Enzyme-linked immunospot and tuberculin skin testing to detect latent tuberculosis infection

被引:97
|
作者
Shams, H
Weis, SE
Klucar, P
Lalvani, A
Moonan, PK
Pogoda, JM
Ewer, K
Barnes, PF
机构
[1] Univ Texas Hlth Ctr, CPIDC, Tyler, TX 75708 USA
[2] Univ Texas Hlth Ctr, Dept Microbiol & Immunol, Tyler, TX 75708 USA
[3] Univ Texas Hlth Ctr, Dept Med, Tyler, TX 75708 USA
[4] Univ N Texas, Hlth Sci Ctr, Dept Internal Med, Ft Worth, TX 76107 USA
[5] Univ Oxford, Nuffield Dept Clin Med, Oxford, England
[6] John Radcliffe Hosp, Oxford OX3 9DU, England
关键词
blood test; contact investigation; diagnosis;
D O I
10.1164/rccm.200505-748OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Diagnosis of latent tuberculosis infection (LTBI) is currently based on the tuberculin skin test. The enzyme-linked immunospot assay (ELISPOT) is a new blood test to diagnose LTBI. Objective: To compare the ELISPOT and the tuberculin skin test for detecting LTBI in contacts of patients with tuberculosis. Methods: Prospective study of 413 contacts of patients with tuberculosis. Measurements and Main Results: Because there is no gold standard for LTBI, the sensitivity and specificity of the ELISPOT and tuberculin skin test cannot be directly measured. For each contact, we therefore estimated the likelihood of having LTBI by calculating a contact score that quantified exposure to and infectiousness of the index case. We analyzed the relationship of contact score to ELISPOT and tuberculin skin test results. The likelihood of a positive ELISPOT (p = 0.0005) and a tuberculin skin test (p = 0.01) increased significantly with rising contact scores. The contact score was more strongly related to the ELISPOT than to the tuberculin skin test results, although this difference was not statistically significant. Among U.S.-born persons and those who were not vaccinated with bacille Calmette-Guerin, approximately 30% had positive ELISPOT or tuberculin skin test results. Foreign-born, bacille Calmette-Guerin-vaccinated persons were significantly more likely to have a positive tuberculin skin test than a positive ELISPOT result (p < 0.0001). Conclusions: Compared with the tuberculin skin test, the ELISPOT appears to be at least as sensitive for diagnosis of LTBI in contacts of patients with tuberculosis.
引用
收藏
页码:1161 / 1168
页数:8
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