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      Necesidad de la determinación inmunológica del Quantiferon (Interferón-gamma Relase-Assay) para el diagnóstico de la Infección Tuberculosa latente Translated title: Need for immunological determination of Quantiferon (Interferon-gamma Relase-Assay) for the diagnosis of latent tuberculous infection

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          Abstract

          RESUMEN. Introducción: La tuberculosis es un importante problema de salud pública, primera causa de muerte en adultos contagiados de un solo agente infeccioso. Diferenciaremos enfermedad tuberculosa activa de Infección Tuberculosa Latente. El control biológico del examen inicial de salud establece si el trabajador es portador de ITL para diferenciarlo de un posible contagio posterior con motivo del trabajo. Objetivos: Objetivo general estimar la validez del Mantoux/Booster y Quantiferon como pruebas diagnósticas de la ITL. Objetivo específico definir los casos diagnosticados como ITL. Material y Métodos: Recogida de datos de las historias clínico-laborales del personal de nueva incorporación, del Área de Salud de Zamora, años 2018-2021, se importan a una base de datos, se realiza estudio descriptivo cualitativo/cuantitativo. Resultados: De los trabajadores estudiados son tuberculina positivos el 29’1%; siendo Quantiferón positivos el 10’3%. Diagnosticamos 159 casos de ITL. Conclusión: La técnica más precisa para diagnosticar la ITL es la determinación del Quantiferón.

          Translated abstract

          ABSTRACT Introduction: Tuberculosis is a major public health problem, first cause of death in adults infected with a single infectious agent. We will differentiate active tuberculosis disease from latent tuberculosis infection. The biological control of the initial health examination establishes whether the worker is a carrier of LTTI to differentiate him/her from a possible subsequent contagion at work. Objectives: General objective to estimate the validity of Mantoux/Booster and Quantiferon as diagnostic tests for LTTI. Specific objective: To define the cases diagnosed as ITL. Material and Methods: Collection of data from the clinical-work histories of newly hired personnel, from the Zamora Health Area, years 2018-2021, imported into a database, qualitative/quantitative descriptive study is performed. Results: 29.1% of the workers studied were tuberculin positive; 10.3% were Quantiferon positive. We diagnosed 159 cases of ITL. Conclusion: The most accurate technique to diagnose ITL is the determination of Quantiferon.

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          The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling

          Background The existing estimate of the global burden of latent TB infection (LTBI) as “one-third” of the world population is nearly 20 y old. Given the importance of controlling LTBI as part of the End TB Strategy for eliminating TB by 2050, changes in demography and scientific understanding, and progress in TB control, it is important to re-assess the global burden of LTBI. Methods and Findings We constructed trends in annual risk in infection (ARI) for countries between 1934 and 2014 using a combination of direct estimates of ARI from LTBI surveys (131 surveys from 1950 to 2011) and indirect estimates of ARI calculated from World Health Organisation (WHO) estimates of smear positive TB prevalence from 1990 to 2014. Gaussian process regression was used to generate ARIs for country-years without data and to represent uncertainty. Estimated ARI time-series were applied to the demography in each country to calculate the number and proportions of individuals infected, recently infected (infected within 2 y), and recently infected with isoniazid (INH)-resistant strains. Resulting estimates were aggregated by WHO region. We estimated the contribution of existing infections to TB incidence in 2035 and 2050. In 2014, the global burden of LTBI was 23.0% (95% uncertainty interval [UI]: 20.4%–26.4%), amounting to approximately 1.7 billion people. WHO South-East Asia, Western-Pacific, and Africa regions had the highest prevalence and accounted for around 80% of those with LTBI. Prevalence of recent infection was 0.8% (95% UI: 0.7%–0.9%) of the global population, amounting to 55.5 (95% UI: 48.2–63.8) million individuals currently at high risk of TB disease, of which 10.9% (95% UI:10.2%–11.8%) was isoniazid-resistant. Current LTBI alone, assuming no additional infections from 2015 onwards, would be expected to generate TB incidences in the region of 16.5 per 100,000 per year in 2035 and 8.3 per 100,000 per year in 2050. Limitations included the quantity and methodological heterogeneity of direct ARI data, and limited evidence to inform on potential clearance of LTBI. Conclusions We estimate that approximately 1.7 billion individuals were latently infected with Mycobacterium tuberculosis (M.tb) globally in 2014, just under a quarter of the global population. Investment in new tools to improve diagnosis and treatment of those with LTBI at risk of progressing to disease is urgently needed to address this latent reservoir if the 2050 target of eliminating TB is to be reached.
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            QuantiFERON TB Gold Plus for the diagnosis of tuberculosis: a systematic review and meta-analysis

