From the Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d´Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.
Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.
Pediatr Infect Dis J. 2018 Dec;37(12):1235-1241. doi: 10.1097/INF.0000000000002015.
Available data to assess the optimal diagnostic approach in infants and preschool children at risk of tuberculosis (TB) are limited.
We conducted a prospective observational study in children younger than 5 years undergoing assessment with both tuberculin skin tests (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) assays at 2 tertiary TB units in Barcelona, Spain.
A total of 383 children were included. One of 304 participants considered uninfected developed active TB during follow-up {median [interquartile range (IQR)]: 47 [30; 48] months}, compared with none of 40 participants with latent TB infection [follow-up since completion of anti-TB treatment: 42 (32; 45) months]. Overall test agreement between TST and QFT-GIT was moderate (κ = 0.551), but very good in children screened after TB contact (κ = 0.801) and in Bacillus Calmette-Guérin (BCG)-unvaccinated children (κ = 0.816). Discordant results (16.8%, all TST+/QFT-GIT-) were mainly observed in new-entrant screening and in BCG-vaccinated children. Children with indeterminate QFT-GIT results were on average younger than those with determinate results (median age: 12 vs. 30 months; P < 0.001). The sensitivity of TSTs and QFT-GIT assays in children with confirmed active TB was 100% (95% confidence interval: 79.4%-100%) and 93.7% (95% confidence interval: 69.8%-99.8%), respectively. In patients with latent TB infection or active TB, there was no correlation between age and antigen-stimulated interferon-γ responses (r = -0.044; P = 0.714).
In young BCG-unvaccinated children with recent TB contact, a dual testing strategy using TST and QFT-GIT in parallel may not be necessary. However, TST+/QFT-GIT- discordance is common, and it remains uncertain if this constellation indicates TB infection or not. In active TB, QFT-GIT assays do not perform better than TSTs.
评估有结核病（TB）风险的婴儿和学龄前儿童最佳诊断方法的现有数据有限。
我们在西班牙巴塞罗那的 2 个三级结核病单位对进行结核菌素皮肤试验（TST）和 QuantiFERON-TB Gold In-Tube（QFT-GIT）检测的 5 岁以下儿童进行了一项前瞻性观察性研究。
共纳入 383 名儿童。在考虑未感染者中，304 名参与者中有 1 名在随访期间发生活动性结核病（中位[四分位距（IQR）]：47[30；48]个月），而潜伏性结核感染者中无一例发生活动性结核病[随访自抗结核治疗完成后开始：42（32；45）个月]。TST 和 QFT-GIT 之间的总检测一致性为中度（κ=0.551），但在 TB 接触后筛查的儿童（κ=0.801）和未接种卡介苗（BCG）的儿童（κ=0.816）中非常好。不一致的结果（16.8%，均为 TST+/QFT-GIT-）主要见于新入学筛查和接种 BCG 的儿童中。QFT-GIT 结果不确定的儿童的平均年龄小于结果确定的儿童（中位年龄：12 与 30 个月；P<0.001）。确诊活动性结核病患儿 TST 和 QFT-GIT 检测的敏感性分别为 100%（95%置信区间：79.4%-100%）和 93.7%（95%置信区间：69.8%-99.8%）。在潜伏性结核感染或活动性结核患者中，年龄与抗原刺激的干扰素-γ反应之间无相关性（r=-0.044；P=0.714）。
在最近接触过 TB 的未接种 BCG 的年轻儿童中，平行使用 TST 和 QFT-GIT 的双重检测策略可能并非必要。然而，TST+/QFT-GIT-不一致很常见，但尚不确定这种组合是否表示存在 TB 感染。在活动性结核病中，QFT-GIT 检测的性能并不优于 TST。
