Table 4– Approaches to diagnose latent tuberculosis (TB) Infection
AssayModalityAntigen/sPathogenetic principleDiagnostic features and progression to TBVisits nReading hDiagnostic pitfalls
TSTIn vivoTuberculin (combination of mycobacterial proteins obtained from the supernatant of M. tuberculosis cultureIdentification of a cellular immune response after the intra-dermal inoculation of tuberculinPPV 0.024
NPV 0.994
248–72Decreased sensitivity:
 Immunocompromised individuals
 Recent viral infections;
 Recent M. Tuberculosis infection
 Recent immunisation with live vaccines;
 Individuals aged <6 months;
 Inadequate management of tuberculin
Decreased specificity
 BCG vaccination;
 Exposure to non-tuberculous mycobacteria
Decreased positive predictive value
 Low TB incidence areas.
IGRAEx vivoESAT-6
CFP-10 TB7.7
Identification of the production of IFN-γ after exposure of lymphocytes to mycobacterial antigensPPV 0.068
NPV 0.997
16–20Indeterminate result
 ELISA No increase, in children;
 ELISPOT No Increase, in immunocompromised individuals
  • TST: tuberculin skin test; IGRA: interferon (IFN)-γ release assay; ELISA: Enzyme-linked immunosorbent assay; M. tuberculosis: Mycobacterium tuberculosis; BCG: bacille Calmette–Guerin; ELISPOT: enzyme-linked immunosorbent spot assay; PPV: positive-predictive value; NPV: negative-predictive value ESAT-6: early secretory antigen target 6; CFP-10: culture filtrate protein 10.