Background: Latent tuberculosis can progress to active TB. To diagnose LTBI the TST is used, which shows cross reactivity with NTM and BCG, giving way to overdiagnosis of LTBI. The sophisticated QFT is also used to diagnose LTBI and hardly has cross reactivity. Based on previous findings we assumed overdiagnosis of LTBI in Suriname because of false positive TST results due to NTM. Method: To evaluate our premise, we conducted a prospective study comparing the TST and QFT results of patients who had undergone both tests. Results: 64.1% of patients with a positive deemed TST had a negative QFT result, of which 64% were not prescribed TPT or did not complete TPT. At one year follow up no cases of active TB were encountered. Conclusion: False positive TST results lead to overestimation of LTBI incidence. Whenever an unexpected positive TST result is encountered it is advisable to perform a QFT for a more accurate diagnosis.
References
[1]
World Health Organization (2018) Latent Tuberculosis Infection: Updated and Consolidated Guidelines for Programmatic Management. Licence: CC BY-NC-SA 3.0 IGO.
[2]
Gong, W. and Wu, X. (2021) Differential Diagnosis of Latent Tuberculosis Infection and Active Tuberculosis: A Key to a Successful Tuberculosis Control Strategy. FrontiersinMicrobiology, 12, Article 745592. https://doi.org/10.3389/fmicb.2021.745592
[3]
Arias Guillén, M. (2011) Avances en el diagnóstico de la infección tuberculosa. ArchivosdeBronconeumología, 47, 521-530. https://doi.org/10.1016/j.arbres.2011.06.018
[4]
Talaat, R.M., Radwan, G.S., Mosaad, A.A., Saleh, S.A. and Bassiouny, K. (2010) Rapid Immunodiagnostic Assays for Mycobacterium Tuberculosis Infection. Health, 2, 171-176. https://doi.org/10.4236/health.2010.23025
[5]
Migliori, G.B., Nardell, E., Yedilbayev, A., D’Ambrosio, L., Centis, R., Tadolini, M., et al. (2019) Reducing Tuberculosis Transmission: A Consensus Document from the World Health Organization Regional Office for Europe. EuropeanRespiratoryJournal, 53, 1900391. https://doi.org/10.1183/13993003.00391-2019
[6]
World Health Organization (2020) WHO Operational Handbook on Tuberculosis. Module 1: Prevention—Tuberculosis Preventive Treatment. Licence: CC BY-NC-SA 3.0 IGO.
[7]
Comstock, G.W., Livesay, V.T. and Woolpert, S.F. (1974) The Prognosis of a Positive Tuberculin Reaction in Childhood and Adolescence. AmericanJournalofEpidemiology, 99, 131-138. https://doi.org/10.1093/oxfordjournals.aje.a121593
[8]
Vynnycky, E. and Fine, P.E.M. (1997) The Natural History of Tuberculosis: The Implications of Age-Dependent Risks of Disease and the Role of Reinfection. EpidemiologyandInfection, 119, 183-201. https://doi.org/10.1017/s0950268897007917
[9]
Getahun, H., Matteelli, A., Chaisson, R.E. and Raviglione, M. (2015) Latent Mycobacteriumtuberculosis Infection. NewEnglandJournalofMedicine, 372, 2127-2135. https://doi.org/10.1056/nejmra1405427
[10]
Ai, J., Ruan, Q., Liu, Q. and Zhang, W. (2016) Updates on the Risk Factors for Latent Tuberculosis Reactivation and Their Managements. EmergingMicrobes&Infections, 5, 1-8. https://doi.org/10.1038/emi.2016.10
[11]
Shea, K.M., Kammerer, J.S., Winston, C.A., Navin, T.R. and Horsburgh, C.R. (2013) Estimated Rate of Reactivation of Latent Tuberculosis Infection in the United States, Overall and by Population Subgroup. AmericanJournalofEpidemiology, 179, 216-225. https://doi.org/10.1093/aje/kwt246
[12]
Kiazyk, S. and Ball, T. (2017) Latent Tuberculosis Infection: An Overview. CanadaCommunicable Disease Report, 43, 62-66. https://doi.org/10.14745/ccdr.v43i34a01
[13]
World Health Organization (2022) Global Tuberculosis Report 2022. Licence: CC BY-NC-SA 3.0 IGO.
[14]
World Health Organization (2021) WHO Operational Handbook on Tuberculosis. Module 2: Screening—Systematic Screening for Tuberculosis Disease. Licence: CC BY-NC-SA 3.0 IGO.
