Download PDF
Pneumologie 2015; 69(05): 271-275
DOI: 10.1055/s-0034-1391919
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Fragestellungen zum Tuberkulose-Screening mit Interferon-Gamma-Release Assays (IGRAs)

Current Issues Arising from Tuberculosis Screening with Interferon-Gamma-Release Assays (IGRAs)
R. Diel
1   Institut für Epidemiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
2   Lungenclinic Grosshansdorf, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), ARCN, Großhansdorf
,
A. Nienhaus
3   IVDP – Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg
4   Fachbereich Gesundheitsschutz, Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, Hamburg
› Author Affiliations
Further Information

Publication History

eingereicht 20 February 2015

akzeptiert nach Revision 14 May 2015

Publication Date:
13 May 2015 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Ein positiver IGRA-Test ist nicht per se gleichbedeutend mit einer latenten Tuberkuloseinfektion (LTBI), sondern die Interpretation der Testergebnisse hängt wesentlich von der Prävalenz der LTBI im jeweils getesteten Kollektiv ab. Bei wiederholtem Testen von Beschäftigten im Gesundheitswesen (BiG) ist vermehrt mit Variabilitäten des Testergebnisses (Konversionen und Reversionen) zu rechnen. Es ist daher sinnvoll, nur diejenigen Personen zu testen, bei denen ein erhöhtes Risiko für eine vorausgehende Infektion mit Mycobacterium tuberculosis (M.tb.) besteht bzw. eine signifikante Exposition gegenüber einem Patienten mit infektiöser Tuberkulose (TB) angenommen werden kann. Positive IGRA-Befunde können die Entwicklung zur aktiven Erkrankung nur unbefriedigend vorhersagen. Bei Kleinkindern sind IGRAs dem Tuberkulinhauttest (THT) nach aktuellem Kenntnisstand nicht überlegen.

Abstract

A positive IGRA test does not always indicate a latent tuberculosis infection (LTBI); the prevalence of LTBI in the tested collective must be carefully considered in test interpretation. When IGRAs are performed repeatedly in healthcare workers (BiG), variabilities of test results (conversions and reversions of the respective previous negative or positive result) can be expected. Therefore only individuals for whom there is an established risk of being infected by Mycobacterium tuberculosis (M.tb.), i. e. significantly prolonged direct exposure to an infectious TB case, should be tested.

Positive IGRA results alone do not reliably predict subsequent progression to active TB disease. According to the current body of scientific knowledge, IGRAs are not superior to the tuberculin skin test (TST) in the case of young children.

 

