| Use of the T-SPOT.TB assay to detect latent tuberculosis infection among rheumatic disease patients on immunosuppressive therapy. | |
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MedLine Citation:
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PMID: 19228655 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: We evaluated the T-SPOT.TB assay to identify latent tuberculosis infection (LTBI) in patients with rheumatic disease receiving immunosuppressive medication including tumor necrosis factor (TNF) antagonists. METHODS: A total of 200 patients seen in the Arthritis Center at Brigham and Women's Hospital were enrolled for study. Most patients were US-born women with rheumatoid arthritis. A medical history was obtained using a questionnaire, whole blood was drawn for the T-SPOT.TB assay, and tuberculin skin testing (TST) was performed. RESULTS: Both tests were performed on 179 subjects, who had no history of a positive TST. All subjects had a strong response to the T-SPOT.TB test positive control, and there were no indeterminate results. Among these 179 subjects, 2 had a positive TST and 10 had a positive T-SPOT.TB test. No subject was positive for both tests. Patients with a positive T-SPOT.TB test did not have typical risk factors for LTBI based on clinical evaluation. CONCLUSION: The lack of concordance between the TST and the T-SPOT.TB assay may indicate that the immunoassay is more sensitive, particularly in a patient population taking immunosuppressive medications. It is equally likely that the low prevalence of LTBI in this low-risk population led to an increase in the false-positive rate despite the high sensitivity and specificity of the T-SPOT.TB assay. In the context of our patient population, the T-SPOT.TB assay is likely to be most useful in evaluation of patients with a positive TST, since these patients have a higher pretest probability of having LTBI. |
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Authors:
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Samuel M Behar; Daniel S Shin; Agnes Maier; Jonathan Coblyn; Simon Helfgott; Michael E Weinblatt |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-02-17 |
Journal Detail:
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Title: The Journal of rheumatology Volume: 36 ISSN: 0315-162X ISO Abbreviation: J. Rheumatol. Publication Date: 2009 Mar |
Date Detail:
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Created Date: 2009-03-16 Completed Date: 2009-05-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7501984 Medline TA: J Rheumatol Country: Canada |
Other Details:
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Languages: eng Pagination: 546-51 Citation Subset: IM |
Affiliation:
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Brigham and Women's Hospital, Boston, MA 02492, USA. sbehar@rics.bwh.harvard.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Antirheumatic Agents / adverse effects, therapeutic use* Female Humans Immunoassay Immunocompromised Host* Immunosuppressive Agents / adverse effects, therapeutic use* Interferon-gamma / analysis Male Middle Aged Reagent Kits, Diagnostic Rheumatic Diseases / complications, drug therapy, immunology* Tuberculosis / diagnosis*, immunology Tumor Necrosis Factor-alpha / antagonists & inhibitors* |
| Chemical | |
Reg. No./Substance:
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0/Antirheumatic Agents; 0/Immunosuppressive Agents; 0/Reagent Kits, Diagnostic; 0/Tumor Necrosis Factor-alpha; 82115-62-6/Interferon-gamma |
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