experience of the Moscow TB service in using the skin test with recombinant tuberculosis allergen as a screening method for tuberculosis infection, its ability to detect the infection at the stage of its development when preventive therapy is most effective since anti-tuberculosis drugs kill mycobacteria that are replicating but not dormant. Such tactics contributed to the incidence rate decrease both in high-risk groups and among the general population.

СКРИНИНГ ДЕТЕЙ И ПОДРОСТКОВ НА ТУБЕРКУЛЕЗНУЮ ИНФЕКЦИЮ В РОССИИ – ПРОШЛОЕ, НАСТОЯЩЕЕ, БУДУЩЕЕ

The article presents a brief overview of the establishment and development of screening system in the pediatric population for tuberculosis and latent tuberculosis infection - from Koch alt-tuberculin to modern recombinant tuberculosis allergens for intradermal administration and in vitro laboratory tests. It gives extensive data on clinical research and the introduction into practical public health of the Russian Federation of the test with recombinant tuberculosis allergen as a screening method for tuberculosis in children from 8 to 14 years old inclusively.

ИММУНОДИАГНОСТИКА ТУБЕРКУЛЕЗА: ДЕСЯТИЛЕТНИЙ ОПЫТ ПРИМЕНЕНИЯ ИММУНОЛОГИЧЕСКИХ ТЕСТОВ В РОССИИ

The introduction of a new generation of immunological tests based on in vitro or in vivo reactions using specific ЕSAT-6 and CFP-10 peptides allowed changing the understanding of the diagnosis of latent tuberculosis infection, as well as improving the diagnosis of tuberculosis in pediatric and adult practice. The article presents the analysis of the Russian studies conducted over the past ten years aimed to investigate the informativeness of a skin test with tuberculosis recombinant allergen. High diagnostic significance of the skin test, comparable to the internationally recognized IGRA-tests has been proved. Today, the test with TRA in the form of locally manufactured Diaskintest has been introduced inRussianot only to the practice of TB units, but also in the practice of pediatricians, pulmonologists and infectious disease specialists.

The use of recombinant tuberculosis allergen in the diagnosis tuberculosis in children

The use of recombinant tuberculosis allergen in the diagnosis tuberculosis in children

The skin test with tuberculous recombinant allergen AT successful treated patients with lung tuberculosis

38 patients with newly diagnosed tuberculosis, immediately after the end of the main course of treatment, when they were transferred to the third group of dispensary supervision (6-9 months) and when they were removed from the dispensary supervision (2-3 years later), a skin test with an allergen tuberculous recombinant was made. The positive skin test with tuberculosis recombinant allergen was defined at 20 patients - 13 mm. At the moment of removing to the III group only one skin test with tuberculosis allergen recombinant became negative, 19 (94,5%) patients had positive reactions - 13±2,3 mm. At the time of discharging from dispensary the positive reactions were determined at 16 (80%) cases - 10±2,3 mm, p0,05. In this group, 13 (65%) patients had normergic skin tests with tuberculosis allergen recombinant and 7 (35%) - hyperergic tests. At the time of removing to the III group at five from seven patients with hyperergic tests the results remained the same, median and at the moment of discharging from tuberculosis service only one patient had the hyperergic skin test with tuberculosis allergen recombinant - 18mm. Among patients with normergic skin tests with tuberculosis allergen recombinant at the time of group III removing median was 11±2,1 mm. At the last dynamic control the normergic results were determined at 15 (75%) patients and the tests median remained almost unchanged - 10±1,8 mm, the differences are reliable compared to the initial data (p0,05). In group which included 18 patients with negative skin tests with tuberculous allergen recombinant, the skin response stayed negative throughout all examination period except for one patient so patients of this group had not only clinical, radiological and bacteriological, but immunological signs of involution of the tuberculosis process. The study of the influence of clinical, epidemic and social factors to skin reaction showed that first group patients were significantly more likely to be unemployed (30% versus 5,5%; p0,05) whereas in second group married patients were reliably registered (61,1% versus 25%; p0,05). Other factors differed unreliably.

A comparison of intradermal test with recombinant tuberculosis allergen (diaskintest) with other immunologic tests in the diagnosis of tuberculosis infection

The WHO strategy for eradication of tuberculosis (TB) by 2035 (The End TB Strategy) is aimed at an early and precise diagnosis and subsequent effective treatment of TB patients. Currently, there is no gold standard for the diagnosis of latent TB infection. This study evaluated the diagnostic capabilities of a new intradermal test using recombinant TB allergen (Diaskintest) compared with tuberculin skin test (TST) and commercial TB interferon-gamma release assays (IGRAs). A post-hoc data analysis that involved examining 860 HIV-negative, bacillus Calmette-Guérin (BCG)-vaccinated persons aged 1-65 years who visited the TB health-care institutions of Saint Petersburg to rule out or confirm an active TB was conducted from 2011 to 2016. A high degree of consistency of the Diaskintest results with the enzyme-linked immunospot and QuantiFERON-TB Gold In-Tube test (ELISPOT and QFT) results was observed in the examined pediatric population (n = 696), with a Diaskintest cutoff ≥5 mm: the kappa consistency indices were 1.000 and 0.937, for ELISPOT and QFT, respectively. A high sensitivity of Diaskintest, comparable with the IGRA tests, was observed in patients with a confirmed TB diagnosis in all age groups. The sensitivity of Diaskintest in patients of the TB/MTB + group aged 18 years and older was 88.7%; of ELISPOT, 90.6%; of QFT, 87.0%. The conducted analysis has shown a high concordance of results of the commercial TB tests in adult HIV-negative patients (n = 164) with a Diaskintest cutoff ≥5 mm: the kappa indices were 0.805 and 0.636 (Diaskintest vs. ELISPOT and QFT, respectively) among BCG-vaccinated people. According to the WHO recommendations, replacing the TST by IGRAs is not recommended as a public health intervention in resource-constrained settings because the IGRA tests are more costly and technically complex to conduct than the TST. Diaskintest has comparable complexity to the TST and its performance is close to that of IGRA in a BCG-vaccinated population. Thus, our study demonstrates that replacing the TST by Diaskintest can be recommended as a public health intervention in resource-constrained and universal BCG vaccination settings.