Use of a T-cell based test for detection of TB infection among immunocompromised patients

¹ Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, IRCCS, Milan, Italy; and Istituto Villa Marelli, Ospedale Niguarda Ca' Granda, Milan, Italy
² Istituto Villa Marelli, Ospedale Niguarda Ca' Granda, Milan, Italy
³ Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, IRCCS, Milan, Italy
⁴ WHO Collaborating Centre for Tuberculosis and Lung Disease, S. Maugeri Foundation, IRCCS, Tradate, Italy
⁵ Ospedale Niguarda Ca' Granda, Milan, Italy

^* To whom correspondence should be addressed. E-mail: cirillo.daniela{at}hsr.it.

	Abstract

We compared the performance of T-SPOT.TB^TM, a T-cell based test, versus TST to diagnose LTBI in 138 immunosuppressed haematology patients who had been nosocomially exposed to a case of smear-positive tuberculosis.

Overall, 44.2% of the contacts were positive by T-SPOT.TB, 17.4% by TST (concordance 67.8%, =0.34, p<0.0001). The apparent prevalence of infection fell from 25.9% to 14.5% with the TST with increasing immunosuppression, although this difference was not significant (p=0.12). In contrast, the apparent prevalence of infection with the T-SPOT.TB test was unaffected at 44.6% and 44.3% respectively. The T-SPOT.TB test had an overall indeterminate rate of 4.3% and this was also unaffected by the level of immunosuppression.

Our study suggests that T-SPOT.TB maintains sensitivity and performance in immunocompromised patients identifying a large number of truly-infected patients anergic to TST.

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