QuantiFERON-TB Gold Plus Is a More Sensitive Screening Tool than QuantiFERON-TB Gold In-Tube for Latent Tuberculosis Infection among Older Adults in Long-Term Care Facilities

We investigated the prevalence of latent tuberculosis infection (LTBI) among the residents in seven long-term care facilities (LTCFs) located in different regions of Taiwan and compared the performance of two interferon gamma release assays, i.e., QuantiFERON-TB Gold In-Tube (QFT-GIT) and QuantiFERON-TB Gold Plus (QFT-Plus) for screening LTBI. We also assessed the diagnostic performance against a composite reference standard (subjects with persistent-positive, transient-positive, and negative results from QFTs during reproducibility analysis were classified as definite, possible, and not LTBI, respectively). ABSTRACT We investigated the prevalence of latent tuberculosis infection (LTBI) among the residents in seven long-term care facilities (LTCFs) located in different regions of Taiwan and compared the performance of two interferon gamma release assays, i.e., QuantiFERON-TB Gold In-Tube (QFT-GIT) and QuantiFERON-TB Gold Plus (QFT-Plus) for screening LTBI. We also assessed the diagnostic performance against a composite reference standard (subjects with persistent-positive, transient-positive, and negative results from QFTs during reproducibility analysis were classified as definite, possible, and not LTBI, respectively). Two hundred forty-four residents were enrolled, and 229 subjects were included in the analysis. The median age was 80 years (range, 60 to 102 years old), and 117 (51.1%) were male. Among them, 66 (28.8%) and 74 (32.3%) subjects had positive results from QFT-GIT and QFT-Plus, respectively, and the results for 215 (93.9%) subjects showed agreement. Using the composite reference standard, 66 (28.8%), 11 (4.8%), and 152 (66.4%) were classified as definite, possible, and not LTBI, respectively. For definite LTBI, the sensitivity, specificity, positive predictive value, and negative predictive value of QFT-GIT were 89.4%, 95.7%, 89.4%, and 95.7%, respectively, and those for QFT-Plus were 100.0%, 95.1%, 89.2%, and 100.0%, respectively. The sensitivity of QFT-GIT decreased gradually with patient age. Compared to QFT-GIT, QFT-Plus displayed significantly higher sensitivity (100.0% versus 89.4%, P = 0.013) and similar specificity (95.1% versus 95.7%). In conclusion, a high prevalence of LTBI was found among elders in LTCFs in Taiwan. The new QFT-Plus test demonstrated a higher sensitivity than QFT-GIT in the older adults in LTCFs.

[1]  G. Ippolito,et al.  Analytical evaluation of QuantiFERON- Plus and QuantiFERON- Gold In-tube assays in subjects with or without tuberculosis. , 2017, Tuberculosis.

[2]  G. Brandeis,et al.  Latent Tuberculosis Infection Testing Practices in Long‐Term Care Facilities, Boston, Massachusetts , 2017, Journal of the American Geriatrics Society.

[3]  A. Nienhaus,et al.  QFT-Plus: a plus in variability? – Evaluation of new generation IGRA in serial testing of students with a migration background in Germany , 2017, Journal of Occupational Medicine and Toxicology.

[4]  G. Ippolito,et al.  First characterization of the CD4 and CD8 T-cell responses to QuantiFERON-TB Plus. , 2016, The Journal of infection.

[5]  S. Ishikawa,et al.  Evaluation of QuantiFERON-TB Gold Plus for Detection of Mycobacterium tuberculosis infection in Japan , 2016, Scientific Reports.

[6]  Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. , 2016, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[7]  J. Kammerer,et al.  Recent Transmission of Tuberculosis — United States, 2011–2014 , 2016, PloS one.

[8]  P. Rancoita,et al.  First independent evaluation of QuantiFERON-TB Plus performance , 2016, European Respiratory Journal.

[9]  Juliana Grant,et al.  A field-validated approach using surveillance and genotyping data to estimate tuberculosis attributable to recent transmission in the United States. , 2015, American journal of epidemiology.

[10]  P. Barry,et al.  Trends in Tuberculosis Cases Among Nursing Home Residents, California, 2000 to 2009 , 2015, Journal of the American Geriatrics Society.

[11]  R. Chaisson,et al.  Latent Mycobacterium tuberculosis infection. , 2015, The New England journal of medicine.

[12]  Francesco Castelli,et al.  Towards tuberculosis elimination: an action framework for low-incidence countries , 2015, European Respiratory Journal.

[13]  S. Abimbola,et al.  Tuberculosis among older adults--time to take notice. , 2015, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[14]  Delia Goletti,et al.  Mycobacterium tuberculosis‐specific CD8+ T cells are functionally and phenotypically different between latent infection and active disease , 2013, European journal of immunology.

[15]  M. Amicosante,et al.  Antigen-specific CD4- and CD8-positive signatures in different phases of Mycobacterium tuberculosis infection. , 2013, Diagnostic microbiology and infectious disease.

[16]  N. Hochberg,et al.  Prevention of tuberculosis in older adults in the United States: obstacles and opportunities. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  P. Bassett,et al.  Tuberculosis infection in the indigenous elderly White UK population: a study of IGRAs [Correspondence]. , 2012, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[18]  J. Hackman,et al.  Three months of rifapentine and isoniazid for latent tuberculosis infection. , 2011, The New England journal of medicine.

[19]  G. Kaplan,et al.  Functional Capacity of Mycobacterium tuberculosis-Specific T Cell Responses in Humans Is Associated with Mycobacterial Load , 2011, The Journal of Immunology.

[20]  C. R. Horsburgh,et al.  Clinical practice. Latent tuberculosis infection in the United States. , 2011, The New England journal of medicine.

[21]  K Dheda,et al.  Interferon-&ggr; release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis , 2010, European Respiratory Journal.

[22]  W. Stead.  Tuberculosis among elderly persons, as observed among nursing home residents. , 1998, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[23]  W. Cheung,et al.  The effect of age on the presentation of patients with tuberculosis. , 1995, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[24]  T. Finucane,et al.  The American Geriatrics Society Statement on Two‐step PPD Testing for Nursing Home Patients on Admission , 1988, Journal of the American Geriatrics Society.

[25]  E. Perez-stable,et al.  Time course and boosting of tuberculin reactions in nursing home residents. , 1986, The American review of respiratory disease.

[26]  K. Powell,et al.  Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. , 2011, MMWR. Morbidity and mortality weekly report.

[27]  T. Sterling,et al.  American Thoracic Society Documents An Official ATS Statement : Hepatotoxicity of Antituberculosis Therapy , 2006 .

[28]  Screening for tuberculosis and tuberculous infection in high-risk populations. Recommendations of the Advisory Committee for Elimination of Tuberculosis. , 1990, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[29]  Prevention and control of tuberculosis in facilities providing long-term care to the elderly. Recommendations of the Advisory Committee for Elimination of Tuberculosis. , 1990, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.