Druszczynska Magdalena, Seweryn Michal, Wawrocki Sebastian, Pankowska Anna, Godkowicz Magdalena, Kowalewska-Pietrzak Magdalena
Department of Immunology and Infectious Biology, Institute of Microbiology, Biotechnology and Immunology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland.
Biobank Laboratory, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland.
Vaccines (Basel). 2023 Feb 7;11(2):387. doi: 10.3390/vaccines11020387.
Children have an increased risk of developing active tuberculosis (TB) after exposure to (), and they are more likely to develop the most severe forms of TB. Rapid diagnosis and treatment of latent infection (LTBI) is essential to lessen the devastating consequences of TB in children.
The aim of the study was to evaluate TST (tuberculin skin test) and IGRA (interferon-gamma release assay) utility in identifying LTBI in a cohort of Bacille Calmette-Guérin (BCG)-vaccinated Polish children and adolescents exposed or not exposed to contagious TB. In addition, we asked whether quantitative assessment of IGRA results could be valuable in predicting active TB disease.
Of the 235 recruited volunteers, 89 (38%) were TST-positive (TST+), 74 (32%) were IGRA-positive (IGRA+), and 62 (26%) were both TST+ and IGRA+. The frequency of TST positivity was significantly higher in the group with (59%) than without TB contact (18%). The percentage of TST+ subjects increased with age from 36% in the youngest children (<2 years) to 47% in the oldest group (>10 years). All positive IGRA results were found solely in the group of children with TB contact. There was a significant increase in the rate of positive IGRA results with age, from 9% in the youngest to 48% in the oldest group. The 10 mm TST cutoff showed good sensitivity and specificity in both TB exposed and nonexposed children and was associated with excellent negative predictive value, especially among nonexposed volunteers. Mean IFN-γ concentrations in IGRA cultures were significantly higher in the group of LTBI compared to the children with active TB disease, both TST+ and TST-.
Both TST and IGRA can be used as screening tests for BCG-vaccinated children and adolescents exposed to contagious TB.
儿童在接触（）后发生活动性肺结核（TB）的风险增加，且更易发展为最严重的肺结核形式。潜伏性结核感染（LTBI）的快速诊断和治疗对于减轻TB对儿童的灾难性后果至关重要。
本研究旨在评估结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）在一组接种卡介苗（BCG）的波兰儿童和青少年中识别LTBI的效用，这些儿童和青少年接触或未接触传染性TB。此外，我们还探讨了IGRA结果的定量评估在预测活动性TB疾病方面是否有价值。
在招募的235名志愿者中，89名（38%）TST阳性（TST+），74名（32%）IGRA阳性（IGRA+），62名（26%）TST+且IGRA+。有TB接触史的组中TST阳性频率（59%）显著高于无TB接触史的组（18%）。TST+受试者的百分比随年龄增长从最年幼儿童（<2岁）的36%增至最年长组（>10岁）的47%。所有IGRA阳性结果仅见于有TB接触史的儿童组。IGRA阳性结果率随年龄显著增加，从最年幼儿童的9%增至最年长组的48%。10mm的TST临界值在有TB接触史和无TB接触史的儿童中均显示出良好的敏感性和特异性，且具有出色的阴性预测价值，尤其是在无TB接触史的志愿者中。与活动性TB疾病儿童（TST+和TST-）相比，LTBI组IGRA培养物中的平均干扰素-γ浓度显著更高。
TST和IGRA均可作为接种BCG的接触传染性TB的儿童和青少年的筛查试验。