[15]
Houben, R.M.G.J. and Dodd, P.J. (2016) The Global Burden of Latent Tuberculosis Infection: A Re-Estimation Using Mathematical Modelling. PLOS Medicine, 13, e1002152. https://doi.org/10.1371/journal.pmed.1002152
[16]
Gualano, G., Mencarini, P., Lauria, F.N., Palmieri, F., Mfinanga, S., Mwaba, P., et al. (2019) Tuberculin Skin Test—Outdated or Still Useful for Latent TB Infection Screening? InternationalJournalofInfectiousDiseases, 80, S20-S22. https://doi.org/10.1016/j.ijid.2019.01.048
[17]
American Thoracic Society (2000) Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection. American Journal of Respiratory and Critical Care Medicine, 161, S221-S247. https://doi.org/10.1164/ajrccm.161.supplement_3.ats600
[18]
Pai, M. and Sotgiu, G. (2016) Diagnostics for Latent TB Infection: Incremental, Not Transformative Progress. EuropeanRespiratoryJournal, 47, 704-706. https://doi.org/10.1183/13993003.01910-2015
[19]
Andersen, P., Munk, M., Pollock, J. and Doherty, T. (2000) Specific Immune-Based Diagnosis of Tuberculosis. TheLancet, 356, 1099-1104. https://doi.org/10.1016/s0140-6736(00)02742-2
[20]
Republic of Suriname (2023) Common Country Analysis.
[21]
World Health Organization (2023) Global Tuberculosis Report 2023. Geneva.
[22]
Republic of Suri-Name Ministry of Health (2023) Nationale Tuberculose Richtlijn, 2023 Update. National Tuberculosis Program
[23]
Gopie, F.A., Hassankhan, A., Zijlmans, W., de Lange, W.C.M., Vreden, S.G.S. and van Ingen, J. (2020) Non-Tuberculous Mycobacteria in Sputum Cultures in Suriname. TheInternationalJournalofTuberculosisandLungDisease, 24, 1106-1108. https://doi.org/10.5588/ijtld.20.0249
[24]
Sia, J.K. and Rengarajan, J. (2019) Immunology of Mycobacteriumtuberculosis infections. In: Fischetti, V.A., et al., Eds, Gram-PositivePathogens, ASM Press, 1056-1086. https://doi.org/10.1128/9781683670131.ch64
[25]
Doan, T.N., Eisen, D.P., Rose, M.T., Slack, A., Stearnes, G. and McBryde, E.S. (2017) Interferon-γ Release Assay for the Diagnosis of Latent Tuberculosis Infection: A Latent-Class Analysis. PLOSONE, 12, e0188631. https://doi.org/10.1371/journal.pone.0188631
[26]
Youssef, E. (2005) Serious Allergic Reactions Following Tuberculin Skin Tests. CanadianMedicalAssociationJournal, 173, 34-34. https://doi.org/10.1503/cmaj.050710
[27]
Gopie, F.A., Hassankhan, A., Zijlmans, W.C.W.R. and Vreden, S.G.S. (2021) Indications, Interpretation and Clinical Consequences of Tuberculin Skin Tests in Resource Limited Settings. JournalofTuberculosisResearch, 9, 172-183. https://doi.org/10.4236/jtr.2021.93016
[28]
Mancuso, J.D., Mody, R.M. et al. (2017) The Long-Term Effect of Bacille Calmette-Guérin Vaccination on Tuberculin Skin Testing: A 55-Year Follow-Up Study. Chest, 152, 282-294.
[29]
Nayak, S. and Acharjya, B. (2012) Mantoux Test and Its Interpretation. IndianDermatologyOnlineJournal, 3, 2-6. https://doi.org/10.4103/2229-5178.93479
[30]
Sloot, R., Schim van der Loeff, M.F., Kouw, P.M. and Borgdorff, M.W. (2014) Risk of Tuberculosis after Recent Exposure. A 10-Year Follow-Up Study of Contacts in Amsterdam. AmericanJournalofRespiratoryandCriticalCareMedicine, 190, 1044-1052. https://doi.org/10.1164/rccm.201406-1159oc
[31]
Krasilnikov, I., Lehnherr-Ilyina, T., Djonovic, M., Artamonova, I., Nikitin, M. and Kislichkin, N. (2024) Cracking the Antigenic Code of Mycobacteria: CFP-10/ESAT-6 Tuberculosis Skin Test and Misleading Results. JournalofClinicalTuberculosisandOtherMycobacterialDiseases, 36, Article ID: 100436. https://doi.org/10.1016/j.jctube.2024.100436
[32]
Montane Jaime, L.K., Akpaka, P.E., Vuma, S. and Justiz-Vaillant, A.A. (2019) A Healthy Patient with Positive Mantoux Test but Negative Quantiferon Gold Assay and No Evidence of Risk Factors—To Treat or Not to Treat? IDCases, 18, e00658. https://doi.org/10.1016/j.idcr.2019.e00658