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Comparison of Two Interferon-Gamma Release Assays for Pediatric Tuberculosis Infection

James T Gaensbauer1,2, Randall R Reves3, Dolly Katz4

  • 1Mayo Clinic Center for Tuberculosis, Mayo Clinic, Rochester, MN, United States.

Journal of the Pediatric Infectious Diseases Society
|January 3, 2025
PubMed

Insights

In pediatric tuberculosis infection testing, QuantiFERON-TB Gold In-Tube (QFT-GIT) showed more positive results than T-SPOT.TB (T-SPOT), with differences unrelated to borderline test values.

Area of Science:

  • Pediatric infectious diseases
  • Immunology
  • Diagnostic test performance

Background:

  • Interferon-gamma release assays (IGRAs) are crucial for identifying tuberculosis infection (TBI) to prevent pediatric tuberculosis (TB).
  • Limited comparative data exist for the two main IGRAs in US pediatric populations.
  • This study addresses the need for comparative performance data of T-SPOT.TB and QuantiFERON-TB Gold In-Tube in children.

Purpose of the Study:

  • To compare the performance of T-SPOT.TB and QuantiFERON-TB Gold In-Tube (QFT-GIT) in a large US pediatric cohort.
  • To investigate if quantitative results near test cutoffs explain discordance between the two IGRAs.
  • To provide data for informed clinical and public health decisions regarding pediatric TBI screening.

Main Methods:

  • A US multicenter study identified 3793 children (aged 0-15 years) tested with both T-SPOT.TB and QFT-GIT.
  • Results were compared using McNemar's Chi-square tests, stratified by age and testing reason.
  • Quantitative results of discordant cases were analyzed to assess proximity to test cutoffs.

Main Results:

  • QFT-GIT yielded a higher positivity rate (10.1%) compared to T-SPOT.TB (7.4%) (P < .001).
  • This difference was consistent across most age groups and testing indications.
  • Discordance was not explained by results near the standard cutoffs for either test.

Conclusions:

  • QFT-GIT demonstrated a higher proportion of positive tuberculosis infection test results than T-SPOT.TB in this pediatric cohort.
  • The observed discordance between the two IGRAs was not attributable to quantitative results falling close to the diagnostic thresholds.
  • Findings highlight differences in IGRA performance in children and suggest further investigation into discordance factors.
Abstract

Keywords:
QuantiFERON-TB Gold In-TubeT-SPOT.TBchildrenpediatrictuberculosistuberculosis infection

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