Clinical evaluation of QuantiFERON®-TB Gold Plus directly compared with QuantiFERON®-TB Gold In-Tube and T-Spot®.TB for active pulmonary tuberculosis in the elderly. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Fukushima, Kiyoyasu; Kubo, Toru; Akagi, Kazumasa; Miyashita, Ritsuko; Kondo, Akira; Ehara, Naomi; Takazono, Takahiro; Sakamoto, Noriho; Mukae, Hiroshi
• Is Part Of: Journal of infection and chemotherapy. Volume 27:Issue 12(2021)
• Page Start: 1716
• Page End: 1722
• Publication Date: 2021-12
• Subjects: QuantiFERON-TB Gold plus -- T-Spot.TB, CD4 T-cell -- CD8 T-cell -- Active tuberculosis -- Elderly; TB Tuberculosis -- IFN Interferon -- IGRAs IFN-γ release assays -- QFT QuantiFERON® -- QFT-GIT QFT-Gold In-Tube -- QFT-Plus QFT-TB Gold Plus -- T-SPOT T-Spot®.TB -- IQR Interquartile range -- CI Confidence interval; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2021.08.016
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Background: Reduced sensitivity of tuberculosis (TB) interferon-γ release assays (IGRAs) among the elderly has been reported, which is presumably due to diminished immune function. We evaluated the clinical performance of QuantiFERON®-TB Gold plus (QFT-Plus) compared with QuantiFERON®-TB Gold In-Tube (QFT-GIT) and T-Spot®. TB (T-SPOT) in the elderly. Methods: Blood samples for all three IGRAs were drawn at the same time from all the participants. Both CD4 and CD8 T-cell counts in patients' peripheral blood were also measured. Results: A total of 142 active pulmonary TB patients (median age: 84, interquartile range; 76–89 years) were recruited. The sensitivities of the tested IGRAs (excluding invalid/indeterminate cases) were as follows: QFT-Plus, 93.6%; QFT-GIT, 91.4%; and T-SPOT 68.1%. QFT-Plus displayed significantly higher sensitivity than T-SPOT (p < 0.00001). All three IGRAs exhibited the same specificity (100%), as assessed using blood samples from healthy, low TB-risk individuals (n = 118; median age: 39, IQR; 32–47 years). Positivity in 43 active TB patients with CD4 T-cell counts <200/μL, 39 of whom were ≥80 years of age, was as follows: QFT-Plus, 83.7%; QFT-GIT, 74.4%; and T-SPOT, 58.1%. The difference between TB2-TB1 of the QFT-Plus assay was statistically correlated with CD8 but not CD4 T-cell counts in blood (r = 0.193, p = 0.0298). Conclusions: QFT-Plus showed high performance in the detection of TB infection in patients irrespective of their advanced age (≥80 years) or lower CD4 counts. QFT-Plus can be useful for the diagnosis of TB infection in all patients, including those who are elderly and/or immunocompromised.