Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug 19;10(8):e0103763.
doi: 10.1371/journal.pone.0103763. eCollection 2015.

Fluctuating Behavior and Influential Factors in the Performance of the QuantiFERON-TB Gold In-Tube Assay in the Diagnosis of Tuberculosis

Lei Bao  1 , Tao Li  2 , Ni Diao  1 , Yaojie Shen  1 , Lingyun Shao  1 , Ying Zhang  3 , Shuihua Lu  4 , Wenhong Zhang  5
Affiliations

Fluctuating Behavior and Influential Factors in the Performance of the QuantiFERON-TB Gold In-Tube Assay in the Diagnosis of Tuberculosis

Lei Bao et al. PLoS One. .

Abstract

Background: The QuantiFERON-TB Gold In-Tube (QFT-GIT) is a newly developed but widely used interferon-γ release assay for diagnosing tuberculosis (TB). However, research has not determined whether age or the use of an immune suppressive or anti-TB treatment influences this assay's ability to detect TB. We assessed the QFT-GIT diagnostic performance for active tuberculosis (ATB) in children and adults in an endemic country and explored the effects of glucocorticoids and anti-TB therapy on the diagnostic value of the QFT-GIT.

Methods: A total of 60 children and 212 adults with suspected ATB were evaluated with the QFT-GIT. The association between the QFT-GIT diagnostic value and pretreatment factors was qualitatively and quantitatively assessed.

Results: The sensitivity of the QFT-GIT was 83.9% (95% CI 66.3%-94.6%) in children, and 73.7% (95% CI 57.8%-85.2%) in adults. Glucocorticoids affected the mitogen-stimulated response in both children and adults. In subjects undergoing glucocorticoid pretreatment, 25.0% of the children presented with false-negative QFT-GIT results, 28.6% of adults presented with indeterminate results. For subjects pre-treated with anti-TB drugs, 44.4% presented with false-negative QFT-GIT results.

Conclusions: The QFT-GIT has higher sensitivity and specificity in children than adults. Glucocorticoid treatment negatively impacts the diagnostic value of the QFT-GIT in all age groups. Anti-TB treatment decreases the sensitivity of the QFT-GIT. Therefore, we recommend that the QFT-GIT assay be performed before TB-specific treatment is initiated and the test should not be used on people undergoing immunosuppression treatment, regardless of their age. A quantitative analysis of the QFT-GIT could be useful for assessing and monitoring TB-specific and non-specific immunity during conversion of the disease.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Recruitment and diagnostic classification of the participants.
*QFT-GIT: QuantiFERON-TB Gold In-Tube.
Fig 2
Fig 2. (A) The effects of glucocorticoids and anti-TB treatment on the QFT-GIT performance in children and adults with ATB. (B) The distribution of the indeterminate cases.
Fig 3
Fig 3. Comparison of the IFN-γ level in mitogen tubes in patients with different therapy regimens.
(A) The effect of glucocorticoids on the mitogen-stimulated IFN-γ level between patients with and without ATB. ATB = active tuberculosis. non-ATB = diseases other than active tuberculosis. (Mean±SEM: column A: 5.45±2.09; column B: 10.44±1.41; column C: 6.06±0.71; column D: 8.42±0.58). (B) The effect of anti-TB therapy on IFN-γ in the mitogen tube in adults with ATB (Mean±SEM: Anti-TB therapy: 13.31±1.17; No therapy: 6.21±1.17).
Fig 4
Fig 4. Comparison of mitogen-stimulated IFN-γ release between patients with and without ATB in the absence of treatment.
(Mean±SEM: ATB children: 7.97±1.70; Non-TB children: 14.16±1.84; ATB adults: 6.21±1.17; Non-TB adults: 8.80±0.65).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Organization WH. Global Tuberculosis Control:WHO Report 2013. Genava: WHO; 2013. May.
    1. Organization WH. Global Tuberculosis Control:WHO Report 2012. Genava: WHO; 2012. 258 p.
    1. Detjen AK, Keil T, Roll S, Hauer B, Mauch H, Wahn U, et al. Interferon-gamma release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children in a country with a low incidence of tuberculosis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2007;45(3):322–8. 10.1086/519266 . - DOI - PubMed
    1. Ashenafi S, Aderaye G, Zewdie M, Raqib R, Bekele A, Magalhaes I, et al. BCG-specific IgG-secreting peripheral plasmablasts as a potential biomarker of active tuberculosis in HIV negative and HIV positive patients. Thorax. 2013;68(3):269–76. 10.1136/thoraxjnl-2012-201817 - DOI - PMC - PubMed
    1. Cruz AT, Geltemeyer AM, Starke JR, Flores JA, Graviss EA, Smith KC. Comparing the tuberculin skin test and T-SPOT.TB blood test in children. Pediatrics. 2011;127(1):e31–8. 10.1542/peds.2010-1725 . - DOI - PubMed

Publication types