Interferon Gamma Release Assay versus Tuberculin Skin Testing among Healthcare Workers of Highly Diverse Origin in a Moderate Tuberculosis Burden Country.
Interferon Gamma Release Assay versus Tuberculin Skin Testing among Healthcare Workers of Highly Diverse Origin in a Moderate Tuberculosis Burden Country.
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DOI：
10.1371/journal.pone.0154803
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Alrajhi A
中科院分区：
文献类型：
--
作者：
Al Hajoj S;Varghese B;Datijan A;Shoukri M;Alzahrani A;Alkhenizan A;AlSaif A;Althawadi S;Fernandez G;Alrajhi A
卫生保健工作者（HCW）总是处于感染结核病（TB）的增加的风险中。在沙特阿拉伯，干扰素γ释放试验（IGRA）尚未被评价为HCW中潜伏性结核感染（LTBI）的筛查工具，因为HCW的人口多样性很高。在2012年2月至2015年1月期间，在首都利雅得的一家三级保健中心进行了一项横断面研究，该中心的工作人员人口统计学差异最大。经过简短的面谈和同意后，所有候选人都接受了结核菌素皮肤试验（TST）和QuantiFERON TB金试管试验（QFT）。进行逻辑回归分析，以建立推定的危险因素和诊断试验之间的关联。候选人根据地理来源分类，并详细分析了他们的来源对TST和QFT结果的影响。在1595名候选人中，90.6%接种了卡介苗，女性（67.9%），主要是护士（53.2%）。疑似或确诊肺结核病人暴露高危人群占56.1%，从业年限<10年者占76.5%。TST阳性503例（31.5%），QFT阳性399例（25%）。大多数候选人是非沙特人（83%），主要来自西太平洋地区（52.4%）。在14.2%的阳性病例和57.7%的阴性病例中获得一致结果。两种试验之间的不一致性相对较高（kappa系数-0.312±0.026，p值- <0.00001），因为TST阳性/QFT阴性不一致性为54.8%，而TST阴性/QFT阳性不一致性为15.7%。候选人的年龄、卡介苗接种和东南亚血统与TST阳性相关，而职业结核病暴露和候选人的地理来源与QFT阳性相关。对最近TST转换的候选人进行定期随访，显示没有进展为活动性TB。与不一致性相关的假定因素为候选人的来源（p值<0.001）、职业（p值-0.001）、卡介苗接种（p值-0.001）和职业结核病暴露水平（P值-0.001）。该研究表明，在人口统计学上不同的研究候选人中，LTBI的患病率很高。QFT和TST之间的一致性较差，因此在我们的常规LTBI筛查中不推荐单独使用QFT。候选人的来源与TST和QFT的结果有很强的关联。TST阴性和QFT阳性的不一致结果需要更详细的分析。
Health care workers (HCW’s) are always at an increased risk of contracting tuberculosis (TB) infection. In Saudi Arabia, Interferon Gamma Release Assay (IGRA) has not been evaluated as a screening tool for latent TB infection (LTBI) among HCW’s considering their high demographic diversity. During February 2012 to January 2015 a cross sectional study has been conducted in a tertiary care center with maximum demographically diverse staff population in the capital city-Riyadh. After a short interview and consenting, all the candidates were subjected to tuberculin skin test (TST) and QuantiFERON TB gold In-tube test (QFT). A logistic regression analysis was carried out for establishing the associations between putative risk factors and the diagnostic tests. The candidates were classified according to geographical origin and a detailed analysis was conducted on the impact of their origin towards the results of TST and QFT. Of the 1595 candidates enrolled, 90.6% were BCG vaccinated, female (67.9%) and mainly nurses (53.2%). Candidates with high risk of suspected or confirmed TB patient exposure were 56.1% and 76.5% of them had <10 year’s work experience. TST positivity was observed in 503 (31.5%) candidates, while QFT was positive among 399 (25%). Majority of the candidates were non-Saudi (83%) and predominantly (52.4%) from Western Pacific region. Concordant results were obtained in 14.2% of positive cases and 57.7% negative cases. The disagreements between the two tests were relatively high (kappa co-efficient-0.312±0.026, p value- <0.00001) as TST positive/QFT negative discordance was 54.8% while TST negative/QFT positive discordance was 15.7%. Age of the candidates, BCG vaccination, and South East Asian origin were associated with TST positivity while Occupational TB exposure and geographical origin of the candidates were associated with QFT positivity. A regular follow up on recently TST converted candidates showed no progression to active TB. The putative factors associated with the discordance were origin of the candidate (p value <0.001), profession (p value-0.001), BCG vaccination (p value-0.001) and occupational TB exposure level (P value-0.001). The study demonstrated high level prevalence of LTBI among the demographically diverse study candidates. The agreement between QFT and TST was poor, thus QFT alone cannot be recommended in our setting for a routine LTBI screening. Origin of the candidates has strong association with the results of TST and QFT. The discordant results particularly TST negative and QFT positive needs more detailed analysis.