  • Literatur

  • 1 Diel R, Loddenkemper R, Zellweger JP et al. Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination. Eur Respir J 2013; 42: 785-801
    CrossrefPubMedSearch in Google Scholar
  • 2 Schaberg T, Bauer T, Castell S et al. [Recommendations for therapy, chemoprevention and chemoprophylaxis of tuberculosis in adults and children. German Central Committee against Tuberculosis (DZK), German Respiratory Society (DGP)]. Pneumologie 2012; 66: 133-171
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 World Health Organization. Guidelines on the management of latent tuberculosis infection. Geneva Switzerland: 2015 (WHO/HTM/TB/2015.01)
    PubMedSearch in Google Scholar
  • 4 American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000; 161: S221-S247
    CrossrefPubMedSearch in Google Scholar
  • 5 Diel R, Goletti D, Ferrara G et al. Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis. Eur Respir J 2011; 37: 88-99
    CrossrefPubMedSearch in Google Scholar
  • 6 Diel R, Loddenkemper R, Nienhaus A. Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis. Chest 2010; 137: 952-968
    CrossrefPubMedSearch in Google Scholar
  • 7 Diel R, Loytved G, Nienhaus A et al. Neue Empfehlungen des Deutschen Zentralkomitees (DZK) für die Umgebungsuntersuchungen bei Tuberkulose. Pneumologie 2011; 65: 359-378
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Diel R, Loddenkemper R, Meywald-Walter K et al. Comparative performance of tuberculin skin test, QuantiFERON-TB-Gold In Tube assay, and T-Spot. TB test in contact investigations for tuberculosis. Chest 2009; 135: 1010-1018
    CrossrefPubMedSearch in Google Scholar
  • 9 Schablon A, Harling M, Diel R et al. Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study. BMC Infect Dis 2010 10: 107
    PubMed
  • 10 Sloot R, Schim van der Loeff MF, Kouw PM et al. Risk of tuberculosis after recent exposure. A 10-year follow-up study of contacts in Amsterdam. Am J Respir Crit Care Med 2014; 190: 1044-1052
    CrossrefPubMedSearch in Google Scholar
  • 11 Rangaka MX, Wilkinson KA, Glynn JR et al. Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12: 45-55
    CrossrefPubMedSearch in Google Scholar
  • 12 Diel R, Loddenkemper R, Nienhaus A. Predictive value of interferon-γ release assays and tuberculin skin testing for predicting progression from latent TB infection to disease state: a meta-analysis. Chest 2012; 142: 63-75
    CrossrefPubMedSearch in Google Scholar
  • 13 Sester M, van Leth F, Bruchfeld J et al. Risk assessment of tuberculosis in immunocompromised patients. A TBNET study. Am J Respir Crit Care Med 2014; 190: 1168-1176
    CrossrefPubMedSearch in Google Scholar
  • 14 Altet N, Dominguez J, de Souza-Galvão M-L et al. Predicting the development of tuberculosis with the tuberculin skin test and QuantiFERON testing. AnnalsATS 2015; [Epub ahead of print]
    PubMedSearch in Google Scholar
  • 15 Diel R, Seidler A, Nienhaus A et al. Occupational risk of tuberculosis transmission in a low incidence area. Respir Res 2005; 6: 35-45
    CrossrefPubMedSearch in Google Scholar
  • 16 Nienhaus A, Brandenburg S, Teschler H Hrsg. Tuberkulose als Berufskrankheit – Ein Leitfaden zur Begutachtung und Vorsorge. 3. Auflage Heidelberg: Ecomed; 2012
    Search in Google Scholar
  • 17 Nardell EA, Wallis RS. Here today--gone tomorrow: the case for transient acute tuberculosis infection. Am J Respir Crit Care Med 2006; 174: 734-735
    CrossrefPubMedSearch in Google Scholar
  • 18 Perry S, Sanchez L, Yang S et al. Reproducibility of QuantiFERON-TB gold in-tube assay. Clin Vaccine Immunol 2008; 15: 425-432
    CrossrefPubMedSearch in Google Scholar
  • 19 Andrews JR, Hatherill M, Mahomed H et al. The Dynamics of QuantiFERON®-TB Gold In-Tube Conversion and Reversion in a Cohort of South African Adolescents. Am J Respir Crit Care Med 2015; [Epub ahead of print]
    PubMedSearch in Google Scholar
  • 20 Pai M, Joshi R, Dogra S et al. T-cell assay conversions and reversions among household contacts of tuberculosis patients in rural India. Int J Tuberc Lung Dis 2009; 13: 84-92
    PubMedSearch in Google Scholar
  • 21 Dorman SE, Belknap R, Graviss EA et al. Tuberculosis Epidemiologic Studies Consortium. Interferon-g release assays and tuberculin skin testing for diagnosis of latent tuberculosis infection in healthcare workers in the United States. Am J Respir Crit Care Med 2014; 189: 77-87
    PubMedSearch in Google Scholar
  • 22 Johi M, Monson TP, Johi A et al. IFN-y release assay conversions and reversions. Challenges with serial testing in U.S. health care workers. Ann Am Thorac Soc 2014; 11: 296-302
    PubMedSearch in Google Scholar
  • 23 Zellweger JP, Rieder HL. Serial screening for latent tuberculosis infection in healthcare workers in low-risk settings. Am J Respir Crit Care Med 2014; 189: 3-4
    PubMedSearch in Google Scholar
  • 24 Pai M, Banaei N. Occupational screening of health care workers for tuberculosis infection: tuberculin skin testing or interferon-γ release assays?. Occup Med (Lond) 2013; 63: 458-460
    CrossrefPubMedSearch in Google Scholar
  • 25 Schluger NW, Burzynski J. Variability in interferon gamma release assay results and screening for tuberculosis. A way forward? . Ann Am Thorac Soc 2014; 11: 1256-1257
    PubMedSearch in Google Scholar
  • 26 Sollai S, Galli L, de Martino M et al. Systematic review and meta-analysis on the utility of Interferon-gamma release assays for the diagnosis of Mycobacterium tuberculosis infection in children: a 2013 update. BMC Infect Dis 2014; 14 (Suppl. 01) S6
    PubMedSearch in Google Scholar
  • 27 Mandalakas AM, Kirchner HL, Walzl G et al. Optimizing the Detection of Recent Tuberculosis Infection in Children in a High TB-HIV Burden Setting. Am J Respir Crit Care Med 2015; [Epub ahead of print]
    PubMedSearch in Google Scholar
  • 28 Hermansen T, Lillebaek T, Hansen AB et al. QuantiFERON–TB Gold In-Tube test performance in Denmark. Tuberculosis (Edinb) 2014; 94: 616-621
    CrossrefPubMedSearch in Google Scholar
  • 29 Riazi S, Zeligs B, Yeager H et al. Rapid diagnosis of Mycobacterium tuberculosis infection in children using interferon-gamma release assays (IGRAs). Allergy Asthma Proc 2012; 33: 217-226
    CrossrefPubMedSearch in Google Scholar