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Published on: July 28, 2023
QuantiFERON to diagnose infection by Mycobacterium tuberculosis: performance in infants and older children
Adeline Blandinières1, Agathe de Lauzanne, Valérie Guérin-El Khourouj
1Laboratory of Immunology, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France; Assistance Publique-Hôpitaux de Paris (AP-H), Univ. Paris Diderot, Sorbonne Paris Cité, Paris, France.
Insights
The QuantiFERON-TB Gold In-Tube (QFT-GIT) test shows 100% specificity for diagnosing tuberculosis (TB) in children. Its sensitivity improves with age, but indeterminate results are common in young children with non-TB infections.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Diagnostic Microbiology
Background:
- Diagnosing tuberculosis (TB) in young children presents unique challenges.
- The utility of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test in pediatric populations requires further clarification.
- Understanding QFT-GIT performance across different age groups and clinical scenarios is crucial for accurate TB diagnosis.
Purpose of the Study:
- To evaluate the performance of the QFT-GIT test for diagnosing TB in immunocompetent children.
- To assess how QFT-GIT performance varies with age and clinical conditions in pediatric TB diagnosis.
- To determine the specificity, sensitivity, and rate of indeterminate results of QFT-GIT in children.
Main Methods:
- A study involving 226 immunocompetent children aged 0-15 years.
- Stratification of children into groups: TB contact (uninfected), active TB disease, latent TB infection (LTBI), and TB suspected with alternative diagnosis (TB excluded).
- Analysis of QFT-GIT reactivity and comparison with Tuberculin Skin Test (TST) where applicable.
Main Results:
- QFT-GIT demonstrated 100% specificity in children with TB excluded.
- Sensitivity in active TB disease was low in infants (40%) but increased with age (77% in 1-5 years, 82% in 5-15 years).
- Agreement between QFT-GIT and TST for LTBI was poor in infants (0%) and improved with age (40% to 57%). High indeterminate results (24%) were observed in children under 5 with TB excluded, particularly those with non-TB pneumonitis (61%).
Conclusions:
- QFT-GIT exhibits 100% specificity for TB diagnosis in children.
- QFT-GIT sensitivity in infants with TB is low but comparable to adult values in older children.
- Indeterminate QFT-GIT results in children are often associated with non-TB related infections.
Objectives:
QuantiFERON value to diagnose tuberculosis (TB) in young children remains to be clarified. To this aim QF-TB-IT performance was evaluated in a large series of immunocompetent children that were stratified according to age and clinical conditions.
Methods:
QF-TB-IT reactivity was analyzed in 226 immunocompetent children (0-15 years old): 31 were uninfected despite TB contact; 51 presented TB disease; 39 had Latent TB (LTBI) and 105 had TB disease suspected but an alternative diagnosis (TB excluded).
Results:
QF-TB-IT specificity was 100% in TB excluded. In TB disease, low sensitivity of QF-TB-IT in infants (40%) increased with aging (77% in 1-<5 years and 82% in 5-<15 years old subgroups). In LTBI, agreement between TST and QF-TB-IT was 0% in infants, 40% in 1-<5 years and 57% in children >5 years old. Finally, the incidence of indeterminate results was high (24%) in children <5 years old with TB excluded, especially with non-TB pneumonitis (61%), but was low (0-6%) regardless of age group in TB disease, LTBI and uninfected contact cases.
Conclusions:
In our low burden country, i) QF-TB-IT specificity was 100%, ii) QF-TB-IT sensitivity was low in infants but commensurable to adult values in older children, and iii) indeterminate results mostly relied on ongoing infections unrelated to TB.
