Interferon Gamma Release Assay Compared With the Tuberculin Skin Test for Latent Tuberculosis Detection in Pregnancy

Worjoloh, Ayaba; Kato‐Maeda, Midori; Osmond, Dennis; Freyre, Rachel; Aziz, Najib; Cohan, Deborah

doi:10.1097/aog.0b013e31823834a9

Cited by 26 publications

(25 citation statements)

References 31 publications

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“…Moreover, we show that a positive QGIT is associated with having contact with someone with pulmonary TB, similar to our prior observations among pregnant women uninfected with HIV in India and that of others (12,(22)(23)(24). Although other studies in pregnant women uninfected with HIV in the United States (22,25) did not show the same QGIT patients were substantially less likely to have been exposed to TB. Only 5-13% of women in these studies were IGRA 1 (vs. 10-23% TST 1 ) and the main discordance seen was IGRA 2 /TST 1 (7-16%).…”

Section: Discussionsupporting

confidence: 78%

“…Only 5-13% of women in these studies were IGRA 1 (vs. 10-23% TST 1 ) and the main discordance seen was IGRA 2 /TST 1 (7-16%). Testing was also conducted earlier in pregnancy, when immune suppression is milder (25). A recent yet unpublished study of pregnant Kenyan women infected with HIV in their second/third trimester, by contrast, reported 25% QGIT 1 /TST 2 discordance (26).…”

Section: Discussionmentioning

confidence: 99%

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Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Mathad

Bhosale

Balasubramanian

et al. 2016

Am J Respir Crit Care Med

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Rationale: Pregnant women with latent tuberculosis infection (LTBI) are at high risk for development of TB, especially if infected with HIV.Objectives: To assess the performance of LTBI tests in pregnant and postpartum women infected with HIV, investigate the immunology behind discordance in pregnancy, and explore the implications for the development of postpartum TB.Methods: We screened pregnant women in their second/third trimester and at delivery for LTBI using the tuberculin skin test (TST) and IFN-g release assay (IGRA) (QuantiFERON Gold). A subset of antepartum women had longitudinal testing, with repeat testing at delivery and postpartum and additional cytokines measured from the IGRA supernatant. The kappa statistic and Wilcoxon rank sum test were used to determine agreement and comparison of cytokine concentrations, respectively.Measurements and Main Results: Of 252 enrolled, 71 (28%) women had a positive IGRA but only 27 (10%) had a positive TST (P , 0.005). There was 75% agreement (kappa, 0.25). When stratified by pregnancy versus delivery, 20% had IGRA 1 /TST 2 discordance at each time point. A positive IGRA was associated with known TB contact (odds ratio, 3.6; confidence interval, 1.2-11.1; P = 0.02). Compared with IGRA 1 /TST 1 , women with IGRA 1 /TST 2 discordance had significantly less IFN-g (1.85 vs. 3.48 IU/ml; P = 0.02) and IL-2 (46.17 vs. 84.03 pg/ml; P = 0.01). Five developed postpartum TB, of which three had IGRA 1 /TST 2 discordance during pregnancy.Conclusions: Choice of LTBI test in pregnant women infected with HIV affects results. Pregnant women with IGRA 1 /TST 2 discordance had less IFN-g and IL-2 than those with concordant-positive results and may represent an especially high-risk subset for the development of active TB postpartum.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Mathad

Bhosale

Balasubramanian

et al. 2016

Am J Respir Crit Care Med

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“…Two studies proved the value of IGRA in detecting LTBI in pregnant women, since the results of this test were not affected by BCG vaccination, thus avoiding the TST false positive result and the unnecessary, consequent INH prophylaxis [11],[21]. …”

Section: Resultsmentioning

confidence: 99%

Tuberculosis care for pregnant women: a systematic review

et al. 2014

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BackgroundTuberculosis (TB) during pregnancy may lead to severe consequences affecting both mother and child. Prenatal care could be a very good opportunity for TB care, especially for women who have limited access to health services. The aim of this review was to gather and evaluate studies on TB care for pregnant women.MethodsWe used a combination of the terms “tuberculosis” and “pregnancy”, limited to human, to search for published articles. Studies reflecting original data and focusing on TB care for pregnant women were included. All references retrieved were collected using the Reference Manager software (Version 11).ResultsThirty five studies were selected for review and their data showed that diagnosis was often delayed because TB symptoms during pregnancy were not typical. TB prophylaxis and anti-TB therapy appeared to be safe and effective for pregnant women and their babies when suitable follow up and early initiation were present, but the compliance rate to TB prophylaxis is still low due to lack of follow up and referral services. TB care practices in the reviewed studies were in line in principle with the WHO International Standards for Tuberculosis Care (ISTC).ConclusionsIntegration of TB care within prenatal care would improve TB diagnosis and treatment for pregnant women. To improve the quality of TB care, it is necessary to develop national level guidelines based on the ISTC with detailed guidelines for pregnant women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0617-x) contains supplementary material, which is available to authorized users.

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“…Interferon-gamma release assays (IGRAs), such as QuantiFERON Gold Test In-Tube (QGIT; Cellestis) and T-SPOT.TB (Oxford Immunotech), measure IFN-γ released from peripheral blood mononuclear cell (PBMC) exposed to TB-specific antigens. For detection of latent TB in pregnancy, IGRA showed good performance, while concordance and agreement were poor when comparing the tuberculin skin test (TST) and IGRA results [ 7 , 8 ]. To avoid false-positive interpretations, TST is discouraged and IGRA is recommended for TB screening and diagnosis in pregnant populations with high BCG vaccination coverage or uncertain vaccination status [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

T-SPOT.TB in Detection of Active Tuberculosis During Pregnancy: A Retrospective Study in China

et al. 2016

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BackgroundInterferon-gamma release assays have not been validated in active TB among pregnant women. Therefore, the objective of this retrospective study was to estimate the diagnostic value of T-SPOT.TB in active TB among pregnant women.Material/MethodsBetween May 2012 and May 2015, 26 consecutive pregnant women with suspected TB were enrolled in our study. The clinicopathological characteristics and T-SPOT.TB results were reviewed and analyzed.ResultsPregnant patients were divided into a TB group (n=21) and a Non-TB group (n=5). In the TB group, 5 patients had pulmonary TB, 5 had pulmonary TB+ extrapulmonary TB, and 11 had exclusively extrapulmonary TB. The most common site of extrapulmonary TB was pleural (n=11). Statistical analysis showed that the lymphocyte count in the TB group was lower than in the Non-TB group (P<0.05). For detection of active TB during pregnancy, T-SPOT.TB had a high sensitivity of 100.0% (84.5%–100.0%) and a specificity of 80.0% (37.6–96.4%).ConclusionsT-SPOT.TB shows good performance in detection of active tuberculosis during pregnancy. Interferon gamma release assay for TB screening of pregnant women is recommended in clinical practice because it may be a more appropriate diagnostic tool than the tuberculin skin test.

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Interferon Gamma Release Assay Compared With the Tuberculin Skin Test for Latent Tuberculosis Detection in Pregnancy

Cited by 26 publications

References 31 publications

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women

Tuberculosis care for pregnant women: a systematic review

T-SPOT.TB in Detection of Active Tuberculosis During Pregnancy: A Retrospective Study in China

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