gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Progression to active tuberculosis in immunocompromised patients with a positive tuberculosis-specific interferon-gamma release assay result

Progression zu aktiver Tuberkulose in immunsupprimierten Patienten nach positivem Tuberkulose spezifischen Interferon-gamma Release Assay Ergebnis

Meeting Abstract

Suche in Medline nach

  • B. Lange - University Hospital Freiburg, Division of Infectious Diseases and IFB-Centre of Chronic Immunodeficiency, Freiburg, Germany
  • M. Vavra - University Hospital Freiburg, Division of Infectious Diseases, Freiburg, Germany
  • W. V. Kern - University Hospital Freiburg, Division of Infectious Diseases and IFB-Centre of Chronic Immunodeficiency, Freiburg, Germany
  • D. Wagner - University Hospital Freiburg, Division of Infectious Diseases and IFB-Centre of Chronic Immunodeficiency, Freiburg, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocINF 09-2

DOI: 10.3205/10kit017, URN: urn:nbn:de:0183-10kit0171

Veröffentlicht: 2. Juni 2010

© 2010 Lange et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objectives: Whereas tuberculosis-specific interferon gamma-release assays (TIGRA) are known to have predictive value in contact tracing [1], the progression rate to active tuberculosis (TB) in immunocompromised (IC) individuals with a positive TIGRA result is not well known.

Methods: After ethical approval, 460 IC patients were prospectively enrolled and tested with the third generation Quantiferon Gold in tube assay (QFT Cellestis, Australia). We retrospectively followed up patients with positive QFT tests (mean follow up time: 2,1 years) by reviewing patient charts for diagnosis of active TB disease. We compared TB events per 100 patient years (pys) for different cut-off values of QFT. Logistic regression was computed in SPSS Version 15 for determination of risk factors for indeterminate (presented elsewhere (Lange et al. European Respiratory Journal. 2010 (in press)) and positive results.

Results: 38/460 (8,3%) patients had a positive QFT result (25 organ transplant, 6 autoimmune disease, 4 HIV positive, 3 other immunodeficiencies). Two patients taking TB prophylaxis after positive QFT were excluded. Risk factors for a positive QFT result included immigrant status and old age (p<0.05, backward logistic regression). Four patients had been treated for TB previously. In these and in 30 further patients there was no indication of active TB when QFT was performed or at follow up. One patient with chronic sialadenitis was treated empirically for presumed TB sialadenitis based on the positive QFT, no tissue culture was obtained. One HIV-positive patient with a history of M. chelonae skin infection had no evidence of mycobacterial disease when QFT was positive. One year later he developed culture proven tuberculous lymphadenitis.

Progression rate assessed retrospectively (including only the culture-proven case) was 1,3/100 pys or excluding known history of TB 1,4/100pys for a cut off of 0,35 IU/ml. Using a cut off of 1 IU/ml progression rate would be 3,2/100 pys or excluding known history of TB 3,4/100pys.

Conclusions: Keeping in mind the limits of a retrospective chart assessment to determine TB status, these results show that IC patients with a positive QFT result should be carefully evaluated. Prophylaxis should be recommended in light of anamnestic data (immigrant status, age) as well as quantity of the TB specific immune response.


References

1.
Diel R, Loddenkemper R, Meywald-Walter K, Niemann S, Nienhaus A. Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis. Am J Respir Crit Care Med. 2008;177(10):1164-70. DOI: 10.1164/rccm.200711-1613OC Externer Link