Uddin Mohammad Khaja Mafij, Islam Ashabul, Jabin Maha Sultana, Alam Tahmina, Khair Salwa, Ferdous Jannatul, Nasrin Rumana, Rahman S M Mazidur, Pouzol Stephane, Hoffmann Jonathan, Banu Sayera
Infectious Diseases Division, Icddr,B, Dhaka, Bangladesh.
Nutrition Research Division, Icddr,B, Dhaka, Bangladesh.
Infect Drug Resist. 2024 Sep 9;17:3925-3932. doi: 10.2147/IDR.S475424. eCollection 2024.
Around one-quarter of the global population has latent tuberculosis infection (LTBI). If left untreated, LTBI has 5-10% lifetime risk of developing into TB. Interferon-gamma release Assays (IGRAs) are more sensitive than the tuberculin skin test for LTBI detection. However, the high cost and complexity of IGRAs are barriers to adoption in resource-constrained settings. This study evaluated the diagnostic performance of a more affordable IGRA, Standard E TB-Feron (TBE), among different risk groups in Bangladesh.
532 participants of all age groups were enrolled from the TB Screening and Treatment Centers and Dhaka Hospital of icddr,b between June and September 2023. The participants were categorized into four risk groups: healthy people, healthcare workers/ attendants of TB patients, patients with microbiologically confirmed TB, and people with a history of TB. The diagnostic performance of TBE was compared to QuantiFERON-TB Gold Plus (QFT-Plus) for all groups. GeneXpert, culture, and microscopy were used to confirm TB microbiologically.
TBE had an overall agreement of 85.9% (95% CI, 82.5% to 88.7%), positive percent agreement of 86.1% (95% CI, 80.6% to 90.5%), and negative percent agreement of 85.7% (95% CI, 81.3% -89.4%) with QFT-Plus. Among 81 culture-positive patients, TBE and QFT-Plus were positive for 60 (74.1%) and 62 (76.5%) respectively. Among healthy people, TBE and QFT results were positive for 49 (24.5%) and 59 (29.5%) respectively. Among health workers and contacts, TBE and QFT-Plus were positive for 79 (39.5%) and 73 (35.5%) respectively.
We found a substantial agreement (Cohen's kappa of 0.71) between TBE and QFT-Plus in detecting LTBI across different groups, suggesting its potential as a cost-effective diagnostic tool. Implementation of TBE in routine clinical practice could increase accessibility to LTBI diagnosis, facilitating the timely initiation of preventative therapy, and leading to a reduction of active TB incidence.
全球约四分之一的人口患有潜伏性结核感染（LTBI）。如果不进行治疗，LTBI发展为结核病的终生风险为5%-10%。干扰素-γ释放试验（IGRAs）在检测LTBI方面比结核菌素皮肤试验更敏感。然而，IGRAs的高成本和复杂性阻碍了其在资源有限环境中的应用。本研究评估了一种更经济实惠的IGRA——标准E TB-Feron（TBE）在孟加拉国不同风险组中的诊断性能。
2023年6月至9月期间，从icddr，b的结核病筛查和治疗中心以及达卡医院招募了532名各年龄段的参与者。参与者被分为四个风险组：健康人群、医护人员/结核病患者的陪护人员、微生物学确诊的结核病患者以及有结核病病史的人群。将TBE的诊断性能与所有组的QuantiFERON-TB Gold Plus（QFT-Plus）进行比较。使用GeneXpert、培养和显微镜检查对结核病进行微生物学确诊。
TBE与QFT-Plus的总体一致性为85.9%（95%CI，82.5%至88.7%），阳性百分比一致性为86.1%（95%CI，80.6%至90.5%），阴性百分比一致性为85.7%（95%CI，81.3%-89.4%）。在81名培养阳性患者中，TBE和QFT-Plus分别有60例（74.1%）和62例（76.5%）呈阳性。在健康人群中，TBE和QFT结果分别有49例（24.5%）和59例（29.5%）呈阳性。在医护人员和接触者中，TBE和QFT-Plus分别有79例（39.5%）和73例（35.5%）呈阳性。
我们发现TBE和QFT-Plus在不同组中检测LTBI方面有高度一致性（Cohen's kappa为0.71），表明其作为一种经济有效的诊断工具的潜力。在常规临床实践中实施TBE可以增加LTBI诊断的可及性，促进预防性治疗的及时启动，并导致活动性结核病发病率的降低。
