Open AccessInterferon gamma release assay in diagnosis of pediatric tuberculosis: a meta‐analysis
Author(s) -
Sun Lin,
Xiao Jing,
Miao Qing,
Feng Weixing,
Wu Xirong,
Yin Qingqin,
Jiao Weiwei,
Shen Chen,
Liu Fang,
Shen Dan,
Shen Adong
Publication year - 2011
Publication title -
fems immunology & medical microbiology
Language(s) - English
Resource type - Journals
eISSN - 1574-695X
pISSN - 0928-8244
DOI - 10.1111/j.1574-695x.2011.00838.x
Subject(s) - elispot , tuberculin , medicine , tuberculosis , latent tuberculosis , meta analysis , vaccination , immunology , quantiferon , bcg vaccine , interferon gamma release assay , interferon gamma , tuberculosis diagnosis , mycobacterium tuberculosis , t cell , pathology , cytokine , immune system
Although interferon gamma release assays ( IGRA s) have been widely used for the diagnosis of latent and active tuberculosis in adults, a relative lack of validation studies in children has led to caution in their clinical interpretation. This meta‐analysis systematically evaluated two IGRA s ( ELISA and ELISPOT ) and the tuberculin skin test ( TST ). We searched databases ( P ub M ed, MEDLINE , O vid) between January 2000 and January 2011 using search terms of latent tuberculosis infection or tuberculosis and interferon gamma release assay, or T‐ SPOT . TB test, or Quanti FERON ‐ TB G old, or ESAT ‐6, or CFP ‐10, and child, or childhood, or pediatrics. We also collected data by performing a manual search of references from relevant articles and communicating with selected authors. The meta‐analysis was conducted with random effects models to account for heterogeneity between selected studies. The sensitivities of all three tests in active tuberculosis were similar. The pooled sensitivity was 70% for ELISA studies, 62% for ELISPOT studies and 71% for TST . Calculated sensitivities for IGRA s and the TST differ in culture‐confirmed tuberculosis [ ELISA (85%) vs. ELISPOT (76%) vs. TST (85%)] and clinical diagnosed cases [ ELISA (64%) vs. ELISPOT (58%) vs. TST (66%)]. The pooled specificity was 100% for ELISA and 90% for ELISPOT , but was much lower for TST [56% in all included studies and 49% in children with bacillus Calmette‐Guerin ( BCG ) vaccination]. The agreement between the TST and IGRA s in non‐ BCG ‐vaccinated children is higher than that in BCG ‐vaccinated children. In the diagnosis of active tuberculosis in children, the TST and IGRA s have similar sensitivity. By contrast, the specificity of IGRA s is far greater than the TST , particularly in children with previous BCG vaccination.