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Borderline QuantiFERON results and the distinction between specific responses and test variability.
Jonathan W Uzorka1, Ailko W J Bossink2, Willeke P J Franken3
1Department of Infectious Diseases, Leiden University Medical Center, Room C5P-40, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Tuberculosis (Edinburgh, Scotland)
|July 22, 2018
Summary
Borderline QuantiFERON (QFT) results often indicate Mycobacterium tuberculosis (Mtb) infection, not just test variability. These findings are biologically significant, especially for immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Immunology
- Diagnostic Testing
Background:
- QuantiFERON (QFT) results near the cutoff values are often debated.
- Distinguishing between Mycobacterium tuberculosis (Mtb)-specific responses and test variability is crucial for borderline QFT results.
Purpose of the Study:
- To investigate the cause of borderline QuantiFERON (QFT) results.
- To determine if borderline QFT results are due to Mycobacterium tuberculosis (Mtb)-specific responses or test variability.
Main Methods:
- A contact investigation involving 785 BCG-unvaccinated individuals.
- Comparison of tuberculin skin test (TST), QFT, and T-SPOT.TB (T-SPOT) results across different QFT result categories (low-negative, borderline, low-positive, high-positive).
- Assessment of active tuberculosis development over 12 years.
Main Results:
- Borderline QFT results were threefold more common than expected from test variability.
- Individuals with borderline or low-positive QFT results showed significantly higher rates of positive TST and T-SPOT results, indicating probable Mtb infection.
- Seven cases of active tuberculosis were diagnosed during follow-up, with two occurring after a low-positive QFT.
Conclusions:
- Most borderline and low-positive QFT results reflect Mtb-specific immune responses, highlighting their biological significance.
- The clinical relevance of borderline QFT results is particularly pronounced in immunocompromised individuals.
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