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The interferon-gamma release assay (IGRA) was significantly more sensitive than a tuberculin skin test as an adjunct tuberculosis diagnosis of children aged 5 years and older, according to data from a population-based study of 778 cases.

IGRAs have shown greater specificity than tuberculin skin tests (TSTs), but data on their sensitivity to TB in children are limited, wrote Alexander W. Kay, MD, of the California Department of Public Health and his colleagues in a study published in Pediatrics.

CDC/James Archer
The researchers reviewed data on children and teens aged 18 years and younger from the California TB registry for 2010-2015. Of 778 reported cases of TB, 360 were laboratory confirmed, and 95 children had both an IGRA and TST with complete results. Of these, IGRA was significantly more sensitive than TST (96% vs. 83%) in children aged 5-18 years. The sensitivities of IGRA and TST were similar in children aged 2-4 years (91% for both) and not significantly different in children younger than 2 years (80% vs. 87%, respectively).

Children younger than 1 year of age and those with CNS disease were significantly more likely to have indeterminate IGRA results, the researchers noted.

The study results were limited by the use of mainly enzyme-linked immunosorbent assay–based IGRA, which limited the data on enzyme-linked immunospot tests, the researchers said. The findings also were limited by the small number of children younger than 5 years.

However, the study is the largest North American analysis of IGRA in children, and based on the findings, “we argue that an IGRA should be considered the test of choice when evaluating children 5-18 years old for TB disease in high-resource, low-TB burden settings,” Dr. Kay and his associates wrote.

The study was funded by the Centers for Disease Control and Prevention. Coauthor Shamim Islam, MD, disclosed financial support from Qiagen, maker of the QuantiFERON test. Dr. Kay and the other investigators had no financial conflicts to disclose.

SOURCE: Kay A et al. Pediatrics. 2018 May 4. doi: 10.1542/peds.2017-3918.

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The interferon-gamma release assay (IGRA) was significantly more sensitive than a tuberculin skin test as an adjunct tuberculosis diagnosis of children aged 5 years and older, according to data from a population-based study of 778 cases.

IGRAs have shown greater specificity than tuberculin skin tests (TSTs), but data on their sensitivity to TB in children are limited, wrote Alexander W. Kay, MD, of the California Department of Public Health and his colleagues in a study published in Pediatrics.

CDC/James Archer
The researchers reviewed data on children and teens aged 18 years and younger from the California TB registry for 2010-2015. Of 778 reported cases of TB, 360 were laboratory confirmed, and 95 children had both an IGRA and TST with complete results. Of these, IGRA was significantly more sensitive than TST (96% vs. 83%) in children aged 5-18 years. The sensitivities of IGRA and TST were similar in children aged 2-4 years (91% for both) and not significantly different in children younger than 2 years (80% vs. 87%, respectively).

Children younger than 1 year of age and those with CNS disease were significantly more likely to have indeterminate IGRA results, the researchers noted.

The study results were limited by the use of mainly enzyme-linked immunosorbent assay–based IGRA, which limited the data on enzyme-linked immunospot tests, the researchers said. The findings also were limited by the small number of children younger than 5 years.

However, the study is the largest North American analysis of IGRA in children, and based on the findings, “we argue that an IGRA should be considered the test of choice when evaluating children 5-18 years old for TB disease in high-resource, low-TB burden settings,” Dr. Kay and his associates wrote.

The study was funded by the Centers for Disease Control and Prevention. Coauthor Shamim Islam, MD, disclosed financial support from Qiagen, maker of the QuantiFERON test. Dr. Kay and the other investigators had no financial conflicts to disclose.

SOURCE: Kay A et al. Pediatrics. 2018 May 4. doi: 10.1542/peds.2017-3918.

 

The interferon-gamma release assay (IGRA) was significantly more sensitive than a tuberculin skin test as an adjunct tuberculosis diagnosis of children aged 5 years and older, according to data from a population-based study of 778 cases.

IGRAs have shown greater specificity than tuberculin skin tests (TSTs), but data on their sensitivity to TB in children are limited, wrote Alexander W. Kay, MD, of the California Department of Public Health and his colleagues in a study published in Pediatrics.

CDC/James Archer
The researchers reviewed data on children and teens aged 18 years and younger from the California TB registry for 2010-2015. Of 778 reported cases of TB, 360 were laboratory confirmed, and 95 children had both an IGRA and TST with complete results. Of these, IGRA was significantly more sensitive than TST (96% vs. 83%) in children aged 5-18 years. The sensitivities of IGRA and TST were similar in children aged 2-4 years (91% for both) and not significantly different in children younger than 2 years (80% vs. 87%, respectively).

Children younger than 1 year of age and those with CNS disease were significantly more likely to have indeterminate IGRA results, the researchers noted.

The study results were limited by the use of mainly enzyme-linked immunosorbent assay–based IGRA, which limited the data on enzyme-linked immunospot tests, the researchers said. The findings also were limited by the small number of children younger than 5 years.

However, the study is the largest North American analysis of IGRA in children, and based on the findings, “we argue that an IGRA should be considered the test of choice when evaluating children 5-18 years old for TB disease in high-resource, low-TB burden settings,” Dr. Kay and his associates wrote.

The study was funded by the Centers for Disease Control and Prevention. Coauthor Shamim Islam, MD, disclosed financial support from Qiagen, maker of the QuantiFERON test. Dr. Kay and the other investigators had no financial conflicts to disclose.

SOURCE: Kay A et al. Pediatrics. 2018 May 4. doi: 10.1542/peds.2017-3918.

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Key clinical point: The IGRA is significantly more sensitive than the TST for adjunct tuberculosis diagnosis in children aged 5 years and older.

Major finding: Sensitivity was 96% for IGRA versus 83% for TST among children aged 5-18 years.

Study details: The data come from TB patients aged 18 years and younger enrolled in the California TB registry during 2010-2015.

Disclosures: The study was funded by the Centers for Disease Control and Prevention. Coauthor Shamim Islam, MD, disclosed financial support from Qiagen, maker of the QuantiFERON test; Dr. Kay and the other investigators had no financial conflicts to disclose.

Source: Kay A et al. Pediatrics. 2018 May 4. doi: 10. 1542/ peds. 2017- 3918.

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