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Discordance among commercially-available diagnostics for latent TB infection
Date:12/8/2011

In populations with a low prevalence of tuberculosis (TB), the majority of positives with the three tests commercially available in the U.S for the diagnosis of TB are false positives, according to a new study.

"We compared commercially available tests for latent tuberculosis infection (LTBI) in a diverse population with a low LTBI prevalence," said James Mancuso, MD, DrPH, of the Walter Reed Army Institute of Research Preventive Medicine Residency Program. "Our results suggest that in low-prevalence populations, most positive results obtained with these tests are false positives."

The findings were published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

The cross-sectional study involved 2,017 military recruits at Fort Jackson, South Carolina, who completed a risk factor questionnaire and underwent testing with the 3 tests: 1) tuberculin skin test (TST), 2) the interferon gamma release assays (IGRAs) QuantiFERON-TB Gold In-Tube test (QFT-GIT) and 3) the TSPOT TB test (T-Spot). The Battey Skin Test (BST) was also administered to assess the impact of non-tuberculosis mycobacteria (NTM) reactivity on test discordance.

The specificities of TST, QFT-GIT, and T-Spot were not significantly different. Of 88 subjects with a positive test, 68 (77%) were positive to one test, 10 (11.4%) were positive to two tests, and only 10 (11.4%) were positive to all three tests. Bacille Calmette Guerin vaccination, tuberculosis prevalence in country of birth,and Battey skin test reaction size were associated with TST positive, IGRA negative test discordance, supporting evidence that NTM sensitization can cause false positive TST results. Greater quantitative test results and higher TB risk strata were associated with increased concordance between tests.

"Our data support a high proportion of false positives with any of these three tests in a
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Contact: Nathaniel Dunford
ndunford@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

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