Elliot Chris, Marais Ben, Williams Phoebe, Joshua Paul, Towle Sherri, Hart Graham, Zwi Karen
Department of Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2018 Aug;54(8):834-839. doi: 10.1111/jpc.13865. Epub 2018 Feb 14.
The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosis infection (LTBI) by comparing paired tuberculin skin test (TST) and Quantiferon Gold In-Tube (QGIT) test results with clinical management decisions and follow-up data in a large cohort of newly arrived refugee children.
This was a retrospective analysis of all refugee children (<15 years of age) evaluated for LTBI with both TST and interferon-γ release assay between 2007 and 2010 in the Illawarra-Shoalhaven region of New South Wales, Australia. Demographics, country of origin, bacille Calmette-Guerin (BCG) vaccination status, chest X-ray results, TST and QGIT test results, clinical management and outcome on long-term follow-up were assessed.
Of 272 children evaluated, complete results were available for 212 (78%). The vast majority (207; 98%) were from Africa or Southeast Asia. Overall, 33 (16%) children were treated for LTBI; 13 (39%) had concordant TST and QGIT results and 20 (61%) discordant results. Of 63 (30%) TST-positive (≥10 mm) children, 46 (73%) were QGIT assay-negative, 44 (70%) had a BCG scar, 3 (5%) were younger than 2 years and 6 (10%) were treated for LTBI. Of 32 QGIT assay-positive children, 15 (47%) were TST negative, 31 (97%) had a BCG scar, all were older than 2 years and 14 (44%) were treated for LTBI.
Discordant TST and QGIT results were found in a high percentage of refugee children. QGIT is convenient and more specific than TST to diagnose LTBI in BCG-vaccinated children, although a careful tuberculosis exposure history and clinical assessment to rule out active disease remain important.
本研究旨在通过比较一大群新抵达的难民儿童的配对结核菌素皮肤试验（TST）和全血γ-干扰素释放试验（QGIT）结果与临床管理决策及随访数据，协助临床医生评估难民儿童的潜伏性结核感染（LTBI）情况。
这是一项对2007年至2010年期间在澳大利亚新南威尔士州伊拉瓦拉-肖尔黑文地区接受TST和干扰素-γ释放试验评估LTBI的所有难民儿童（<15岁）进行的回顾性分析。评估了人口统计学特征、原籍国、卡介苗（BCG）接种状况、胸部X线检查结果、TST和QGIT试验结果、临床管理以及长期随访结果。
在评估的272名儿童中，212名（78%）有完整结果。绝大多数（207名；98%）来自非洲或东南亚。总体而言，33名（16%）儿童接受了LTBI治疗；13名（39%）TST和QGIT结果一致，20名（61%）结果不一致。在63名（30%）TST阳性（≥10毫米）儿童中，46名（73%）QGIT试验阴性，44名（70%）有BCG疤痕，3名（5%）年龄小于2岁，6名（10%）接受了LTBI治疗。在32名QGIT试验阳性儿童中，15名（47%）TST阴性，31名（97%）有BCG疤痕，所有儿童年龄均大于2岁，14名（44%）接受了LTBI治疗。
在很大比例的难民儿童中发现TST和QGIT结果不一致。QGIT在诊断接种BCG儿童的LTBI方面比TST更方便、更具特异性，尽管仔细询问结核暴露史和进行临床评估以排除活动性疾病仍然很重要。
