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Review
. 2024 Oct 1;16(10):e70621.
doi: 10.7759/cureus.70621. eCollection 2024 Oct.

Performance of Current Diagnostic Tools in Detecting Latent Tuberculosis Among Healthcare Workers: A Systematic Review

Aishwarya R  1 , Maheshwary D  1 , Leela Kv  1 , Vijay R Suriya  1 , Kanya R  1
Affiliations
Review

Performance of Current Diagnostic Tools in Detecting Latent Tuberculosis Among Healthcare Workers: A Systematic Review

Aishwarya R et al. Cureus. .

Abstract

Testing for latent tuberculosis infection is essential for diagnosing Mycobacterium tuberculosis infections in asymptomatic individuals. Preventing the transition of latent to active tuberculosis is imperative, especially in high-risk populations such as healthcare workers. Interferon-gamma release assays (IGRAs) and the Mantoux/tuberculin skin test (TST) are two examples of diagnostic instruments utilized for detection. Systematic evaluations of the characteristics of widely available tests are very helpful for diagnosticians because these tests might not be easily accessible in situations with limited resources. This systematic review aims to evaluate and compare the diagnostic accuracy of tests for latent tuberculosis infection in healthcare workers. The review, conducted from 2013 to 2024, aimed to identify studies on "Latent Tuberculosis," "Healthcare workers," "Diagnostic modalities," "TST," "Interferon-gamma release assays," and "IGRA." The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and developed a data extraction toolkit. Three authors independently reviewed the literature, ensuring uniformity. Discrepancies were resolved through discussions and mediation until a consensus was reached. Statistical significance was defined as a p-value of 0.05 or lower. The review provides valuable insights into the diagnostic accuracy of these tests, particularly in high-risk populations. The TST had a sensitivity of 76.5% (confidence interval (CI) = 61.5-91.5%) and specificity of 77.2% (CI = 65-85%). Its positive predictive value (PPV) was 54.8% (CI = 45-65%), and the negative predictive value (NPV) was 88.5% (CI = 85-92%), with an odds ratio of 63.6 and an area under the curve (AUC) of 0.72. QuantiFERON-TB Gold In-Tube (QFT-GIT) showed a sensitivity of 68.35% (CI = 67.15-70.55%) and a specificity of 82.32% (CI = 72.32-97.47%). Its PPV was 56% (CI = 54-92%), and NPV was 92.7% (CI = 89-96%), with an odds ratio of 357.9 and an AUC of 0.767. QuantiFERON-TB Gold Plus (QFT-Plus) had a sensitivity of 85% (CI = 78.9-91.1%) and a specificity of 73.52% (CI = 35.71-93.75%). Its PPV was 59.2% (CI = 39.3-78.2%), and NPV was 95% (CI = 91.2-98%), with an odds ratio of 125.39 and an AUC of 0.89. T-SPOT.TB showed a sensitivity of 92% (CI = 87-97%) and a specificity of 95.7% (CI = 94-98%). Its PPV was 86.8% (CI = 85-95.8%), and NPV was 95.8% (CI = 92.5-96.7%), with an odds ratio of 1.03 and an AUC of 0.7. CLIA-IGRA had a sensitivity of 100% (CI = 99.9-100%) and a specificity of 95.57% (CI = 95.57-100%). Its PPV was 96.8% (CI = 96.8-100%), and NPV was 99.8% (CI = 99.8-100%), with an odds ratio of 1509 and an AUC of 0.97. HBHA-induced IGRA showed a sensitivity of 86.4% (CI = 71.1-97.3%) and a specificity of 82.5% (CI = 66.4-92.6%). Its PPV was 86.8% (CI = 66.7-95.3%), and NPV was 86.4% (CI = 57.8-95.7%), with an odds ratio of 6.18 and an AUC of 0.886. There are specific benefits and drawbacks of each diagnostic test for latent tuberculosis infection. With its exceptional sensitivity and specificity, the CLIA-IGRA test is a top choice for a precise diagnosis of tuberculosis. Practical factors such as availability and cost, however, might prevent its widespread usage. Both the QuantiFERON and TST are still useful tools, especially when used in certain populations or situations when their performance characteristics meet clinical requirements.

