Contribuição do teste de liberação de interferon-gama após estimulação in vitro no diagnóstico da infecção latente e doença por M. tuberculosis em crianças e adolescentes

• Autor(a) principal: Silveira, Mariana Bernardi Viviani [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4265549; http://repositorio.unifesp.br/handle/11600/47084
• topic: Interferon gama release immuno assay; Childhood tuberculosis; M. tuberculosis infection; Tuberculosis infection; Ensaio de liberação de interferon gama; Tuberculose na infância; Infecção pelo M; Tuberculosis

Objectives: To evaluate the contribution of ELISpot on diagnosis of M. tuberculosis infection in children and adolescents, on medical decision and in patients? outcome. To identify the agreement between ELISpot and tuberculin skin test (TST) and conditions in which ELISpot contributed most. Methods: This retrospective cohort study took place at Pediatric Units of Federal University of São Paulo. T-SPOT.TBTM was performed in patients who were on investigation for latent or active tuberculosis along with other diagnostic tests like tuberculin skin test (TST) and microbiological tests, from 2007 to 2011. Later, data were collected from medical records until September 2015. Patients were classified in two groups according to presence or absence of an immunodeficiency condition. We evaluated the performance of ELISpot, concordance between tests and its contribution to diagnosis. The study was approved by the Ethics Committee of Federal University of São Paulo. Results: Median age of 86 patients was 9.8y (range, 0.1-24.1); 55% were female. Forty-one (48%) immunocompetent children (IC) and 45 (52%) with some immunodeficiency condition (ID) (14 HIV infection, 12 oncologic disease, 11 autoimmune disease, 8 other immunodeficiency conditions) were evaluated. All patients were submitted to ELISpot that was indeterminate in 13 (15%) patients (4 IC and 9 ID; Chi-squared, p=0.306). In 63 patients both ELISpot and TST were performed; tests were concordant in 50 (79.4%), 22/31 (71%) IC (Kappa=0.418, p=0.02) and 28/32 (87.5%) ID (Kappa=0.526, p=0.003). Tuberculosis infection (latent or active disease) was diagnosed in 31 (36%) children (18 IC and 13 ID) and excluded in 55 (64%) (23 IC and 32 ID; Chi-squared between groups, p=0.221). ELISpot contributed to diagnosis in 18/86 patients (21%) (13/41 IC and 5/45 ID) and did not add to other tests or was not considered for clinical management in 28 IC and 40 ID (Chi-squared, p=0.038). Conclusion: ELISpot and TST had a moderate agreement in both groups of patients. ELISpot contribution among immunocompetent patients was higher than among immunodeficient patients.