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T cell-based diagnosis of childhood tuberculosis infection

Ajit Lalvani1, Kerry A Millington

  • 1Tuberculosis Immunology Group, Department of Respiratory Medicine, National Heart and Lung Institute, Wright-Fleming Institute of Infection & Immunity, Imperial College London, London, UK. a.lalvani@imperial.ac.uk

Current Opinion in Infectious Diseases
|May 2, 2007
PubMed

Insights

T-cell interferon-gamma release assays (TIGRAs) offer improved tuberculosis diagnosis in children compared to the tuberculin skin test (TST). These blood tests, ELISpot and ELISA, show higher specificity and sensitivity, especially ELISpot, aiding pediatric tuberculosis management.

Area of Science:

  • Pediatric Infectious Diseases
  • Immunology
  • Diagnostic Microbiology

Background:

  • Tuberculin skin test (TST) is a traditional method for tuberculosis infection diagnosis.
  • Bacille Calmette-Guérin (BCG) vaccination status can affect TST results.
  • There is a need for more accurate diagnostic tools for pediatric tuberculosis.

Purpose of the Study:

  • To review publications on T-cell interferon-gamma release assays (TIGRAs) in children.
  • To evaluate the advantages and limitations of TIGRAs (ELISpot and ELISA) compared to TST.
  • To inform pediatricians about the utility of these novel blood tests for tuberculosis diagnosis.

Main Methods:

  • Systematic review of studies utilizing TIGRAs in pediatric populations.
  • Comparative analysis of ELISpot and ELISA performance against TST.
  • Assessment of TIGRA results in relation to tuberculosis infection, exposure, and clinical factors.

Main Results:

  • TIGRAs are independent of BCG vaccination, offering higher specificity than TST.
  • ELISpot demonstrates higher sensitivity than TST in children with active tuberculosis, unaffected by HIV, age, or malnutrition.
  • ELISpot correlates better with tuberculosis exposure than TST; ELISA shows similar correlation.
  • Indeterminate results are less frequent with ELISpot than ELISA in young children.

Conclusions:

  • TIGRAs, particularly ELISpot, present significant advantages over TST for diagnosing pediatric tuberculosis.
  • While further longitudinal studies are needed, current evidence supports the judicious clinical use of TIGRAs.
  • National guidelines increasingly recommend TIGRAs for managing childhood tuberculosis.
Abstract

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