Diagnostic performance of T-SPOT.TB for extrapulmonary tuberculosis according to the site of infection

• Published in: The Journal of infection Vol. 63; no. 5; pp. 362 - 369
• Main Authors: CHO, Oh-Hyun, PARK, Ki-Ho, CHOI, Sang-Ho, JUN HEE WOO, YANG SOO KIM, KIM, Sung-Han, KIM, Sun-Mi, PARK, Su-Jin, SONG MI MOON, YONG PHIL CHONG, SUNG, Heungsup, KIM, Mi-Na, JEONG, Jin-Yong, LEE, Sang-Oh
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier 01.11.2011
• Subjects: Adult; Aged; Antigens, Bacterial; Bacterial diseases; Biological and medical sciences; Enzyme-Linked Immunosorbent Assay; Female; General aspects; Human bacterial diseases; Humans; Infectious diseases; Interferon-gamma - blood; Lymphocyte Count; Male; Medical sciences; Middle Aged; Molecular Diagnostic Techniques - methods; Mycobacterium; Mycobacterium tuberculosis - isolation & purification; Prospective Studies; Republic of Korea; Sensitivity and Specificity; T-Lymphocytes - metabolism; Tuberculosis - diagnosis; Tuberculosis and atypical mycobacterial infections; Republic of Korea; Infection; Performance evaluation; Tuberculosis; Extrapulmonary; Bacteriosis; Mycobacterial infection; Diagnosis
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2011.06.010

The clinical manifestations of extrapulmonary tuberculosis (E-TB) vary according to site of disease, so we tested the hypothesis that IFN-γ producing T-cell responses also vary in parallel. Therefore we conducted a prospective, blinded, observational study to evaluate the diagnostic performance of blood T-SPOT.TB according to the various sites of E-TB. From April 2008 to August 2010, all patients with suspected E-TB were enrolled at a tertiary hospital in an intermediate TB-burden country. Final diagnosis in patients with suspected E-TB was classified by clinical category. A total of 368 patients with suspected E-TB were enrolled; 196 (53%) were classified as having TB, including 119 (32%) with confirmed TB, 34 (9%) probable TB, and 43 (12%) possible TB; the remaining 172 (47%) were classified as not having TB. After excluding patients with possible TB, the T-SPOT.TB was more sensitive in patients with chronic forms of E-TB such as lymph node or osteoarticular TB (93%, 95% CI 83%-97%) than in patients with acute forms of E-TB such as TB meningitis or miliary TB (79%, 95% CI 66%-87%, P = 0.03). The diagnostic performance of the blood T-SPOT.TB differs among patients with various clinical manifestations of E-TB.