Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes

Detalhes bibliográficos
Autor(a) principal: Boni, Patrícia Marques Rodrigues
Data de Publicação: 2015
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
Texto Completo: http://repositorio.ufes.br/handle/10/1620
Resumo: Background: One of the main characteristics of M. tuberculosis (Mtb) is its capacity to produce latent infection. The World Health Organization (WHO) estimates that 2 billion people are infected by this bacillus, only 10% of whom develop active disease. Until recently the tuberculin skin test (TST) was the only test available for the diagnosis of latent infection. However, because of its potential limitations an effort was made to develop a more accurate method to diagnose latent tuberculosis. The interferon-gamma release assays (IGRA’s) were the result. These tests measure the interferon-gamma production by T-lymphocytes in response to a challenge of three synthetic antigens, specific for Mtb (ESAT-6, CFP-10 e TB7.7). The objective of our study was to evaluate the performance of the TST and the QuantiFERON®-TB Gold assay-in-tube (QFT-GIT), for the diagnostic of latent Mtb infection in children and adolescents identified as household contacts of smear positive pulmonary Mtb index cases. Methods: This was a comparative study conducted in the Metropolitan area of Vitória, Espírito Santo, Brazil from March 2008 through October 2013. Clinical, demographic and epidemiological data were collect from all participants. We defined latency as a positive TST (induration ≥ 10mm) or a positive QFT-GIT test (Nil ≤8.0 IU/ml, TB Antigen minus Nil ≥0.35 IU/ml and ≥25% of Nil value). Both tests were performed in each volunteer between eight and ten weeks after the identification of the respective index cases. Concordance, as defined by kappa testing, was used to compare the results of the two methods of diagnosing latency. The factors associated with positivity of both tests in bivariate analysis (p ≤0.30) were included in the multivariate model (logistic regression), and the odds ratios (OR) and 95%CI were calculated. Results: 291 subjects were enrolled in the study. The global concordance between TST and QFT-GIT was high (87,6%) - k 0.75 [CI 95%: 0.63- 0.86]. However in children age ≤ 5 years the concordance was even higher (93.65%) - κ 0.87 [CI 95%: 0,63-1,12]. The presence of BCG scar was not statistically associated with tests positivity. There was a positive correlation between the size of TST induration and the probability of a positive QFT-GIT. Conclusion: There was no advantage in the use of QFT-GIT in relation to the TST. We recommend the twomonth timeframe after the identification of the index case to perform the tests in the household contacts.
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spelling Miranda, Angelica Espinosa BarbosaDietze, ReynaldoBoni, Patrícia Marques RodriguesPalaci, MoisésDalcolmo, Margareth Maria Pretti2015-11-23T18:20:37Z2016-06-24T06:00:07Z2015-07-062015-07-06Background: One of the main characteristics of M. tuberculosis (Mtb) is its capacity to produce latent infection. The World Health Organization (WHO) estimates that 2 billion people are infected by this bacillus, only 10% of whom develop active disease. Until recently the tuberculin skin test (TST) was the only test available for the diagnosis of latent infection. However, because of its potential limitations an effort was made to develop a more accurate method to diagnose latent tuberculosis. The interferon-gamma release assays (IGRA’s) were the result. These tests measure the interferon-gamma production by T-lymphocytes in response to a challenge of three synthetic antigens, specific for Mtb (ESAT-6, CFP-10 e TB7.7). The objective of our study was to evaluate the performance of the TST and the QuantiFERON®-TB Gold assay-in-tube (QFT-GIT), for the diagnostic of latent Mtb infection in children and adolescents identified as household contacts of smear positive pulmonary Mtb index cases. Methods: This was a comparative study conducted in the Metropolitan area of Vitória, Espírito Santo, Brazil from March 2008 through October 2013. Clinical, demographic and epidemiological data were collect from all participants. We defined latency as a positive TST (induration ≥ 10mm) or a positive QFT-GIT test (Nil ≤8.0 IU/ml, TB Antigen minus Nil ≥0.35 IU/ml and ≥25% of Nil value). Both tests were performed in each volunteer between eight and ten weeks after the identification of the respective index cases. Concordance, as defined by kappa testing, was used to compare the results of the two methods of diagnosing latency. The factors associated with positivity of both tests in bivariate analysis (p ≤0.30) were included in the multivariate model (logistic regression), and the odds ratios (OR) and 95%CI were calculated. Results: 