Document Detail


Challenges of Interferon-γ Release Assay Conversions in Serial Testing of Health-care Workers in a TB Control Program.
MedLine Citation:
PMID:  22796839     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Clinical data with use of serial interferon-γ release assay (IGRA) testing in US health-care workers (HCWs) are limited.
METHODS: A single-center, retrospective chart review was done from 2007 to 2010 of HCWs who underwent preemployment QuantiFERON-TB Gold In-Tube testing. Demographic data, bacille Calmette-Guérin history, prior tuberculin skin test result if done, and baseline and serial IGRA values were obtained. The number of IGRA converters and reverters and their subsequent management by infectious disease physicians were reviewed. Quantitative IGRA-negative values were not available.
RESULTS: A total of 7,374 IGRAs were performed on newly hired HCWs. Of these tests, 486 (6.6%) were positive at baseline, 305 (4.1%) were indeterminate, and 6,583 (89.3%) were negative. From 2007 to 2010, 52 of 1,857 HCWs (2.8%) with serial IGRA tests were identified as converters, with a serial IGRA median value of 0.63 IU/mL. Seventy-one percent of HCWs with IGRA conversion had values ≤ 1 IU/mL. None of the converters had active TB or were part of an outbreak investigation.
CONCLUSIONS: Clinical significance of most QuantiFERON-TB Gold In-Tube conversions in serial testing remains a challenging task for clinicians. The use of a single cutoff point criterion for IGRA may lead to overdiagnosis of new TB infections. Clinical assessment and evaluation may help to prevent unnecessary therapy in these cases. The criteria for defining conversions and reversions by establishing new cutoffs needs to be evaluated further, especially in HCWs.
Authors:
Kimberlee S Fong; J Walton Tomford; Lucileia Teixeira; Thomas G Fraser; David van Duin; Belinda Yen-Lieberman; Steve M Gordon; Cyndee Miranda
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  142     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  55-62     Citation Subset:  AIM; IM    
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