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Published online before print October 24, 2007
Eur Respir J 2007, doi:10.1183/09031936.00054707
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ORIGINAL ARTICLE

Comparison of T-Spot.TB and tuberculin skin test among silicotic patients

C.C. Leung 1*, W.C. Yam 2, W.W. Yew 3, P.L. Ho 2, C.M. Tam 1, W.S. Law 1, M.Y. Wong 1, M. Leung 1, D. Tsui 1

1 Tuberculosis and Chest Service, Centre for Health Protection, Dept of Health, Hong Kong, China
2 Dept of Microbiology and Centre of Infection, University of Hong Kong, Hong Kong, China
3 Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China

* To whom correspondence should be addressed. E-mail: cc_leung{at}dh.gov.hk.


  Abstract

T-Spot.TB and tuberculin skin test were compared in the screening of latent tuberculosis infection among silicotic patients.

A conditional probability model was used to compare the potential clinical utilities of T-Spot.TB and tuberculin test performed on 134 silicotic subjects from 1 December 2004 to 31 January 2007. Data from a historical cohort were also reanalyzed for further comparison.

Agreement with T-Spot.TB was best using a tuberculin test cutoff of 10mm (kappa=0.432). Age ≥65 independently predicted a tuberculin reaction <10mm (odds ratio: 3.00) but not negative T-Spot.TB response. Lower kappa measures were observed among current smokers and those aged ≥65. Tuberculin reaction size was well correlated with both ESAT6 and CFP10 spot counts, except among current smokers. Within the current estimates of sensitivity (88–95%) and specificity (86–99%) for T-Spot.TB, the positive likelihood ratio for T-Spot.TB test would be substantially higher (6.29–95.0 vs 1.65–1.94) and negative likelihood ratio substantially lower (0.05–0.14 vs 0.32–0.41) than the corresponding ratios for the tuberculin test. A low TB risk differential was similarly observed between tuberculin-negative and untreated tuberculin-positive subjects in the historical cohort.

T-Spot.TB is likely to perform better than tuberculin test in the screening of latent tuberculosis infection among silicotic subjects.

Keywords:  Latent tuberculosis infection, silicosis, smoking




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