Kim Young, Kim Byeong Ki, Choi Hong Jo, Ryu Sung Weon, Kim Eui Sook, Chang Yoon Soo, Kim Hee Jin, Cha Jae Hyung, Kim Je Hyeong, Shin Chol, Lee Seung Heon
Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Yonsei University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2017 Nov 16;12(11):e0188076. doi: 10.1371/journal.pone.0188076. eCollection 2017.
We investigated the aftereffects of confirmatory QuantiFERON testing (QFT) added to a positive tuberculin skin test (TST). We reviewed the pre and post course of sequential tuberculosis (TB) outbreaks in a high school where massive 43 active TB cases had been found within one year before delayed contact investigation. And we investigated the TB development in relation to initial TST and QFT during mean follow-up of 3.9 ± 0.9 years. After delayed contact investigation for two subsequent TB outbreaks, 925 contacts were divided into the following 3 groups: TST- (n = 632), TST+/QFT+ (n = 24), TST+/QFT- (n = 258). QFT- was more prevalent than QFT+ in contacts with 10mm ≤ TST <15mm (158, 61.2%) compared with TST ≥15mm (100, 38.8%) among the TST+ reactors (P < 0.001). Among the 258 TST+/QFT- subjects, 256 received no latent TB infection (LTBI) treatment, but 7 contacts developed TB during follow-up. Among these 7 patients, 4 had initial TST ≥15mm and 3 had 10mm ≤ TST <15mm. In conclusion, the delayed contact investigation for LTBI in a high school resulted in continued TB developments. False-negative QFT performed late among the TST+ reactors should not be considered criteria for LTBI treatment. Additionally, the contacts only with TST ≥15mm should be considered for LTBI treatment in congregate settings of intermediate-burden countries.
我们研究了在结核菌素皮肤试验（TST）呈阳性的基础上增加确诊性全血干扰素检测（QFT）的后续影响。我们回顾了一所高中连续发生的结核病（TB）疫情的前后过程，该校在延迟接触者调查前一年内发现了43例活动性TB病例。我们还研究了在平均3.9±0.9年的随访期间，TB发病情况与初始TST和QFT的关系。在对随后两起TB疫情进行延迟接触者调查后，925名接触者被分为以下3组：TST阴性（n = 632）、TST阳性/QFT阳性（n = 24）、TST阳性/QFT阴性（n = 258）。在TST阳性反应者中，与TST≥15mm（100例，38.8%）相比，TST为10mm≤TST＜15mm的接触者中QFT阴性更为普遍（158例，61.2%）（P＜0.001）。在258名TST阳性/QFT阴性受试者中，256人未接受潜伏性结核感染（LTBI）治疗，但7名接触者在随访期间发生了TB。在这7例患者中，4例初始TST≥15mm，3例TST为10mm≤TST＜15mm。总之，一所高中对LTBI进行的延迟接触者调查导致TB持续发生。TST阳性反应者中晚期出现的QFT假阴性不应被视为LTBI治疗的标准。此外，在中等负担国家的聚集场所，仅TST≥15mm的接触者应考虑进行LTBI治疗。
