Persistent IGRA Positivity Among Serially Tested Healthcare Workers Without Extensive TB Exposure

August 2, 2010

Data on the performance of Mycobacterium-tuberculosis-specific interferon-(IFN)-gamma release assays (IGRAs) in the serial testing of healthcare workers (HCWs) is limited. Ringshausen, et al. sought to determine the frequency of IGRA conversions and reversions and to identify predictors of persistent IGRA positivity among serially tested German HCWs in the absence of recent extensive tuberculosis (TB) exposure. Their research was published in BMC Infectious Diseases.

In this observational cohort-study, HCWs were prospectively recruited within occupational safety and health measures and underwent a tuberculin skin test (TST) and the IGRA QuantiFERON-TB Gold In-Tube (QFT-GIT) at baseline. The QFT-GIT was repeated 18 weeks later in the median. QFT-GIT conversions (and reversions) were defined as baseline IFN-gamma < 0.35 IU/ml and follow-up IFN-gamma >= 0.35 IU/ml (and vice versa). Predictors of persistently positive QFT-GIT results were calculated by logistic regression analysis.

In total, the researchers report that 18 (9.9 percent) and 15 (8.2 percent) of 182 analyzed HCWs were QFT-GIT-positive at baseline and at follow-up, respectively. They observed a strong overall agreement between baseline and follow-up QFT-GIT results (kappa = 0.70). Reversions (6/18, 33.3 percent) occurred more frequently than conversions (3/162, 1.9 percent). Age and positive prior and recent TST results independently predicted persistent QFT-GIT positivity. Furthermore, the researchers explain that the chance of having persistently positive QFT-GIT results raised about 3 percent with each additional 0.1 IU/ml increase in the baseline IFN-gamma response (adjusted odds ratio 1.03, 95 percent confidence interval 1.01-1.04). No active TB cases were detected within an observational period of more than two years.

The researchers concluded that QFT-GIT's utility for the application in serial testing was limited by a substantial proportion of reversions. This shortcoming could be overcome by the implementation of a borderline zone for the interpretation of QFT-GIT results. However, further studies are needed to clearly define the within-subject variability of the QFT-GIT and to confirm that increasing age, concordantly positive TST results, and the extend of baseline IFN-gamma responses may predict the persistence of QFT-GIT positivity over time in serially tested HCWs with only a low or medium TB screening risk in a TB low-incidence setting.

Reference: Ringshausen FC, Nienhaus A, Schablon A, Schlosser S, Schultze-Werninghaus G and Rohde G. Predictors of persistently positive Mycobacterium-tuberculosis-specific interferon-gamma responses in the serial testing of health care workers. BMC Infectious Diseases 2010, 10:220doi:10.1186/1471-2334-10-220.