Evaluation of the impact of interferon-gamma release assays on the management of childhood tuberculosis

Daphne I. Ling, Claire A. Crépeau, Marieke Dufresne, Shazia Khan, Caroline Quach, Nandini Dendukuri, Kevin Schwartzman, Dick Menzies, Larry C. Lands, Madhukar Pai

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

BACKGROUND: Interferon-gamma release assays are increasingly being used in low-incidence settings, but there is little information on whether test results influence clinical decisions in children. METHODS: In June 2009, the Montreal Children's Hospital began implementing the QuantiFERON-TB Gold In-Tube (QFT) as a follow-up test to the tuberculin skin test (TST). Pediatric respirologists were asked to document how the QFT result changed their initial clinical management based on the TST. RESULTS: During a 2-year period, 399 children with TST and QFT results were recruited prospectively. The median age was 13 years. In the cohort, 83% were foreign-born and 82% were Bacille Calmette-Guérin vaccinated. The QFT was negative in 5 of 11 (45.5%) children diagnosed with active tuberculosis (TB). Among 55 TST+/QFT- children evaluated as TB contacts, the negative QFT changed the treatment decision in only 3 (5.5%), and isoniazid was prescribed to the remainder. In 201 TST+/QFT- children from targeted school and immigrant screening programs, a negative QFT result was used to withhold isoniazid in 145 (72.1%) children. These children were followed for 1 year, during which no TB cases occurred. In a multivariable analysis, history of TB contact and TST induration ≥20 mm were associated with fewer changes in clinical decisions. CONCLUSIONS: Our cohort study showed that pediatric respirologists used negative QFT results to withhold isoniazid in most low-risk children who were referred for a positive TST found through targeted screening programs. In contrast, in almost all TST-positive children who were evaluated as TB contacts, negative QFT results did not change clinical management.

Original languageEnglish
Pages (from-to)1258-1262
Number of pages5
JournalPediatric Infectious Disease Journal
Volume31
Issue number12
DOIs
Publication statusPublished - 2012 Dec

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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