581. Comparison of QuantiFERON-TB Gold In-Tube Test with Tuberculin Skin Test for Detecting Latent Tuberculosis Infection Prior to Hematologic Stem Cell Transplantation
Session: Poster Abstract Session: Mycobacterial Diagnostics
Friday, October 21, 2011
Room: Poster Hall B1
Background: Hematopoietic stem cell transplantation (HCT) recipients are prone to bacterial, viral and fungal infection. Tuberculosis (TB) is infrequent seen in HCT recipients, but TB development after HCT has been challenging in intermediate-high TB burden countries. Traditionally, tuberculin skin test (TST) to diagnose latent TB infection (LTBI) has been used but it is limited in immunocompromised patients. A new T-cell based interferon-gamma release assays (IGRAs) such as the QuantiFERON-TB Gold In-Tube (QFT-GIT) for diagnosing LTBI gave promising results, but little information is available for diagnosing LTBI in HCT recipients. We prospectively compared the QFT-GIT with those of TST in HCT candidates in the intermediate TB burden country.

Methods: All adult patients admitted for HCT unit between March 2009 and February 2011 at a tertiary hospital were prospectively enrolled. Each patient underwent QFT-GIT, TST using 2 tuberculin units (TU) of PPD RT-23, and a chest x-ray to exclude active TB.

Results: A total of 180 patients including 80 (44%) patients had autologous HCT and 100 (56%) patients had allogenic HCT were enrolled. Of these, 144 (80%) patients had BCG scars or prior history of BCG vaccination. Thirty-five (19%) of 180 patients had a positive QFT-GIT, 30 (17%) had a positive TST result (induration size ≥ 5 mm), and 20 (11%) had a positive TST result (induration size ≥ 10 mm). The overall agreement between the TST (induration size ≥ 5 mm) and the QFT-GIT was 69% (k = 0.04) and between the TST (induration size ≥ 10 mm) and the QFT-GIT was 74% (k = 0.09).

Conclusion: There was poor correlation between QFT-GIT and TST. So, further longitudinal studies are needed to determine whether the ability of QFT-GIT assay to detect LTBI in HCT patients can better predict the development of TB than can TST after transplantation.

Table 1. Agreement between TST and QFT-GIT, excluding patients with a QFT-GIT indeterminate result

 

TST ≥ 5 mm

TST ≥ 10 mm

QFT-GIT

Positive

Negative

Total

Positive

Negative

Total

Positive

Negative

Total

Aggrement

coefficients

7 (4)

20 (13)

27 (17)

69%

0.04

28 (18)

100 (64)

128 (82)

 

35 (23)

120 (77)

155 (100)

 

6 (4)

12 (8)

18 (12)

74%

0.09

29 (18)

108 (70)

137 (88)

 

35 (22)

120 (78)

155 (100)

 


Subject Category: O. Transplant infectious diseases

Song Mi Moon, MD1,2, Sang-Oh Lee, MD1, Sang-Ho Choi, MD, PhD1, Jun Hee Woo, MD, PhD1, Yang Soo Kim, MD, PhD1, Dok Hyun Yoon, MD3, Cheolwon Suh, MD, PhD3, Dae-Young Kim, MD4, Jung-Hee Lee, MD, PhD4, Je-Hwan Lee, MD, PhD4, Kyoo-Hyung Lee, MD, PhD4 and Sung-Han Kim, MD, PhD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (2)Graduate School, Kyung Hee University, Seoul, South Korea, (3)Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (4)Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

S. M. Moon, None

S. O. Lee, None

S. H. Choi, None

J. H. Woo, None

Y. S. Kim, None

D. H. Yoon, None

C. Suh, None

D. Y. Kim, None

J. H. Lee, None

J. H. Lee, None

K. H. Lee, None

S. H. Kim, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.