Petrucci Roberta, Lombardi Giulia, Corsini Ilaria, Bacchi Reggiani Maria Letizia, Visciotti Francesca, Bernardi Filippo, Landini Maria Paola, Cazzato Salvatore, Dal Monte Paola
From the *Department of Medical and Surgical Sciences, Unit of Pediatrics, S. Orsola-Malpighi University Hospital, Bologna, Italy; †Department of Medical and Surgical Sciences, Unit of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy; ‡Unit of Pediatric Emergency, S. Orsola-Malpighi University Hospital, Bologna, Italy; and §Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Pediatr Infect Dis J. 2017 Jan;36(1):44-49. doi: 10.1097/INF.0000000000001350.
The diagnostic accuracy of Quantiferon-TB Gold In-Tube (QFT-IT) is uncertain in the pediatric population, while tuberculin skin test (TST) is still conventionally used despite its limitations. The aim of this study was to compare the performance of QFT-IT with TST in a large cohort of children screened for tuberculosis (TB) infection because of contact tracing, suspected TB, arrival from endemic country or immunosuppressive therapy.
A retrospective analysis was conducted on 517 children 0-14 years of age evaluated at the pediatric unit of the S. Orsola-Malpighi University Hospital of Bologna, Italy; 366 of them were also tested with TST. Results were analyzed for Calmette-Guérin bacillus vaccination, country of origin, reason for testing, diagnosis and age.
The overall agreement between the 2 tests was 89.9%, but it was highly affected by Calmette-Guérin bacillus vaccination (P < .0001). According to diagnosis and age, QFT-IT detected latent tuberculous infection cases better than TST in all age groups. Sensitivity for diagnosing active TB in symptomatic children was higher for QFT-IT than TST (93.3% vs. 86.5%), especially in children younger than 2 years, while specificity was high for both tests (99.3% and 98.8%, respectively). Low rate of indeterminate QFT-IT results (3.9%) was not differently distributed among age groups, but was associated with diagnosis of TB exclusion (P < 0.0001), mainly pneumonia (35%), and to Italian children (P = 0.0024).
Despite the concern about the use of QFT-IT in children because of their immature immune system, our results suggest the preferential use of QFT-IT as a support tool for diagnosis and management of TB, even in infants.
管内定量结核菌素金标试验（QFT-IT）在儿科人群中的诊断准确性尚不确定，而结核菌素皮肤试验（TST）尽管存在局限性，但仍被常规使用。本研究的目的是比较QFT-IT与TST在一大群因接触者追踪、疑似结核病、来自流行国家或免疫抑制治疗而接受结核病（TB）感染筛查的儿童中的表现。
对意大利博洛尼亚圣奥索拉-马尔皮基大学医院儿科病房评估的517名0至14岁儿童进行回顾性分析；其中366名儿童也接受了TST检测。对卡介苗接种情况、原籍国、检测原因、诊断和年龄的结果进行了分析。
两种检测方法的总体一致性为89.9%，但受卡介苗接种的影响很大（P <.0001）。根据诊断和年龄，QFT-IT在所有年龄组中检测潜伏性结核感染病例的能力均优于TST。QFT-IT在有症状儿童中诊断活动性结核病的敏感性高于TST（93.3%对86.5%），尤其是在2岁以下儿童中，而两种检测方法的特异性都很高（分别为99.3%和98.8%）。QFT-IT不确定结果的发生率较低（3.9%），在各年龄组中的分布没有差异，但与结核病排除诊断相关（P < 0.0001），主要是肺炎（35%），并且与意大利儿童相关（P = 0.0024）。
尽管由于儿童免疫系统不成熟而对QFT-IT在儿童中的使用存在担忧，但我们的结果表明，即使在婴儿中，QFT-IT也可优先用作结核病诊断和管理的辅助工具。
