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Received April 21, 2006
Accepted on September 7, 2006

ORIGINAL ARTICLES

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 ^*||1

*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

¹ To whom correspondence should be addressed. E-mail: michael.gardam{at}uhn.on.ca.

	Abstract

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.

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