Comparison of enzyme-linked immunospot assay and tuberculin skin test in healthy children exposed to Mycobacterium tuberculosis
Comparison of enzyme-linked immunospot assay and tuberculin skin test in healthy children exposed to Mycobacterium tuberculosis
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DOI：
10.1542/peds.2005-2095
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发表时间：
2006-05-01
期刊：
影响因子：
8
通讯作者：
McAdam, KPWJ
中科院分区：
文献类型：
--
作者：
Hill, PC;Brookes, RH;McAdam, KPWJ
客观的。比较冈比亚儿童中酶联免疫斑点 (ELISPOT) 测定与结核菌素皮试 (TST) 诊断结核分枝杆菌感染的情况。方法。我们将痰涂片阳性结核病病例的儿童接触者分为 3 个年龄组（< 5 岁、5 - 9 岁和 10 - 14 岁），并评估了 2 种测试之间的一致性及其与先前卡介苗 (BCG) 疫苗接种的关系。我们根据儿童相对于病例的睡眠地点对儿童的结核分枝杆菌暴露水平进行分类：同一房间、同一房屋或不同房屋。通过多元逻辑回归评估暴露与测试结果之间的关系。结果。在 287 例儿童接触者中，693 例中的 225 例（32.5%）经 TST 检测呈阳性，718 例中 232 例（32.3%）经 ELISPOT 检测呈阳性。测试之间的总体一致性为 83%，不一致并不显着。两项测试都对每个年龄组的结核分枝杆菌暴露梯度做出了反应。 TST 阳性/ELISPOT 阴性的比例随着暴露的增加而增加。在最低暴露水平下，与最高暴露水平相比，TST 阴性的 ELISPOT 阳性儿童的百分比有所增加。两项测试都没有证据表明卡介苗导致假阳性结果。结论。在冈比亚儿童中，ELISPOT 在诊断近期暴露的结核分枝杆菌感染方面的敏感性略低于 TST，并且这两种测试都不会因之前接种过 BCG 疫苗而混淆。已知近期结核分枝杆菌暴露最低的受试者 TST 敏感性降低的证据表明，当最大敏感性很重要时，这两种测试可能最好一起使用。
OBJECTIVE. To compare the enzyme-linked immunospot (ELISPOT) assay with the tuberculin skin test (TST) in children for the diagnosis of Mycobacterium tuberculosis infection in the Gambia.METHODS. We divided child contacts of sputum smear-positive tuberculosis cases into 3 age categories (< 5, 5 - 9, and 10 - 14 years) and assessed agreement between the 2 tests plus their relationship to prior Bacille Calmette-Guerin ( BCG) vaccination. We categorized a child's level of M tuberculosis exposure according to where he/she slept relative to a case: the same room, same house, or a different house. The relationship between exposure and test result was assessed by multiple logistic regression.RESULTS. In child contacts of 287 cases, 225 (32.5%) of 693 were positive by TST and 232 (32.3%) of 718 by ELISPOT. The overall agreement between tests was 83% and the discordance was not significant. Both tests responded to the M tuberculosis exposure gradient in each age category. The percentage of those who were TST positive/ELISPOT negative increased with increasing exposure. At the lowest exposure level, the percentage of ELISPOT-positive children who were TST negative was increased compared with the highest exposure level. Neither test had evidence of false positive results because of BCG.CONCLUSIONS. In Gambian children, the ELISPOT is slightly less sensitive than the TST in the diagnosis of M tuberculosis infection from recent exposure, and neither test is confounded by prior BCG vaccination. Evidence of reduced TST sensitivity in subjects with the lowest known recent M tuberculosis exposure suggests that, when maximal sensitivity is important, the 2 tests may be best used together.