Clinical evaluation of QuantiFERON TB-2G test for immunocompromised patients

¹ Division of Respiratory Diseases, Dept of Medicine, Kawasaki Medical School, Kurashiki, Japan

^* To whom correspondence should be addressed. E-mail: yoshihiro{at}med.kawasaki-m.ac.jp.

	Abstract

We compared the usefulness of tuberculin skin test (TST) and QuantiFERON TB-2G (QFT-TB) test in immunocompromised patients.

The subjects were 252 immunocompromised patients who were clinically suspected of tuberculosis (TB) infection between April 2005 and December 2006.

Regarding the underlying diseases, 74 had malignant diseases, 72 were undergoing immunosuppressive treatment, 52 had diabetes mellitus, 50 had chronic renal failure, and four had HIV infection. While the positive rate of the QFT-TB test for the diagnosis of TB infection (TB disease or latent tuberculosis infection) was 78.1%, that of TST for TB infection was 50.0%. The QFT-TB test was significantly better than TST. However, thirty-two patients (13%) had an indeterminate QFT-TB result. Indeterminate findings were significantly more frequent in patients receiving immunosuppressive treatment (28%), especially with lymphocytopenia in the peripheral blood, than in those who had other underlying diseases. While the result of TST positive and QFT-TB test negative were recognized in immunocompromised patients with BCG vaccination or nontuberculous mycobacterial (NTM) disease, the result of TST negative and QFT-TB test positive were recognized in immunocompromised patients with a past history of TB infection.

We concluded that the QFT-TB test is a more useful diagnostic method for TB infection than TST for immunocompromised patients suspected of TB disease. However, because the results of the QFT-TB test show an indeterminate response for patients receiving immunosuppressive treatment, especially for those with lymphocytopenia due to severe underlying diseases, care must be taken in the interpretation of the QFT-TB test for these patients.

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