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Comparative Study
. 2014 Oct;33(10):e260-9.
doi: 10.1097/INF.0000000000000399.

Influence of age and nutritional status on the performance of the tuberculin skin test and QuantiFERON-TB gold in-tube in young children evaluated for tuberculosis in Southern India

Synne Jenum  1 , Sumithra Selvam, Diana Mahelai, Nelson Jesuraj, Vicky Cárdenas, John Kenneth, Anneke C Hesseling, Timothy Mark Doherty, Mario Vaz, Harleen M S Grewal
Affiliations
Free PMC article
Comparative Study

Influence of age and nutritional status on the performance of the tuberculin skin test and QuantiFERON-TB gold in-tube in young children evaluated for tuberculosis in Southern India

Synne Jenum et al. Pediatr Infect Dis J. 2014 Oct.
Free PMC article

Abstract

Background: Reliable identification of Mycobacterium tuberculosis infection or tuberculosis (TB) disease in young children is vital to assure adequate preventive and curative treatment. The tuberculin skin test (TST) and IFNγ-release assays may supplement the diagnosis of pediatric TB as cases are typically bacteriologically unconfirmed. However, it is unclear to what extent the performance of TST and QuantiFERON-TB Gold In-Tube (QFT; Cellestis' IFNγ-release assay test) depends on the demographic, clinical and nutritional characteristics of children in whom they are tested.

Methods: During a 2-year prospective observational study of 4382 neonates in Southern India, children with suspected TB were investigated and classified by a standard TB diagnostic algorithm.

Results: Clinical TB was diagnosed in 13 of 705 children referred for case verification with suspected TB. TST and QFT had a susceptibility for clinical TB of 31% and 23%, respectively, in this group. Children <2 years were more likely to test QFT indeterminate. A height-for-age Z score within the lowest quartile increased the odds ratio (OR) for a positive or indeterminate QFT result [OR 2.46 (1.19-5.06), OR 3.08 (1.10-8.58)], whereas the OR for a positive TST was reduced with a weight-for-height Z score within the lowest quartile [OR 0.17 (0.06-0.47)].

Conclusion: The sensitivities of the TST and QFT for clinical TB in children <3 years of age were equally poor in this population. Stunted children were more susceptible to Mycobacterium tuberculosis infection and more prone to indeterminate QFT results. TST was less reliable in children with wasting.

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Conflict of interest statement

The authors have no other funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
A DAG illustrating the causal relationships between the determinants for the outcomes clinical TB and positive TST and/or QFT. A causal relationship between a determinate (variable names listed in parenthesis) and an outcome is indicated with arrows. Ancestors (variables that is a cause of another variable more closely linked to the outcome) and descendants of the outcome not included in the multivariate models are in italic. Variables significantly associated to the outcomes in univariate analysis are in bold. Dashed arrows indicate more uncertain relationships.
FIGURE 2.
FIGURE 2.
A DAG illustrating the causal relationships between the determinants for the outcome indeterminate QFT. A causal relationship between a determinate (variable names listed in parenthesis) and an outcome is indicated with arrows. Ancestors (variables that is a cause of another variable more closely linked to the outcome) and descendants of the outcome not included in the multivariate models are in italic. Variables significantly associated to the outcomes in univariate analysis are in bold. Dashed arrows indicate more uncertain relationships.
FIGURE 3.
FIGURE 3.
Flow-chart for the 746 study participants. The diagnostic procedures applied at the *CVW are listed.
See this image and copyright information in PMC

References

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