Keywords: clia-igra; diagnostic test accuracy; healthcare worker; igra; latent tb; latent tuberculosis infection; quantiferon gold plus; quantiferon-tb; tb screening; tst.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart for retrieval of included articles.
Figure 2
Figure 2. Performance characteristics: specificity of QuantiFeron TB Plus, QuantiFeron TB GIT, TST and T-Spot TB, CLIA, and HBHA-IGRA.
TB = tuberculosis; GIT = gold in tube; TST = tubercullin skin test; IGRA = interferon-gamma release assay; PPV = positive predictive value; NPV = negative predictive value; HBHA = heparin-binding hemagglutinin; CLIA = chemiluminescence immunoassay
Figure 3
Figure 3. Performance characteristics: specificity of QuantiFeron TB Plus, QuantiFeron TB GIT, TST and T-Spot TB, CLIA, and HBHA-IGRA.
TB = tuberculosis; GIT = gold in tube; TST = tubercullin skin test; BCG = Bacille Calmette-Guérin; IGRA = interferon-gamma release assay; HBHA = heparin-binding hemagglutinin; CLIA = chemiluminescence immunoassay
Figure 4
Figure 4. Performance characteristics: positive predictive value of QuantiFeron TB Plus, QuantiFeron TB GIT, TST and T-Spot TB, CLIA, and HBHA-IGRA.
TB = tuberculosis; GIT = gold in tube; TST = tubercullin skin test; BCG = Bacille Calmette-Guérin; IGRA = interferon-gamma release assay; HBHA = heparin-binding hemagglutinin; CLIA = chemiluminescence immunoassay
Figure 5
Figure 5. Performance characteristics: negative predictive value of QuantiFeron TB Plus, QuantiFeron TB GIT, TST and T-Spot TB, CLIA, and HBHA-IGRA.
TB = tuberculosis; GIT = gold in tube; TST = tubercullin skin test; BCG = Bacille Calmette-Guérin; IGRA = interferon-gamma release assay; HBHA = heparin-binding hemagglutinin; CLIA = chemiluminescence immunoassay
Figure 6
Figure 6. Performance characteristics: accuracy of QuantiFeron TB Plus, QuantiFeron TB GIT, TST and T-Spot TB, CLIA, and HBHA-IGRA.
TB = tuberculosis; GIT = gold in tube; TST = tubercullin skin test; BCG = Bacille Calmette-Guérin; IGRA = interferon-gamma release assay; HBHA = heparin-binding hemagglutinin; CLIA = chemiluminescence immunoassay
Figure 7
Figure 7. Performance characteristics – Integrated Sensitivity, Specificity of QuantiFeron TB Plus, QuantiFeron TB GIT, TST and T-Spot TB, CLIA and HBHA-IGRA
TB: Tuberculosis; HBHA-Heparin-Binding Hemagglutinin; CLIA- Chemiluminescent Immunoassay
Figure 8
Figure 8. Performance characteristics: integrated PPV and NPV of QuantiFeron TB Plus, QuantiFeron TB GIT, TST and T-Spot TB, CLIA, and HBHA-IGRA.
TB = tuberculosis; HBHA = heparin-binding hemagglutinin; CLIA = chemiluminescent immunoassay; PPV = positive predictive value; NPV = negative predictive value
Figure 9
Figure 9. Summary receiver operating characteristic curve of TST.
SROC = summary receiver operating characteristic curve; AUC = area under the curve; TST = tuberculin skin test
Figure 10
Figure 10. Summary receiver operating characteristic curve for QuantiFeron GIT.
SROC = summary receiver operating characteristic curve; AUC = area under the curve
Figure 11
Figure 11. Summary receiver operating characteristic curve of QuantiFeron Gold Plus.
SROC = summary receiver operating characteristic curve; AUC = area under the curve
Figure 12
Figure 12. Forest plot illustrating the cumulative performance of the tests in terms of sensitivity with 95% confidence intervals.
Figure 13
Figure 13. Forest plot illustrating the cumulative performance of the tests in terms of specificity with 95% confidence intervals.
See this image and copyright information in PMC

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