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Enzyme-linked Immunospot Assay (ELISPOT): Quantification of Th-1 Cellular Immune Responses Against Microbial Antigens
Published on: November 23, 2010
Can ELISpot replace the tuberculin skin test for latent tuberculosis?
1Inflammatory Bowel Disease, Royal Free Hospital NHS Trust, London.
British Journal of Nursing (Mark Allen Publishing)
|January 19, 2010
Summary
Screening for latent tuberculosis infection (LTBI) before anti-tumour necrosis factor alpha (anti-TNF-alpha) therapy is crucial. The ELISpot test shows promise for diagnosing LTBI in patients on corticosteroids, outperforming the tuberculin skin test (TST).
Area of Science:
- Immunology
- Infectious Diseases
- Rheumatology
Background:
- Screening for latent tuberculosis infection (LTBI) before anti-tumour necrosis factor alpha (anti-TNF-alpha) therapy significantly reduces active tuberculosis (TB) incidence.
- Conventional LTBI screening (clinical history, chest X-ray, tuberculin skin test [TST]) has limitations, especially in immunosuppressed patients.
Purpose of the Study:
- To evaluate the evidence quality of the interferon gamma release assay (ELISpot test) for diagnosing LTBI before anti-TNF-alpha therapy.
- To assess the agreement between ELISpot and TST in this patient population.
Main Methods:
- A systematic literature search was conducted using Ovid Medline, Embase, and the Cochrane library.
- Search terms included tuberculosis, anti-TNF-alpha agents, TST, and interferon-gamma release assay (ELISpot).
Main Results:
- ELISpot is more sensitive and specific than TST in patients on corticosteroids, avoiding cross-reactions with Bacillus Calmette-Guérin (BCG) vaccination.
- Discordance between TST and ELISpot is higher in BCG-vaccinated individuals taking corticosteroids.
- Fair agreement was observed between TST and ELISpot (72.8% agreement, kappa value=0.38).
Conclusions:
- Reactivation of LTBI post anti-TNF therapy remains a concern, though screening mitigates the risk.
- Further research is needed on the cost-effectiveness and sensitivity of ELISpot versus TST in clinical practice.
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