Children's Hospital Zagreb, University Hospital Sestre milosrdnice, Zagreb, Croatia.
Pediatr Infect Dis J. 2011 Oct;30(10):866-70. doi: 10.1097/INF.0b013e318220c52a.
There are limited data available on interferon-γ release assay (IGRA) performance in children up to 5 years of age, with documented exposure to active tuberculosis (TB). The aim of this study was to evaluate (1) the influence of infectivity of adult source cases on test results, (2) the impact of age, and (3) the level of agreement, between IGRA and tuberculin skin test (TST) results.
A total of 142 Bacille Calmette-Guerin-vaccinated children up to 5 years of age were investigated because of a history of exposure to active TB. QuantiFERON-TB Gold In-Tube IGRA (QFT) and TST assays were performed.
Test results were significantly influenced by positive finding of cavitary lesions (QFT, odds ratio [OR] = 6.15; TST, OR = 7.48) and positive acid-fast bacilli (QFT, OR = 4.01; TST, OR = 4.47) in active TB contacts. QFT resulted in 1 indeterminate response (0.7%), attributable to low mitogen. There was no evidence for age having any effect on QFT performance. The 2 tests showed a moderate overall concordance (89%; κ = 0.591) at a TST cutoff value of ≥ 10 mm.
Association of positive QFT and TST results with risk factors for infection in child contacts (presence of cavitary lesions and acid-fast bacilli smear positivity in index cases) suggests that both the tests have good diagnostic accuracy. However, there was significant discord between results of the 2 tests that could not be definitively resolved. Thus, in a high-risk population of children up to 5 years of age, both tests (QFT and TST) should be performed and the child should be considered infected if either or both tests are positive.
对于有结核病（TB）接触史、5 岁以下的儿童，干扰素-γ 释放试验（IGRA）的性能数据有限。本研究的目的是评估：（1）成人源病例的传染性对检测结果的影响；（2）年龄的影响；（3）IGRA 与结核菌素皮肤试验（TST）结果之间的一致性。
共有 142 名卡介苗接种儿童因有活动性 TB 接触史而接受调查。进行了 QuantiFERON-TB Gold In-Tube IGRA（QFT）和 TST 检测。
检测结果受到活动性 TB 接触者中存在空洞性病变（QFT，优势比[OR] = 6.15；TST，OR = 7.48）和抗酸杆菌阳性（QFT，OR = 4.01；TST，OR = 4.47）的显著影响。QFT 有 1 例（0.7%）结果不确定，归因于低刺激物。QFT 性能未发现年龄有任何影响。两种检测方法在 TST 截断值≥10mm 时总体一致性较好（89%；κ = 0.591）。
与儿童接触者感染风险因素相关的 QFT 和 TST 阳性结果（指数病例中存在空洞性病变和抗酸杆菌涂片阳性）表明两种检测方法均具有良好的诊断准确性。然而，两种检测方法之间存在显著的不一致，无法明确解决。因此，在 5 岁以下高风险儿童人群中，应同时进行两种检测（QFT 和 TST），如果两种检测均阳性，则应认为儿童已感染。
