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Discordant QuantiFERON-TB Gold Test Results Among US Healthcare Workers With Increased Risk of Latent Tuberculosis Infection: A Problem or Solution?

Published online by Cambridge University Press:  02 January 2015

Nira R. Pollock ,
Antonio Campos-Neto ,
Suely Kashino ,
Danielle Napolitano ,
Samuel M. Behar ,
Daniel Shin ,
Alex Sloutsky ,
Swati Joshi ,
Jasmine Guillet  and
Michael Wong
...Show all authors
Nira R. Pollock*
Affiliation:
Department of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Antonio Campos-Neto
Affiliation:
Department of Cytokine Biology, Forsyth Institute, Boston, Massachusetts
Suely Kashino
Affiliation:
Department of Cytokine Biology, Forsyth Institute, Boston, Massachusetts
Danielle Napolitano
Affiliation:
Department of Cytokine Biology, Forsyth Institute, Boston, Massachusetts
Samuel M. Behar
Affiliation:
Department of Rheumatology, Boston, Massachusetts
Daniel Shin
Affiliation:
Department of Rheumatology, Boston, Massachusetts
Alex Sloutsky
Affiliation:
Brigham and Women's Hospital, and , Massachusetts State Laboratory Institute, Boston, Massachusetts
Swati Joshi
Affiliation:
Brigham and Women's Hospital, and , Massachusetts State Laboratory Institute, Boston, Massachusetts
Jasmine Guillet
Affiliation:
Brigham and Women's Hospital, and , Massachusetts State Laboratory Institute, Boston, Massachusetts
Michael Wong
Affiliation:
Department of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Edward Nardell
Affiliation:
Division of Social Medicine and Health Inequalities, Boston, Massachusetts
*
Department of Infectious Diseases, Beth Israel Deaconess Medical Center, Lowry Medical Building, 110 Francis Street, Suite GB, Boston, MA 02215 ([email protected])
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Abstract

Objective.

In late 2006, our hospital implemented use of the QuantiFERON-TB Gold (QFT-G) assay, a whole-blood interferon-γ release assay, for detection of tuberculosis infection. All newly hired healthcare workers (HCWs) with positive Mantoux tuberculin skin test (TST) results were routinely tested with the QFT-G assay, to take advantage of its higher specificity. We then undertook a quality assurance review to evaluate the QFT-G test results in HCWs with multiple risk factors for latent tuberculosis infection (LTBI).

Methods.

The clinical records for TST-positive HCWs tested with the QFT-G assay were reviewed. HCWs with 2 or more risk factors commonly associated with LTBI were classified as “increased risk” (IR). IR HCWs who had negative QFT-G test results underwent repeat QFT-G testing and were offered testing with a different interferon-γ release assay (T-SPOT.TB) and with extended T cell stimulation assays.

Results.

Ofl43 TST-positive HCWs tested with the QFT-G assay, 26 (18%) had positive results, 115 (81%) had negative results, and 2 (1 %) had indeterminate results. Of 82 IR HCWs, 23 (28%) had positive QFT-G test results, and 57 (70%) had negative results. Of the 57 IR HCWs with negative results, 43 underwent repeat QFT-G testing: 41 had negative results again, and 2 had positive results. These 43 HCWs were also offered additional testing with the T-SPOT.TB diagnostic, and 36 consented: 31/36 tested negative, and 5/36 tested positive. Extended assays using the antigens ESAT-6 and CFP-10 confirmed the positive results detected by the overnight assays and yielded positive results for an additional 7/36 (19%) of individuals; strikingly, all 36 HCWs had strongly positive test results with assays using purified protein derivative.

Conclusions.

The extreme discordance between the results of our clinical diagnostic algorithm and the results of QFT-G testing raises concern about the sensitivity of the QFT-G assay for detection of LTBI in our HCWs. Results of extended stimulation assays suggest that many of our IR HCWs have indeed been sensitized to Mycobacterium tuberculosis. It is possible that the QFT-G assay identifies those at higher reactivation risk rather than all previously infected, but, in the absence of long-term follow-up data, we should interpret negative QFT-G results with some caution.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 9 , September 2008 , pp. 878 - 886
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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