Malnutrition and helminth infection affect performance of an interferon γ-release assay

Tania A. Thomas, Dinesh Mondal, Zannatun Noor, Lei Liu, Masud Alam, Rashidul Haque, Sayera Banu, Haiyan Sun, Kristine M. Peterson

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

OBJECTIVE: We sought to compare the tuberculin skin test (TST) to the QuantiFERON-TB Gold In-Tube assay (QFT-IT) and assess the effects of malnourishment and intestinal helminth infection on QFT-IT results. METHODS: In this population-based cross-sectional study from Dhaka, Bangladesh, we screened children for latent tuberculosis infection with the QFT-IT and TST. We assess the agreement between the TST and QFT-IT, risk factors associated with indeterminate QFT-IT results, and magnitude of interferon γ (IFN-γ) production. RESULTS: Three hundred and two children (aged 11-15.3 years) were enrolled, including 93 (30.8%) who were malnourished. Of 251 participants who provided stool samples, 117 (46.6%) were infected with Ascaris lumbricoides and/or Trichuris trichiura. TST results were positive (≥10 mm) for 101 (33.4%) children and negative for 201 (66.6%) children. QFT-IT results were positive for 107 (35.4%) children, negative for 121 (40.1%) children, and indeterminate for 74 (24.5%) children. Agreement between the tests was moderate (κ = 0.55 [95% confidence interval: 0.44-0.65]; P < .0001) when excluding indeterminate results. Children with indeterminate QFT-IT results were separately compared with children with positive and negative QFT-IT results; malnutrition (P = .0006 and .0003), and helminth infection (P = .05 and .02), and the statistical interaction between these 2 terms (P = .03 and .004) were associated with indeterminate results. Higher levels of IFN-γin response to tuberculosis antigens were associated with positive TST results (P < .0001); lower levels were associated with malnutrition (P = .02). CONCLUSIONS: Malnutrition and helminth infections were associated with indeterminate QFT-IT results. Therefore, the presence of such conditions may limit the interpretability of QFT-IT results in children.

Original languageEnglish (US)
Pages (from-to)e1522-e1529
JournalPediatrics
Volume126
Issue number6
DOIs
StatePublished - Dec 2010

Keywords

  • Helminth infection
  • Interferon γ-release assay
  • Latent tuberculosis infection
  • Malnutrition
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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