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              Fourth-Generation QuantiFERON-TB Gold Plus: What Is the Evidence?

              QuantiFERON-TB Gold Plus (QFT-Plus) is the latest generation of interferon gamma release assays (IGRAs) to receive approval from the U.S. FDA, replacing its predecessor, QuantiFERON-TB Gold In-Tube (QFT-GIT). The novelty of QFT-Plus is that it elicits a response from CD8 T cells, in addition to CD4 T cells, thus collecting a broader response from T-cell subsets than QFT-GIT. It was developed with the aim to improve the detection of latent tuberculosis infection (LTBI), especially among recently exposed contacts, immunocompromised hosts, and young children. QuantiFERON-TB Gold Plus (QFT-Plus) is the latest generation of interferon gamma release assays (IGRAs) to receive approval from the U.S. FDA, replacing its predecessor, QuantiFERON-TB Gold In-Tube (QFT-GIT). The novelty of QFT-Plus is that it elicits a response from CD8 T cells, in addition to CD4 T cells, thus collecting a broader response from T-cell subsets than QFT-GIT. It was developed with the aim to improve the detection of latent tuberculosis infection (LTBI), especially among recently exposed contacts, immunocompromised hosts, and young children. In this minireview, we summarize the performance of QFT-Plus compared with that of QFT-GIT among active tuberculosis (TB) patients (a surrogate for LTBI patients), high-risk populations, and low-risk individuals based on recent publications. Studies comparing QFT-Plus to QFT-GIT currently do not support the superior performance of QFT-Plus in individuals with active TB and LTBI. The difference in sensitivity between QFT-Plus and QFT-GIT in active TB patients was not significant in nearly all studies and ranged from −4.0 to 2.0%. Among high-risk groups, the agreement between QFT-Plus and QFT-GIT was 89.9 to 96.0% (kappa coefficient range, 0.80 to 0.91). The specificity in the low-risk population was slightly lower for QFT-Plus than for QFT-GIT, with the difference ranging from −7.4 to 0%. Further studies are needed to accurately evaluate the sensitivity of QFT-Plus in immunocompromised hosts and children. In addition, further evidence is required to validate a modified interpretation of QFT-Plus for the identification of false-positive results in low-risk health care workers.
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                Author and article information

                Journal
                medtra
                Revista de la Asociación Española de Especialistas en Medicina del Trabajo
                Rev Asoc Esp Espec Med Trab
                Asociación Española de Especialistas en Medicina del Trabajo (Madrid, Madrid, Spain )
                1132-6255
                3020-1160
                2022
                : 31
                : 3
                : 254-259
                Affiliations
                [3] Zamora Castilla y León orgnameÁrea de Salud de Zamora España
                [5] Zamora Castilla y León orgnameÁrea de Salud de Zamora España
                [2] Zamora Castilla y León orgnameÁrea de Salud de Zamora orgdiv1SPRL España
                [1] Zamora Castilla y León orgnameÁrea de Salud de Zamora orgdiv1SPRL España
                [6] Zamora Castilla y León orgnameHospital Clínico Universitario de Valladolid España
                [4] Zamora Castilla y León orgnameÁrea de Salud de Zamora España
                Article
                S3020-11602022000300002 S3020-1160(22)03100300002
                6117c409-a65f-4510-974a-eaa27d513a85

                This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

                History
                : 04 September 2022
                : 23 June 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 6
                Product

                SciELO Spain

                Categories
                Textos Originales

                Infección Tuberculosa Latente,Tuberculosis,Quantiferon,Tuberculin test,Latent Tuberculous Infection,Prueba de tuberculina

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