Tuberculin skin test – Outdated or still useful for Latent TB infection screening?
•Tuberculin skin test (TST) is over a century old but it continues to be used widely.•When IGRAs were introduced it was anticipated that they would rapidly replace TST.•Neither TST nor IGRAs have a high accuracy for predicting active TB.•Latest WHO recommendations are that either TST or IGRA can be...
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| Vydáno v: | International journal of infectious diseases Ročník 80; s. S20 - S22 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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Canada
Elsevier Ltd
01.03.2019
Elsevier |
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| ISSN: | 1201-9712, 1878-3511, 1878-3511 |
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| Abstract | •Tuberculin skin test (TST) is over a century old but it continues to be used widely.•When IGRAs were introduced it was anticipated that they would rapidly replace TST.•Neither TST nor IGRAs have a high accuracy for predicting active TB.•Latest WHO recommendations are that either TST or IGRA can be used to test for LTBI.•TST will be clinically useful until more accurate tests become available.
To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB Infection (LTBI) in different geographical settings.
We reviewed the current literature on TST compared to IGRA, including national implementation of WHO LTBI recommendations and retrospective data over the past 7 years at the National Institute for Infectious Diseases “L. Spallanzani” as indirect indicator of usage of both tests under actual programmatic conditions.
Current national guidelines vary considerably, reflecting the uncertainty and rapidly evolving evidence about the potential use of these tests. Data from Institute “L. Spallanzani” showed IGRA concordance in TST positive subjects only in 54.74% of subjects, while there was strong concordance between two tests in TST negative subjects (93.78%).
Neither IGRAs nor TST can distinguish active TB from LTBI. TST will continue to be clinically useful in low and high TB endemic areas until more accurate and predictive tests will become available. Clinical judgment remains fundamental in choosing between IGRA/TST tests and interpreting their results. |
|---|---|
| AbstractList | Objective: To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB Infection (LTBI) in different geographical settings. Methods: We reviewed the current literature on TST compared to IGRA, including national implementation of WHO LTBI recommendations and retrospective data over the past 7 years at the National Institute for Infectious Diseases “L. Spallanzani” as indirect indicator of usage of both tests under actual programmatic conditions. Results: Current national guidelines vary considerably, reflecting the uncertainty and rapidly evolving evidence about the potential use of these tests. Data from Institute “L. Spallanzani” showed IGRA concordance in TST positive subjects only in 54.74% of subjects, while there was strong concordance between two tests in TST negative subjects (93.78%). Conclusion: Neither IGRAs nor TST can distinguish active TB from LTBI. TST will continue to be clinically useful in low and high TB endemic areas until more accurate and predictive tests will become available. Clinical judgment remains fundamental in choosing between IGRA/TST tests and interpreting their results. Keywords: Tuberculin skin test, TST, Interferon-γ release assays, IGRA, Tuberculosis, Quantiferon, TB, Latent TB, LTBI To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB Infection (LTBI) in different geographical settings. We reviewed the current literature on TST compared to IGRA, including national implementation of WHO LTBI recommendations and retrospective data over the past 7 years at the National Institute for Infectious Diseases "L. Spallanzani" as indirect indicator of usage of both tests under actual programmatic conditions. Current national guidelines vary considerably, reflecting the uncertainty and rapidly evolving evidence about the potential use of these tests. Data from Institute "L. Spallanzani" showed IGRA concordance in TST positive subjects only in 54.74% of subjects, while there was strong concordance between two tests in TST negative subjects (93.78%). Neither IGRAs nor TST can distinguish active TB from LTBI. TST will continue to be clinically useful in low and high TB endemic areas until more accurate and predictive tests will become available. Clinical judgment remains fundamental in choosing between IGRA/TST tests and interpreting their results. •Tuberculin skin test (TST) is over a century old but it continues to be used widely.•When IGRAs were introduced it was anticipated that they would rapidly replace TST.•Neither TST nor IGRAs have a high accuracy for predicting active TB.•Latest WHO recommendations are that either TST or IGRA can be used to test for LTBI.•TST will be clinically useful until more accurate tests become available. To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB Infection (LTBI) in different geographical settings. We reviewed the current literature on TST compared to IGRA, including national implementation of WHO LTBI recommendations and retrospective data over the past 7 years at the National Institute for Infectious Diseases “L. Spallanzani” as indirect indicator of usage of both tests under actual programmatic conditions. Current national guidelines vary considerably, reflecting the uncertainty and rapidly evolving evidence about the potential use of these tests. Data from Institute “L. Spallanzani” showed IGRA concordance in TST positive subjects only in 54.74% of subjects, while there was strong concordance between two tests in TST negative subjects (93.78%). Neither IGRAs nor TST can distinguish active TB from LTBI. TST will continue to be clinically