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Performance of Current Diagnostic Tools in Detecting Latent Tuberculosis Among Healthcare Workers: A Systematic
Aishwarya R1, Maheshwary D1, Leela Kv1
1Microbiology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Chengalpattu, IND.
Cureus
|November 1, 2024
Summary
This review compares diagnostic tests for latent tuberculosis infection in healthcare workers. CLIA-IGRA shows the highest accuracy, but TST and QuantiFERON remain valuable for specific situations.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Public Health
Background:
- Latent tuberculosis infection (LTBI) diagnosis is crucial for preventing active tuberculosis, especially in high-risk groups like healthcare workers.
- Interferon-gamma release assays (IGRAs) and the Mantoux/tuberculin skin test (TST) are key diagnostic tools for LTBI.
- Systematic evaluations of test characteristics aid diagnosticians, particularly in resource-limited settings.
Purpose of the Study:
- To systematically evaluate and compare the diagnostic accuracy of various tests for latent tuberculosis infection (LTBI) specifically in healthcare workers.
- To identify studies published between 2013 and 2024 focusing on LTBI diagnostics in this population.
Main Methods:
- A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.
- Literature search using keywords: "Latent Tuberculosis," "Healthcare workers," "Diagnostic modalities," "TST," "Interferon-gamma release assays," and "IGRA."
- Independent review of literature by three authors, with discrepancies resolved through discussion.
Main Results:
- CLIA-IGRA demonstrated the highest diagnostic accuracy with 100% sensitivity and 95.57% specificity (AUC=0.97).
- T-SPOT.TB showed 92% sensitivity and 95.7% specificity (AUC=0.7).
- TST had 76.5% sensitivity and 77.2% specificity (AUC=0.72), while QuantiFERON-TB Gold In-Tube (QFT-GIT) had 68.35% sensitivity and 82.32% specificity (AUC=0.767).
Conclusions:
- CLIA-IGRA is a highly accurate test for LTBI diagnosis in healthcare workers, though availability and cost may limit its use.
- TST and QuantiFERON assays remain relevant and useful diagnostic tools, particularly when their performance aligns with clinical needs and resource availability.
- The choice of LTBI diagnostic test should consider a balance between accuracy, practicality, and specific population requirements.
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