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Discordance between TST and QFT-TBGold Plus for Latent Tuberculosis Screening among Under-Five Children: An Interim

Suchitra Surve1, Vikrant Bhor2, Kajal Naukariya1

  • 1Department of Clinical Research, Indian Council of Medical Research-National Institute of Research in Reproductive Health (ICMR-NIRRH), Mumbai 400012, Maharashtra, India.

Journal of Tropical Pediatrics
|December 14, 2021
PubMed

Insights

The tuberculin skin test (TST) and QuantiFERON (QFT)-TB Gold Plus assay show moderate agreement for diagnosing latent tuberculosis infection (LTBI) in young children. Both tests are recommended for accurate LTBI diagnosis in this vulnerable population.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Latent tuberculosis infection (LTBI) diagnosis in under-five children, particularly those who are undernourished or have contact with active tuberculosis (TB) patients, presents unique challenges.
  • Accurate diagnostic tools are crucial for timely intervention and management of LTBI in this age group.

Purpose of the Study:

  • To evaluate the concordance between the tuberculin skin test (TST) and the fourth-generation QuantiFERON (QFT)-TB Gold Plus interferon gamma release assay (IGRA) for diagnosing LTBI in under-five children.
  • To assess the reliability of these diagnostic methods in undernourished children and those with a history of TB contact.

Main Methods:

  • A cohort of 299 children aged 6 months to 5 years in Mumbai, India, were screened between September 2019 and January 2021.
  • Both TST and QFT-TB Gold Plus (IGRA) tests were administered to diagnose LTBI in children identified through anganwadis and TB Health posts.

Main Results:

  • Out of 299 children, 11.7% tested positive by IGRA and 22.7% by TST, indicating moderate concordance (κ = 0.483) between the two tests.
  • Moderate concordance was observed in children under 24 months (κ = 0.478) and those with TB contact (κ = 0.550).
  • A fair concordance (κ = 0.396) was noted in undernourished children, with 13.0% showing TST-positive/IGRA-negative results.

Conclusions:

  • Both TST and QFT-TB Gold Plus are recommended for LTBI diagnosis in under-five children, with QFT-TB Gold Plus showing reliability in children under 24 months.
  • The study emphasizes the need for screening undernourished children for LTBI and suggests considering repeat IGRA testing for TST-positive cases, especially with ongoing exposure risk.
Abstract

Keywords:
QFT-TB Gold Pluschildreninterferon gamma release assaylatent tuberculosistuberculin skin test

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