useful in low and high TB endemic areas until more accurate and predictive tests will become available. Clinical judgment remains fundamental in choosing between IGRA/TST tests and interpreting their results. To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB Infection (LTBI) in different geographical settings.OBJECTIVETo make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB Infection (LTBI) in different geographical settings.We reviewed the current literature on TST compared to IGRA, including national implementation of WHO LTBI recommendations and retrospective data over the past 7 years at the National Institute for Infectious Diseases "L. Spallanzani" as indirect indicator of usage of both tests under actual programmatic conditions.METHODSWe reviewed the current literature on TST compared to IGRA, including national implementation of WHO LTBI recommendations and retrospective data over the past 7 years at the National Institute for Infectious Diseases "L. Spallanzani" as indirect indicator of usage of both tests under actual programmatic conditions.Current national guidelines vary considerably, reflecting the uncertainty and rapidly evolving evidence about the potential use of these tests. Data from Institute "L. Spallanzani" showed IGRA concordance in TST positive subjects only in 54.74% of subjects, while there was strong concordance between two tests in TST negative subjects (93.78%).RESULTSCurrent national guidelines vary considerably, reflecting the uncertainty and rapidly evolving evidence about the potential use of these tests. Data from Institute "L. Spallanzani" showed IGRA concordance in TST positive subjects only in 54.74% of subjects, while there was strong concordance between two tests in TST negative subjects (93.78%).Neither IGRAs nor TST can distinguish active TB from LTBI. TST will continue to be clinically useful in low and high TB endemic areas until more accurate and predictive tests will become available. Clinical judgment remains fundamental in choosing between IGRA/TST tests and interpreting their results.CONCLUSIONNeither IGRAs nor TST can distinguish active TB from LTBI. TST will continue to be clinically useful in low and high TB endemic areas until more accurate and predictive tests will become available. Clinical judgment remains fundamental in choosing between IGRA/TST tests and interpreting their results. |
| Author | Lauria, Francesco Nicola Palmieri, Fabrizio Ippolito, Giuseppe Gualano, Gina Mfinanga, Sayoki Mwaba, Peter Chakaya, Jeremiah Mencarini, Paola Zumla, Alimuddin |
| Author_xml | – sequence: 1 givenname: Gina orcidid: 0000-0001-6149-0005 surname: Gualano fullname: Gualano, Gina email: gina.gualano@inmi.it organization: National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy – sequence: 2 givenname: Paola surname: Mencarini fullname: Mencarini, Paola email: paola.mencarini@inmi.it organization: National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy – sequence: 3 givenname: Francesco Nicola surname: Lauria fullname: Lauria, Francesco Nicola email: francesco.lauria@inmi.it organization: National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy – sequence: 4 givenname: Fabrizio surname: Palmieri fullname: Palmieri, Fabrizio email: fabrizio.palmieri@inmi.it organization: National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy – sequence: 5 givenname: Sayoki surname: Mfinanga fullname: Mfinanga, Sayoki email: gsmfinanga@yahoo.com organization: National Institute for Medical Research Muhimbili, Dar es Salaam, Tanzania – sequence: 6 givenname: Peter surname: Mwaba fullname: Mwaba, Peter email: pbmwaba2000@gmail.com organization: UNZA-UCLMS Project, and Lusaka Apex University Medical School, Lusaka, Zambia – sequence: 7 givenname: Jeremiah surname: Chakaya fullname: Chakaya, Jeremiah email: chakaya.jm@gmail.com organization: International Union Against TB and Lung Diseases, Paris, France – sequence: 8 givenname: Alimuddin surname: Zumla fullname: Zumla, Alimuddin email: a.i.zumla@ucl.ac.uk organization: Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, & NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK – sequence: 9 givenname: Giuseppe orcidid: 0000-0002-1076-2979 surname: Ippolito fullname: Ippolito, Giuseppe email: giuseppe.ippolito@inmi.it organization: National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy |
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| Cites_doi | 10.1001/jama.2012.7511 10.1183/09031936.00114810 10.1111/j.1469-0691.2011.03555.x 10.7326/0003-4819-149-3-200808050-00241 10.1177/003335491613100214 10.1016/S1473-3099(11)70210-9 10.4046/trd.2017.0072 10.1016/S1473-3099(18)30355-4 |
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| Keywords | Latent TB Tuberculosis TST Quantiferon Tuberculin skin test Interferon-γ release assays LTBI TB IGRA |
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| Snippet | •Tuberculin skin test (TST) is over a century old but it continues to be used widely.•When IGRAs were introduced it was anticipated that they would rapidly... To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of Latent TB... Objective: To make an informed viewpoint on the usefulness of Tuberculin Skin test (TST) compared to Interferon Gamma Release Assays (IGRAs) for diagnosis of... |
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| SubjectTerms | IGRA Interferon-γ release assays Latent TB LTBI Quantiferon TST Tuberculin skin test Tuberculosis |
| Title | Tuberculin skin test – Outdated or still useful for Latent TB infection screening? |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S120197121930061X https://dx.doi.org/10.1016/j.ijid.2019.01.048 https://www.ncbi.nlm.nih.gov/pubmed/30738186 https://www.proquest.com/docview/2186618250 https://doaj.org/article/9ae99226fca74a4fa326ec130e4c44b9 |
| Volume | 80 |
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