Performance of QuantiFERON-TB Gold and Tuberculin Skin Test Relative to Subjects' Risk of Exposure to Tuberculosis

• Published in: Clinical infectious diseases Vol. 58; no. 9; pp. 1260 - 1266
• Main Authors: McMullen, Sharon E., Pegues, David A., Shofer, Frances S., Sheller, Alexandra C., Wiener, Evelyn B.
• Format: Journal Article
• Language: English
• Published: Oxford OXFORD UNIVERSITY PRESS 01.05.2014; Oxford University Press
• Subjects: Adult; ARTICLES AND COMMENTARIES; Bacillus Calmette Guerin vaccine; Bacterial diseases; Biological and medical sciences; College students; Cutaneous tuberculosis; Demographics; Diagnostic tests; Female; Health care industry; Health risk assessment; Human bacterial diseases; Human exposure; Humans; Infections; Infectious diseases; Male; Medical sciences; Odds Ratio; Pennsylvania; Performance evaluation; Predictive Value of Tests; Predisposing factors; Risk Factors; Sensitivity and Specificity; Skin tests; Students; Tuberculin; Tuberculin Test; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - immunology; Tuberculosis and atypical mycobacterial infections; Tuberculosis vaccine; United States; United States; Pennsylvania; United States > US; Infection; Performance evaluation; Human; Tuberculosis; Risk factor; Bacteriosis; Exploration; Mycobacterial infection; Tuberculin; Skin test; diagnostic techniques and procedures; latent tuberculosis; interferon-gamma release tests; sensitivity and specificity
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciu119

Background. Performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) has not been compared in a US college population with varying risk of tuberculosis exposure. Methods. We performed a retrospective chart review of students tested for tuberculosis at the University of Pennsylvania Student Health Service between 2009 and 2011. We stratified students into high-, low-, and no-risk categories for exposure to tuberculosis and compared QFT-GIT and TST performance in risk groups adjusting demographic characteristics. Results. During the study period, 15 936 tuberculosis tests were performed in 9483 college students. Coming from a tuberculosis-endemic country was the only risk factor significantly associated with having a positive result (odds ratio [OR] 12.9; 95% confidence interval [CI], 10.2–16.5). Test specificity was higher for TST than QFT-GIT (99.7% vs 91.4%; P < .0001). Application of a higher threshold for positivity improved comparability of QFT-GIT with TST in the low-risk group (adjusted OR [AOR] 1.2; 95% CI, .4–3.3) but not in the high-risk group (AOR .4; 95% CI, .3–.5). Conclusions. QFT-GIT was less specific than TST. Our findings support the use of TST for US college students who need tuberculosis testing and the use of risk-stratified interpretation for students who are tested with QFT-GIT.