Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
Pediatrics and Infectious Disease Unit, Hospital Universitario La Paz, Madrid, Spain; Fundación IdiPaz, Madrid, Spain; Translational Research Network of Pediatric Infectious Diseases (RITIP), Madrid, Spain.
J Pediatr. 2021 Sep;236:211-218.e2. doi: 10.1016/j.jpeds.2021.05.008. Epub 2021 May 10.
To assess the performance of interferon-gamma release assays (IGRAs) in the differential diagnosis between Mycobacterium avium complex (MAC) and tuberculosis (TB) in children affected with subacute/chronic submandibular/cervical lymphadenitis.
Multicenter observational study comparing children with microbiologically confirmed MAC lymphadenitis from the European NontuberculouS MycoBacterial Lymphadenitis in childrEn study with children with TB lymphadenitis from the Spanish Network for the Study of Pediatric TB database.
Overall, 78 patients with MAC and 34 with TB lymphadenitis were included. Among MAC cases, 44 out of 74 (59.5%) had positive tuberculin skin test (TST) results at the 5-mm cut-off, compared with 32 out of 33 (97%) TB cases (P < .001); at the 10-mm cut-off TST results were positive in 23 out of 74 (31.1%) vs 26 out of 31 (83.9%), respectively (P < .001). IGRA results were positive in only 1 out of 32 (3.1%) patients with MAC who had undergone IGRA testing, compared with 21 out of 23 (91.3%) TB cases (P < .001). Agreement between TST and IGRA results was poor in MAC (23.3%; κ = 0.017), but good in TB cases (95.6%; κ = 0.646). IGRAs had a specificity of 96.9% (95% CI 84.3%-99.8%), positive predictive value of 95.4% (95% CI 78.2%-99.8%), and negative predictive value of 93.9% (95% CI 80.4%-98.9%) for TB lymphadenitis.
In contrast to TST, IGRAs have high specificity, negative predictive value, and positive predictive value for TB lymphadenitis in children with subacute/chronic lymphadenopathy, and consequently can help to discriminate between TB and MAC disease. Therefore, IGRAs are useful tools in the diagnostic work-up of children with lymphadenopathy, particularly when culture and polymerase chain reaction results are negative.
评估干扰素 - γ 释放试验（IGRAs）在亚急性/慢性颌下/颈部淋巴结炎患儿中区分鸟分枝杆菌复合群（MAC）和结核（TB）的性能。
比较欧洲非结核分枝杆菌儿童淋巴结炎研究中微生物学证实的 MAC 淋巴结炎患儿和西班牙儿科结核病网络数据库中 TB 淋巴结炎患儿的多中心观察性研究。
共有 78 例 MAC 和 34 例 TB 淋巴结炎患儿入组。在 MAC 病例中，44 例（59.5%）74 例在 5mm 截断值时有阳性结核菌素皮肤试验（TST）结果，而 33 例 TB 病例中有 32 例（97%）（P<0.001）；在 10mm 截断值时，TST 结果阳性的分别为 74 例中的 23 例（31.1%）和 31 例中的 26 例（83.9%）（P<0.001）。仅对 32 例接受 IGRA 检测的 MAC 患者中的 1 例（3.1%）进行了 IGRA 检测，而 23 例 TB 病例中有 21 例（91.3%）（P<0.001）。TST 和 IGRA 结果在 MAC 中一致性差（23.3%；κ=0.017），但在 TB 病例中一致性好（95.6%；κ=0.646）。IGRAs 对 TB 淋巴结炎的特异性为 96.9%（95%CI 84.3%-99.8%），阳性预测值为 95.4%（95%CI 78.2%-99.8%），阴性预测值为 93.9%（95%CI 80.4%-98.9%）。
与 TST 相比，IGRAs 在亚急性/慢性淋巴结病患儿中对 TB 淋巴结炎具有较高的特异性、阴性预测值和阳性预测值，因此有助于区分 TB 和 MAC 疾病。因此，IGRAs 是淋巴结病患儿诊断性检查的有用工具，特别是当培养和聚合酶链反应结果为阴性时。
