Open AccessPerformance of Interferon‐Gamma Release Assays for Tuberculosis Screening in Pediatric Inflammatory Bowel Disease
Author(s) -
Stevens James P.,
Ballengee Cortney R.,
Chandradevan Raguraj,
Thompson Amelia B.,
Schoen Bess T.,
Kugathasan Subra,
Sauer Cary G.
Publication year - 2019
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002428
Subject(s) - medicine , interferon gamma release assay , latent tuberculosis , tuberculosis , inflammatory bowel disease , retrospective cohort study , indeterminate , quantiferon , disease , population , cohort , mycobacterium tuberculosis , pathology , mathematics , environmental health , pure mathematics
Objectives: The aim of the study was to analyze the diagnostic accuracy and utility of QuantiFERON‐TB Gold In‐Tube, an interferon‐gamma release assay (IGRA), as a screening tool for latent tuberculosis infection (LTBI) in pediatric patients with inflammatory bowel disease (IBD) undergoing treatment with anti‐tumor necrosis factor (anti‐TNF) medications. To describe cases of tuberculosis in the pediatric IBD population, TB treatment courses, outcomes, and their effect on IBD management. Methods: A single‐center, retrospective cohort study of pediatric IBD patients who underwent tuberculosis screening. IGRA testing from 2011 to 2017 were analyzed to determine result rates, characteristics, and outcomes. Results: One thousand seven hundred fifty‐four (1,754) tests were performed on 859 patients. One thousand six hundred thirty‐four (1,634) tests were negative, 9 were positive, and 111 were indeterminate. Eight of 9 positive tests resulted during repeat annual screening while receiving IBD treatment. Five patients were treated for latent tuberculosis infection (LTBI), and 4 were false‐positives. IBD therapy was interrupted in 3 patients, with no negative long‐term outcomes. We report 1 known false‐negative, in a patient who developed disseminated TB on anti‐TNF therapy. Indeterminate testing rates were higher at IBD diagnosis than during treatment (10.3% vs 5.3%, P < 0.001). Follow‐up testing of indeterminate results was negative in all patients retested, with 14 patients lost to follow‐up. No patient with indeterminate testing developed TB. Conclusions: IGRAs are a useful tool to screen for LTBI, both before anti‐TNF therapy and during treatment. Results should be used in concert with detailed history and examination. Positive and indeterminate results should be promptly repeated for timely TB diagnosis and to minimize interruptions in IBD therapy.