HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.01280406v1 2/1/68    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Passalent, L. Articles by Gardam, M. Search for Related Content PubMed PubMed Citation Articles by Passalent, L. Articles by Gardam, M.

Detecting Latent Tuberculosis Infection in Hemodialysis Patients: A Head-to-Head Comparison of the T-SPOT.TB Test, Tuberculin Skin Test, and an Expert Physician Panel

Laura Passalent^*, Kamran Khan^,, Robert Richardson, Jun Wang, Helen Dedier^*, and Michael Gardam^*,||

^* Infection Prevention and Control Unit and Divisions of Nephrology and ^|| Infectious Diseases, University Health Network, and Division of Infectious Diseases and Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, Ontario, Canada

Address correspondence to: Dr. Michael Gardam, 200 Elizabeth Street, 3ES-428, Toronto General Hospital, Toronto, ON, Canada, M5G 2C4. Phone: 416-340-3758; Fax: 416-340-5047; E-mail: michael.gardam{at}uhn.on.ca

Current guidelines advocate screening hemodialysis patients for latent tuberculosis infection; however, the tuberculin skin test (TST) is believed to be insensitive in this population. This study compared the diagnostic utility of the TST with that of an IFN- assay (T-SPOT.TB) and the clinical consensus of an expert physician panel. A total of 203 patients with ESRD were evaluated for latent tuberculosis infection with the TST, T-SPOT.TB test, and an expert physician panel. Test results were compared with respect to their association with established tuberculosis risk factors. Tuberculosis infection, as estimated by the tuberculin test, T-SPOT.TB test, and expert physician panel, was detected in 12.8%, 35.5, and 26.1 of patients respectively. Among patients with a history of active tuberculosis and radiographic markers of previous infection, 78.6 and 72.7% had positive T.SPOT.TB results, compared with 21.4 and 18.2% who had positive tuberculin tests. The physician panel unanimously declared infection in these two groups. On multivariate analysis, a positive T-SPOT.TB test was associated with a history of active tuberculosis, radiographic markers of previous infection, and birth in an endemic country, whereas a physician panel diagnosis also was associated with a history of previous tuberculosis contact. The TST is insensitive in hemodialysis patients and is not recommended to be used in isolation to diagnose latent tuberculosis infection. It is suggested that a combination of T-SPOT.TB testing and medical assessment may be the most accurate screening method.

This article has been cited by other articles:

				K. L. Winthrop, M. Nyendak, H. Calvet, P. Oh, M. Lo, G. Swarbrick, C. Johnson, D. A. Lewinsohn, D. M. Lewinsohn, and G. H. Mazurek Interferon-{gamma} Release Assays for Diagnosing Mycobacterium tuberculosis Infection in Renal Dialysis Patients Clin. J. Am. Soc. Nephrol., September 1, 2008; 3(5): 1357 - 1363. [Abstract] [Full Text] [PDF]

				R. Dinser, M. Fousse, U. Sester, K. Albrecht, M. Singh, H. Kohler, U. Muller-Ladner, and M. Sester Evaluation of latent tuberculosis infection in patients with inflammatory arthropathies before treatment with TNF-{alpha} blocking drugs using a novel flow-cytometric interferon-{gamma} release assay Rheumatology, February 1, 2008; 47(2): 212 - 218. [Abstract] [Full Text] [PDF]