291 subjects were enrolled in the study. The global concordance between TST and QFT-GIT was high (87,6%) - k 0.75 [CI 95%: 0.63- 0.86]. However in children age ≤ 5 years the concordance was even higher (93.65%) - κ 0.87 [CI 95%: 0,63-1,12]. The presence of BCG scar was not statistically associated with tests positivity. There was a positive correlation between the size of TST induration and the probability of a positive QFT-GIT. Conclusion: There was no advantage in the use of QFT-GIT in relation to the TST. We recommend the twomonth timeframe after the identification of the index case to perform the tests in the household contacts.Introdução: Uma das principais características do M. tuberculosis (Mtb) refere-se a sua capacidade de produzir infecção latente. A Organização Mundial de Saúde (OMS) estima que dois bilhões de pessoas estejam infectadas pelo bacilo da tuberculose, e que, somente 10% dessas, desenvolvem doença ativa. Até recentemente o único exame laboratorial disponível para o diagnóstico da infecção latente pelo Mtb era a prova tuberculínica (PT). Entretanto, algumas de suas limitações estimularam o desenvolvimento de ensaios de liberação de interferongama por linfócitos T em resposta ao desafio de antígenos sintéticos específicos do Mtb (ESAT-6, CFP-10 e TB7.7). O objetivo do nosso estudo foi avaliar a concordância entre a prova tuberculínica e o teste QuantiFERON®-TB Gold in tube, no diagnóstico da infecção latente pelo Mtb, em crianças e adolescentes, contatos domiciliares de casos índices com doença pulmonar bacilífera. Métodos: Estudo comparativo, conduzido na Região Metropolitana de Vitória-ES, no período de Março de 2008 a Outubro de 2013. Dados clínicos, demográficos e epidemiológicos foram coletados de todos os participantes. A infecção latente pelo Mtb foi mensurada através da PT e do QFT-GIT. Definiu-se latência através da positividade da PT (induração ≥ 10mm) e do QFT-GIT (controle negativo ≤8.0 UI/mL, Antígeno TB menos controle negativo ≥0.35 UI/ml e ≥25% do valor do controle negativo). Os voluntários da pesquisa foram avaliados pelos dois testes entre oito a dez semanas após a identificação dos respectivos casos índices. O teste Kappa foi utilizado na comparação dos resultados dos testes para avaliação da concordância entre eles. Os fatores associados com a positividade de ambos os testes na análise bivariada (p ≤0,30) foram incluídos no modelo multivariado (regressão logística), sendo calculadas as razões de chance (OR) e os IC95%. Resultados: Foram arrolados 291 participantes. A concordância global entre os resultados da PT e do QFT-GIT foi elevada (87,6%) - k 0,75 [IC 95%: 0,63-0,86]. Nos indivíduos com idade ≤ 5 anos a concordância foi ainda maior (93,65%) - κ 0,87 [IC 95%: 0,63-1,12]. Não houve associação estatisticamente significativa entre a presença de cicatriz ao BCG e a positividade dos dois testes. Houve uma correlação positiva entre o tamanho da induração da PT e probabilidade de positividade do QFT-GIT. Conclusão: Não há vantagem na utilização do QFT-GIT em relação à PT. O segundo mês após a identificação do caso índice seria o tempo recomendado para a realização dos testes em questão.Texthttp://repositorio.ufes.br/handle/10/1620porUniversidade Federal do Espírito SantoMestrado em Doenças InfecciosasPrograma de Pós-Graduação em Doenças InfecciosasUFESBRCentro de Ciências da SaúdeTuberculose latenteCriançasProva tuberculínicaInterferon gamaDoenças Infecciosas e Parasitárias61Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)instname:Universidade Federal do Espírito Santo (UFES)instacron:UFESORIGINALAVALIAÇÃO DA CONCORDÂNCIA ENTRE OS TESTES.pdfAVALIAÇÃO DA CONCORDÂNCIA ENTRE OS TESTES.pdfapplication/pdf9729341http://repositorio.ufes.br/bitstreams/7a806ba5-7c3c-4b21-9a07-5d41d9b1bfb8/download5ce0a10c9bab80b9be2c1cd61a5aca56MD51CC-LICENSElicense_urllicense_urltext/plain; charset=utf-849http://repositorio.ufes.br/bitstreams/8b85a7db-6983-4889-a9b2-9317f063bd09/download4afdbb8c545fd630ea7db775da747b2fMD52license_textlicense_texttext/html; charset=utf-821328http://repositorio.ufes.br/bitstreams/6e7e29ae-2542-4fef-b319-e2d872e72b71/download683d9883b2ad62ac3b8bafc566b2e600MD53license_rdflicense_rdfapplication/rdf+xml; charset=utf-823148http://repositorio.ufes.br/bitstreams/b6d39b7d-f21b-4b83-80ba-afdb28bbdb5e/download9da0b6dfac957114c6a7714714b86306MD54LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repositorio.ufes.br/bitstreams/d24d17b1-cab0-489d-9df3-a49481d75819/download8a4605be74aa9ea9d79846c1fba20a33MD5510/16202024-07-16 17:09:54.139oai:repositorio.ufes.br:10/1620http://repositorio.ufes.brRepositório InstitucionalPUBhttp://repositorio.ufes.br/oai/requestopendoar:21082024-10-15T17:54:38.331517Repositório Institucional da Universidade Federal do Espírito Santo (riUfes) - Universidade Federal do Espírito Santo (UFES)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
