574. Screening for Latent Tuberculosis in Pregnant Women: A Comparison of an Interferon-γ Release Assay with Tuberculin Skin Testing in Pune, India
Session: Poster Abstract Session: Mycobacterial Diagnostics
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Screening for Latent TB in Pregnant Women in India-IDSA 2011.pdf (838.5 kB)
  • Background:Active tuberculosis (TB) during pregnancy has poor outcomes for mother and child. Women in resource-limited countries are not routinely screened for latent TB infection (LTBI). LTBI screening has relied on the tuberculin skin test (TST), which is operator- dependent, requires a return visit, and lacks sufficient sensitivity and specificity. A commercially available interferon-gamma release assay, QuantiFERON® Gold Test-in-tube, is more sensitive and specific for LTBI screening in the general population of low endemic countries. Its performance in high TB endemic countries and among pregnant women, however, is not well established.

    Methods:We conducted a cross-sectional study of HIV-negative women seeking prenatal care at a public government hospital in Pune, India, from January to May 2011. Trained counselors and nurses administered a questionnaire including sociodemographic information, medical and TB symptom history. Women with negative TB symptom screens received TST and QGIT testing.  Agreement was measured using the kappa statistic, and % positivity with binomial exact confidence intervals was estimated for TST and QGIT. 

    Results: The median gestational age was 26 weeks (IQR: 23-29). Of the 132 women enrolled, 121 had their TST read and 20% were positive (95% CI 13%-27%). Eleven (8%) did not return for TST reading. Thirty-five percent were QGIT positive (95% CI 23%-41%). There was 75.4% agreement between the two tests (kappa= 0.41). Twenty-nine had discordant results. Four women reported a history of known TB exposure and one had a history of prior TB.

     

    TST+

    TST-

    No return

    Total

    QGIT+

    19 (79%)

    24 (25%)

    3 (27%)

     46 (35%)

    QGIT-

      5 (21%)

    70 (72%)

    8 (73%)

     83 (63%)

    QGIT indeterminate

      0

      3 (3%)

    0

       3 (2%)

    Total

    24 (18%)

    97 (73%)

    11 (8%)

    132

    Conclusion: In our cohort, the prevalence of LTBI was 16% if defined as having both a positive TST and QGIT, but varied widely if looking at the results of either test individually. Overall TST and QGIT had fair-to-moderate concordance. Loss-to follow-up remained a challenge for the TST. Longitudinal follow-up of those with discordant results may help determine which test has a higher predictive value during pregnancy in high endemic countries.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Jyoti Mathad, MD1, Pradeep Sambarey, MD, PhD2, Renu Bharadwaj, MD2, Prasad Deshpande, MSc3, Vikrant Sangar, PhD3, Vandana Kulkarni, MSc3, Savita Kanade, MSc3, Nishi Suryavanshi, PhD3, Vidya Mave, MD, MPH3,4, Nikhil Gupte, PhD3,4, Marshall Glesby, MD, PhD1 and Amita Gupta, MD, MHS3,4, (1)Division of Infectious Diseases, Weill Cornell Medical College- New York Presbyterian Hospital, New York, NY, (2)Byramjee Jeejeebhoy Medical Center-Sassoon Hospital, Pune, India, (3)Byramjee Jeejeebhoy Medical Center-Johns Hopkins University Clinical Trials Unit, Pune, India, (4)Johns Hopkins University School of Medicine, Baltimore, MD

    Disclosures:

    J. Mathad, None

    P. Sambarey, None

    R. Bharadwaj, None

    P. Deshpande, None

    V. Sangar, None

    V. Kulkarni, None

    S. Kanade, None

    N. Suryavanshi, None

    V. Mave, None

    N. Gupte, None

    M. Glesby, Pfizer: Investigator and Scientific Advisor, Consulting fee and Research support

    A. Gupta, Gilead Foundation: Grant Investigator, Research grant

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