Tuberculosis infection and anergy in hemodialysis patients

Interferon-γ Release Assays for Diagnosing Mycobacterium tuberculosis Infection in Renal Dialysis Patients

“…Previous studies have suggested high rates of anergy to TST among ESRD patients (8,9). This is the first study, to our knowledge, that has assessed the ability of IFN-␥ assays to detect recent TB infection in renal dialysis patients.…”

“…Their underlying immune suppression raises the likelihood of false-negative TB skin test (TST) results and makes interpretation of negative results unreliable. Dialysis patients have been shown to have significant rates of cutaneous anergy to antigens, such as Candida, mumps, or tetanus (8,9). Furthermore, as in immunocompetent populations, the TST can be falsely positive in persons with a history of previous nontuberculous mycobacterium infection or vaccination with bacillus Calmette-Guerin (BCG) (10).…”

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

“…The prevalence of latent TB infection in ESRD patients varies from 11% to 63% using the tuberculin skin test (TST) (12)(13)(14). The TST may grossly underestimate the prevalence because of the high rates of cutaneous anergy (up to 44%) (10,(15)(16)(17) and is limited by a low specificity, with cross-reactions to Bacille-Calmette-Guérin (BCG) vaccination and exposure to nontuberculous mycobacteria.…”

Superior Sensitivity of Ex Vivo IFN-γ Release Assays as Compared to Skin Testing in Immunocompromised Patients

“…Our study provides a direct proof for the clinical notion that IGRAs are of higher sensitivity to detect a specific immune response as compared to the TST, particularly in immunocompromised patients (4,8,(13)(14)(15)(16). Unlike the TST, IGRAs were more closely associated with clinically assessable variables consistent with prior contact with mycobacterial antigens such as history of active tuberculosis, prior exposure to M. tuberculosis, long-term residence in a M. tuberculosis-endemic country or BCG vaccination.…”