dc.title.none.fl_str_mv Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
title Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
spellingShingle Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
Boni, Patrícia Marques Rodrigues
Tuberculose latente
Crianças
Prova tuberculínica
Interferon gama
Doenças Infecciosas e Parasitárias
61
title_short Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
title_full Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
title_fullStr Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
title_full_unstemmed Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
title_sort Avaliação da concordância entre os testes tuberculínico e o QuantiFERON®-TB Gold in tube no diagnóstico da infecção latente pelo Mycobacterium tuberculosis em crianças e adolescentes
author Boni, Patrícia Marques Rodrigues
author_facet Boni, Patrícia Marques Rodrigues
author_role author
dc.contributor.advisor-co1.fl_str_mv Miranda, Angelica Espinosa Barbosa
dc.contributor.advisor1.fl_str_mv Dietze, Reynaldo
dc.contributor.author.fl_str_mv Boni, Patrícia Marques Rodrigues
dc.contributor.referee1.fl_str_mv Palaci, Moisés
dc.contributor.referee2.fl_str_mv Dalcolmo, Margareth Maria Pretti
contributor_str_mv Miranda, Angelica Espinosa Barbosa
Dietze, Reynaldo
Palaci, Moisés
Dalcolmo, Margareth Maria Pretti
dc.subject.por.fl_str_mv Tuberculose latente
Crianças
Prova tuberculínica
Interferon gama
topic Tuberculose latente
Crianças
Prova tuberculínica
Interferon gama
Doenças Infecciosas e Parasitárias
61
dc.subject.cnpq.fl_str_mv Doenças Infecciosas e Parasitárias
dc.subject.udc.none.fl_str_mv 61
description Background: One of the main characteristics of M. tuberculosis (Mtb) is its capacity to produce latent infection. The World Health Organization (WHO) estimates that 2 billion people are infected by this bacillus, only 10% of whom develop active disease. Until recently the tuberculin skin test (TST) was the only test available for the diagnosis of latent infection. However, because of its potential limitations an effort was made to develop a more accurate method to diagnose latent tuberculosis. The interferon-gamma release assays (IGRA’s) were the result. These tests measure the interferon-gamma production by T-lymphocytes in response to a challenge of three synthetic antigens, specific for Mtb (ESAT-6, CFP-10 e TB7.7). The objective of our study was to evaluate the performance of the TST and the QuantiFERON®-TB Gold assay-in-tube (QFT-GIT), for the diagnostic of latent Mtb infection in children and adolescents identified as household contacts of smear positive pulmonary Mtb index cases. Methods: This was a comparative study conducted in the Metropolitan area of Vitória, Espírito Santo, Brazil from March 2008 through October 2013. Clinical, demographic and epidemiological data were collect from all participants. We defined latency as a positive TST (induration ≥ 10mm) or a positive QFT-GIT test (Nil ≤8.0 IU/ml, TB Antigen minus Nil ≥0.35 IU/ml and ≥25% of Nil value). Both tests were performed in each volunteer between eight and ten weeks after the identification of the respective index cases. Concordance, as defined by kappa testing, was used to compare the results of the two methods of diagnosing latency. The factors associated with positivity of both tests in bivariate analysis (p ≤0.30) were included in the multivariate model (logistic regression), and the odds ratios (OR) and 95%CI were calculated. Results: 291 subjects were enrolled in the study. The global concordance between TST and QFT-GIT was high (87,6%) - k 0.75 [CI 95%: 0.63- 0.86]. However in children age ≤ 5 years the concordance was even higher (93.65%) - κ 0.87 [CI 95%: 0,63-1,12]. The presence of BCG scar was not statistically associated with tests positivity. There was a positive correlation between the size of TST induration and the probability of a positive QFT-GIT. Conclusion: There was no advantage in the use of QFT-GIT in relation to the TST. We recommend the twomonth timeframe after the identification of the index case to perform the tests in the household contacts.
publishDate 2015
dc.date.submitted.none.fl_str_mv 2015-07-06
dc.date.accessioned.fl_str_mv 2015-11-23T18:20:37Z
dc.date.issued.fl_str_mv 2015-07-06
dc.date.available.fl_str_mv 2016-06-24T06:00:07Z
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dc.publisher.none.fl_str_mv Universidade Federal do Espírito Santo
Mestrado em Doenças Infecciosas
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dc.publisher.initials.fl_str_mv UFES
dc.publisher.country.fl_str_mv BR
dc.publisher.department.fl_str_mv Centro de Ciências da Saúde
publisher.none.fl_str_mv Universidade Federal do Espírito Santo
Mestrado em Doenças Infecciosas
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