From the Denver Metro Tuberculosis Clinic, Denver Public Health, Denver, CO.
Department of Pediatrics, Denver Health Medical Center, Denver, CO.
Pediatr Infect Dis J. 2020 Sep;39(9):803-807. doi: 10.1097/INF.0000000000002711.
Use of interferon-gamma releasing assays (IGRAs) in children <2 years old may derive many of the same advantages, which have led to preference over tuberculin skin test (TST) in older children, but data are limited. Since 2011, we have tested children <2 years old with Quantiferon-TB Gold/Gold Plus (QFT)) in select clinical scenarios at Denver Health, a health system encompassing a TB clinic, refugee and immigrant screening and primary care.
We identified patients <2 years old tested with QFT between February, 2011 and August, 2019. The primary outcome measure was incident cases of TB among tested patients. Test results and in vitro characteristics were analyzed, as were demographic, epidemiologic and clinical outcomes.
We analyzed 116 QFTs ordered in children age 7-23 months. Two were positive, 3 indeterminate, 3 failed/refused phlebotomy and the remainder (93%) were negative. Mitogen tube results were robust. Thirteen patients were TST-positive: 11 were QFT-negative, 1 QFT-positive and 1 failed phlebotomy. Eight patients received some form of TB medication, including 4 QFT-negative patients who were treated for active TB or latent TB infection based on positive TST or clinical findings. Among QFT-negative patients, including 6 TST-positive, not treated for active TB or latent TB infection, no TB disease has been identified over a median follow-up time of 2.96 years.
IGRA use was not limited by barriers of phlebotomy, indeterminate result or gamma-interferon production. The risk of missing an infected but IGRA-negative patient can be reduced by treatment of select patients at higher risk. Current recommendations against IGRA use in children <2 years old could be amended to allow careful introduction, particularly among well-appearing BCG-vaccinated patients.
在 <2 岁的儿童中使用干扰素 -γ 释放测定（IGRAs）可能会带来许多与在年龄较大的儿童中偏好结核菌素皮肤试验（TST）相同的优势，但数据有限。自 2011 年以来，我们在丹佛健康中心（一个包含结核病诊所、难民和移民筛查以及初级保健的医疗系统）的特定临床情况下对 <2 岁的儿童进行了 Quantiferon-TB Gold/Gold Plus（QFT）测试。
我们确定了 2011 年 2 月至 2019 年 8 月期间接受 QFT 检测的 <2 岁儿童患者。主要结局指标是接受检测的患者中结核病的发生率。分析了检测结果和体外特征，以及人口统计学、流行病学和临床结局。
我们分析了 116 例 7-23 个月龄儿童的 QFT 结果。2 例阳性，3 例不确定，3 例因采血失败/拒绝而未能进行，其余 93%为阴性。有丝分裂原管的结果很可靠。13 例 TST 阳性：11 例 QFT 阴性，1 例 QFT 阳性，1 例采血失败。8 例患者接受了某种形式的抗结核药物治疗，包括 4 例 QFT 阴性患者，根据 TST 或临床发现，他们因活动性结核病或潜伏性结核病感染而接受治疗。在 QFT 阴性患者中，包括 6 例 TST 阳性但未接受活动性结核病或潜伏性结核病感染治疗的患者，在中位随访时间 2.96 年期间未发现结核病。
IGRA 的使用不受采血、不确定结果或γ-干扰素产生的限制。通过治疗高危患者，可以降低错过感染但 IGRA 阴性患者的风险。目前不建议在 <2 岁的儿童中使用 IGRA 的建议可以修改，允许在卡介苗接种良好的患者中谨慎引入，特别是在这些患者中。
