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Identifying predictors of interferon-gamma release assay results in pediatric latent tuberculosis: a protective role of BCG?

Basu Roy, Robindra and Sotgiu, Giovanni and Altet Gómez, Neus and Tsolia, Maria and Ruga, Ezia and Velizarova, Svetlana and Kampmann, Beate (2012) Identifying predictors of interferon-gamma release assay results in pediatric latent tuberculosis: a protective role of BCG? American Journal of Respiratory and Critical Care Medicine, Vol. 186 (4), p. 378-384. eISSN 1535-4970. Article.

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DOI: 10.1164/rccm.201201-0026OC

Abstract

Rationale: Interferon-gamma release assays are widely used to diagnose latent infection with Mycobacterium tuberculosis in adults, but their performance in children remains incompletely evaluated to date.
Objectives: To investigate factors influencing results of interferon gamma release assays in children using a large European dataset.
Methods: The Pediatric Tuberculosis Network European Trials group pooled and analysed data from five sites across Europe comprising 1128 children who were all investigated for latent tuberculosis infection by using TST and at least one interferon-gamma release assay. Multi-variate analyses examined age, Bacille Calmette-Guérin (BCG) vaccination status, and gender as predictor variables of results. Subgroup analyses included children who were household contacts.
Measurements and results:1,093 children had a Quantiferon Gold In-Tube and 382 had a T-SPOT.TB interferon gamma release assay. Age was positively correlated with a positive blood result (Quantiferon Gold In-Tube: OR=1.08 per year increasing age, p<0.0001; T-SPOT.TB: OR=1.14 per year increasing age, p<0.001). 5.5% of children with a tuberculin skin test result <5mm, 14.8% if <10mm, and 23.9% if <15mm, had a positive Quantiferon Gold In-Tube result. Prior BCG vaccination was associated with a negative interferon gamma release assay result (Quantiferon Gold In-Tube: OR=0.41, p<0.001; T-SPOT.TB: OR=0.41, p<0.001). Young age was a predictor of indeterminate IGRA, but indeterminate rates were low (3.6% in <5years, 1% in >5 years).
Conclusions: Our data show BCG vaccination may be effective in protecting children against Mycobacterium tuberculosis infection. To restrict use of interferon-gamma release assays to children with positive skin tests risks underestimating latent infection.

Item Type:Article
ID Code:7889
Status:Published
Refereed:Yes
Uncontrolled Keywords:Mycobacterium tuberculosis, children, bacillus Calmette-Guérin (BCG)
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Biomediche
Publisher:American Thoracic Society
eISSN:1535-4970
Deposited On:27 Aug 2012 09:13

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