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1684
Diagnostic usefulness of IFN-gamma releasing assays in patients with disseminated tuberculosis compared with conventional tests

Session: Poster Abstract Session: Mycobacterial Infection: Screening and Diagnosis
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Rapid diagnosis and treatment for disseminated tuberculosis (TB) are important prognostic factors for patients with disseminated TB. Recently, IFN-gamma releasing assay (IGRA) shows promising results for diagnosis of TB. However, little is known about the usefulness of these assays for diagnosing disseminated TB. We therefore evaluated their usefulness compared with traditional tests in patients with disseminated TB.

Methods: All adult patients with suspected disseminated TB were prospectively enrolled at a tertiary hospital in an intermediate TB-burden country during a 6-year period. Disseminated TB was defined as the involvement of bone marrow, ≥ 2 noncontiguous organs, or the presence of miliary lung lesions.

Results: A total of 101 patients with confirmed and probable disseminated TB were finally analyzed. Of these 101 patients, 52 (52%) were miliary TB and the remaining 49 (48%) were non-miliary disseminated TB. The 29 (29%) patients including 6 HIV patients had immunosuppressive conditions. T-SPOT.TB assay was positive in 90% (91/101). The sensitivity of T-SPOT.TB assay in patients with miliary TB (90%) was similar to that in those with non-miliary TB (90%)(p>0.99). In the subgroup analysis including the 58 patients in whom both QFT-GIT and T-SPOT.TB were available, the sensitivity of QFT-GIT (67%) showed a trend of being lower than that of T-SPOT.TB (90%).

Conclusion: T-SPOT.TB assay may be a helpful adjunct test for disseminated TB.

Table1. Result of diagnostic test for disseminated TB

        °°Diagnostic tool

Total (n=101)

miliary TB      (n=52)

non-miliary TB (n=49)

P

Granulomatous inflammation with/without necrosis seen in biopsy specimen

47/58 (81)

20/24 (83)

27/34 (79)

>0.99

Positive MTB AFB of specimen1

54/229 (24)

31/114 (27)

23/115 (20)

0.54

Positive MTB PCR of specimen1

83/164 (51)

41/85 (48)

42/79 (53)

0.68

Positive MTB culture of specimen1

110/208 (53)

60/100 (60)

50/108 (46)

0.11

Positive MTB AFB in sputum

21/94 (22)

17/51 (33)

4/43 (9)

0.006

Positive MTB PCR in sputum

25/46 (54)

17/31 (55)

8/15 (53)

0.92

Positive MTB culture in sputum

56/94 (60)

37/51 (73)

19/43 (44)

0.005

Positive tuberculin skin test

28/64 (44)

8/32 (25)

20/32 (63)

0.002

Positive QFT-GIT

39/58 (67)2

18/27 (67)3

21/31 (68)4

0.48

Positive T-SPOT.TB

91/101 (90)2

47/52 (90)3

44/49 (90)4

0.99

1)including sputum

2)p = 0.25

3)p = 0.33

4) p = > 0.99

Shi Nae Yu, MD, Sun-Mi Kim, Su Jin Park, PhD, Sang-Oh Lee, MD, Sang-Ho Choi, MD, Yang Soo Kim, MD, Jun Hee Woo, MD and Sung-Han Kim, MD, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

S. N. Yu, None

S. M. Kim, None

S. J. Park, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

S. H. Kim, None

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