Using Tests for Latent Tuberculous Infection to Diagnose Active Tuberculosis: Can We Eat Our Cake and Have It Too?

Editorials4 March 2008Using Tests for Latent Tuberculous Infection to Diagnose Active Tuberculosis: Can We Eat Our Cake and Have It Too?Dick Menzies, MD, MScDick Menzies, MD, MScFrom McGill University, Montreal, Quebec, Canada H2X 2P4.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-5-200803040-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Rapid diagnosis of active tuberculosis is challenging. The only rapid test for active tuberculosis is smear microscopy, which has poor sensitivity for both extrapulmonary and less extensive pulmonary forms of tuberculosis (1). Nucleic acid amplification tests have somewhat better but still suboptimal sensitivity (2), whereas mycobacterial cultures are sensitive but require several weeks before results are available (1). The tuberculin skin test (TST) and the new interferon-γ release assays (3, 4) detect a cellular immune response to tuberculosis antigens. On the basis of numerous longitudinal studies (5), the TST is considered to have good sensitivity for the detection of latent ...References1. Brodie D, Schluger NW. The diagnosis of tuberculosis. Clin Chest Med. 2005;26:247-71, vi. [PMID: 15837109] CrossrefMedlineGoogle Scholar2. Pai M, Kalantri S, Dheda K. New tools and emerging technologies for the diagnosis of tuberculosis: part I. Latent tuberculosis. Expert Rev Mol Diagn. 2006;6:413-22. [PMID: 16706743] CrossrefMedlineGoogle Scholar3. Andersen P, Munk ME, Pollock JM, Doherty TM. Specific immune-based diagnosis of tuberculosis. Lancet. 2000;356:1099-104. [PMID: 11009160] CrossrefMedlineGoogle Scholar4. Pai M, Riley LW, Colford JM. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis. 2004;4:761-76. [PMID: 15567126] CrossrefMedlineGoogle Scholar5. Menzies D, Doherty TM. Diagnosis of latent tuberculosis infection.. In: Raviglione MC, eds. Reichman and Hershfield's Tuberculosis, A Comprehensive International Approach. New York: Informa Healthcare USA; 2006:215-63. Google Scholar6. Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007;146:340-54. [PMID: 17339619] LinkGoogle Scholar7. Dosanjh DP, Hinks TS, Innes JA, Deeks JJ, Pasvol G, Hackforth S, et al. Improved diagnostic evaluation of suspected tuberculosis. Ann Intern Med. 2008;148:325-336. LinkGoogle Scholar8. Katz J, Krasnitz A, Kunofsky S. Comparative study of the Heaf and Mantoux tests. Am Rev Respir Dis. 1967;96:1033-8. [PMID: 6059188] MedlineGoogle Scholar9. Ebell MH. Likelihood ratios. 2007. Accessed at www.poems.msu.edu/InfoMastery/Diagnosis/Diagnosis.htm on 20 December 2007. Google Scholar10. World Health Organization. Global Tuberculosis Control. Surveillance, Planning, Financing. WHO/HTM/TB/2006.362. Geneva: World Health Organization; 2007. Google Scholar Author, Article, and Disclosure InformationAffiliations: From McGill University, Montreal, Quebec, Canada H2X 2P4.Disclosures: None disclosed.Corresponding Author: Dick Menzies, MD, MSc, Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, 3650 St. Urbain Street, Room K1.24, Montreal, Quebec H2X 2P4, Canada; e-mail, dick.[email protected]ca. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoImproved Diagnostic Evaluation of Suspected Tuberculosis Davinder P.S. Dosanjh , Timothy S.C. Hinks , John A. Innes , Jonathan J. Deeks , Geoffrey Pasvol , Sarah Hackforth , Hansa Varia , Kerry A. Millington , Rubamalar Gunatheesan , Valerie Guyot-Revol , and Ajit Lalvani Metrics Cited ByMultifocal bone tuberculosis simulating metastasisReview on advanced diagnostic techniques for Mycobacterium species and its significance to control TuberculosisMultifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case reportLong-Incubation-Time Gamma Interferon Release Assays in Response to Purified Protein Derivative, ESAT-6, and/or CFP-10 for the Diagnosis of Mycobacterium tuberculosis Infection in ChildrenWeakly positive tests and chronologic variation of the QuantiFERON assay: A retrospective appraisal of usefulnessThe role of in vitro interferonγ-release assay in differentiating intestinal tuberculosis from Crohn's disease in ChinaTuberculosis and Nontuberculous Mycobacterial DiseaseInterferon-γ Release Assays for Active Pulmonary Tuberculosis Diagnosis in Adults in Low- and Middle-Income Countries: Systematic Review and Meta-analysisImmunodiagnosis of Tuberculosis: a Dynamic View of Biomarker DiscoveryTranscriptional responses of host peripheral blood cells to tuberculosis infectionRisk factors for false-negative results of QuantiFERON-TB Gold In-Tube assay in non-HIV-infected patients with culture-confirmed tuberculosisRole of interferon-gamma release assays in the diagnosis of pulmonary tuberculosis in patients with advanced HIV infectionCommercial Interferon Gamma Release Assays Compared to the Tuberculin Skin Test for Diagnosis of Latent Mycobacterium tuberculosis Infection in Childhood Contacts in the GambiaQuantitative evaluation of T-cell response after specific antigen stimulation in active and latent tuberculosis infection in adults and childrenA case of Poncet disease diagnosed with interferon-γ-release assaysCan ELISpot replace the tuberculin skin test for latent tuberculosis?Interferon-γ Release Assays for the Diagnosis of TuberculosisThe Impact of HIV Infection and CD4 Cell Count on the Performance of an Interferon Gamma Release Assay in Patients with Pulmonary TuberculosisSystematic Review: T-Cell–based Assays for the Diagnosis of Latent Tuberculosis Infection: An UpdateMadhukar Pai, MD, PhD, Alice Zwerling, MSc, and Dick Menzies, MD, MSc 4 March 2008Volume 148, Issue 5Page: 398-399KeywordsAntigensClinical epidemiologyImmune responseInfectious diseasesPopulation statisticsSpecificitySystematic reviewsTuberculinTuberculosis ePublished: 4 March 2008 Issue Published: 4 March 2008 CopyrightCopyright © 2008 by American College of Physicians. 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