Tuberculin skin test – Outdated or still useful for Latent TB infection screening?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
Hlavní autoři: Gualano, Gina, Mencarini, Paola, Lauria, Francesco Nicola, Palmieri, Fabrizio, Mfinanga, Sayoki, Mwaba, Peter, Chakaya, Jeremiah, Zumla, Alimuddin, Ippolito, Giuseppe
Médium: Journal Article
Jazyk:angličtina
Vydáno: 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 •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.
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.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.
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.
Author Lauria, Francesco Nicola
Palmieri, Fabrizio
Ippolito, Giuseppe
Gualano, Gina
Mfinanga, Sayoki
Mwaba, Peter
Chakaya, Jeremiah
Mencarini, Paola
Zumla, Alimuddin
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  surname: Mencarini
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  givenname: Francesco Nicola
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  organization: National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
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  givenname: Fabrizio
  surname: Palmieri
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  givenname: Sayoki
  surname: Mfinanga
  fullname: Mfinanga, Sayoki
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  organization: National Institute for Medical Research Muhimbili, Dar es Salaam, Tanzania
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  givenname: Peter
  surname: Mwaba
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  organization: UNZA-UCLMS Project, and Lusaka Apex University Medical School, Lusaka, Zambia
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  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
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  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
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30738186$$D View this record in MEDLINE/PubMed
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Keywords Latent TB
Tuberculosis
TST
Quantiferon
Tuberculin skin test
Interferon-γ release assays
LTBI
TB
IGRA
Language English
License This is an open access article under the CC BY-NC-ND license.
Copyright © 2019. Published by Elsevier Ltd.
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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?
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https://dx.doi.org/10.1016/j.ijid.2019.01.048
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