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Reduced sensitivity of the QuantiFERON(®) test in diabetic patients with smear-negative tuberculosis
J C Choi1, L G Jarlsberg2, J A Grinsdale3
1Curry International Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco General Hospital, San Francisco, California, USA; Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, South Korea.
Setting:
Immunosuppressive conditions have been associated with low sensitivity of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for the diagnosis of tuberculosis (TB). However, no systematic analysis of patient and bacterial characteristics has been performed before.
Objective:
To determine the sensitivity and the risk factors for false-negative QuantiFERON(®)-TB (QFT) assay and TST in TB patients.
Design:
We performed a retrospective analysis of data collected in a community-based study of TB in San Francisco, CA, USA. We included 300 TB patients who underwent QFT and TST.
Results:
The risk factors for false-negative QFT were human immunodeficiency virus infection and the use of QuantiFERON(®)-TB Gold. In patients with sputum smear-negative TB, diabetes mellitus (DM) was associated with false-negative QFT (OR 2.85, 95%CI 1.02-7.97, P = 0.045). TST sensitivity was higher than QFT sensitivity in DM patients (OR 9.46, 95%CI 2.53-35.3).
Conclusions:
In San Francisco, QFT sensitivity was lower than that of TST, especially in patients with DM. Stratified analysis by sputum smear results showed that this association was specific to smear-negative TB. In contrast, TST was not affected by the presence of DM.
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