Tuberculin skin test and quantiferon in BCG vaccinated, immunosuppressed patients with moderate-to-severe inflammatory bowel disease

Zsuzsanna Kurti, Barbara Dorottya Lovasz, Krisztina Barbara Gecse, Anita Balint, Klaudia Farkas, Agnes Morocza-Szabo, Andras Gyurcsanyi, Katalin Kristof, Zsuzsanna Vegh, Lorant Gonczi, Lajos Sandor Kiss, Petra Anna Golovics, Laszlo Lakatos, Tamas Molnar, Peter Laszlo Lakatos

Research output: Article

8 Citations (Scopus)

Abstract

Background & Aims: There are few data available on the effect of immunomodulator/biological therapy on the accuracy of the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) in BCG-vaccinated immunosuppressed patients with inflammatory bowel disease (IBD). Our aim was to define the accuracy, predictors and agreement of TST and IGRA in a BCG-vaccinated immunosuppressed referral IBD cohort. Methods: 166 consecutive moderate-to-severe IBD patients (122 Crohn’s disease, CD and 44 ulcerative colitis, UC) were enrolled in a prospective study from three centers. Patients were treated with immunosuppressives and/or biologicals. IGRA and TST were performed on the same day. Both in- and outpatient records were collected and comprehensively reviewed. Results: TST positivity rate was 23.5%, 21.1%,14.5% and 13.9% when cut-off values of 5, 10, 15 and 20mm were used. IGRA positivity rate was 8.4% with indeterminate result in 0.6%. Chest X-ray was suggestive of latent tuberculosis in 2 patients. Correlation between TST and IGRA was moderate (kappa: 0.39-0.41, p<0.001). In addition, a cut-off of 14 and 17mm for TST was defined to identify IGRA positivity in a ROC analysis (AUC: 0.76, p=0.03). TST and/or IGRA positivity was not influenced by medical therapy or disease phenotype. Importantly, smoking was identified as a risk factor for TST but not IGRA positivity (OR: 2.70-5.02, p<0.01, for TSTcut-offs=5-20mm). Conclusion: TST and IGRA tests are partly complimentary methods, and additional testing by TST (with a cut-off of >15mm) should be considered to identify patients at risk for latent TB. Accuracy is satisfactory in BCG-vaccinated, immunosuppressed IBD patients. Smoking is a risk factor for TST positivity.

Original languageEnglish
Pages (from-to)467-472
Number of pages6
JournalJournal of Gastrointestinal and Liver Diseases
Volume24
Issue number4
DOIs
Publication statusPublished - dec. 2015

ASJC Scopus subject areas

  • Gastroenterology

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    Kurti, Z., Lovasz, B. D., Gecse, K. B., Balint, A., Farkas, K., Morocza-Szabo, A., Gyurcsanyi, A., Kristof, K., Vegh, Z., Gonczi, L., Kiss, L. S., Golovics, P. A., Lakatos, L., Molnar, T., & Lakatos, P. L. (2015). Tuberculin skin test and quantiferon in BCG vaccinated, immunosuppressed patients with moderate-to-severe inflammatory bowel disease. Journal of Gastrointestinal and Liver Diseases, 24(4), 467-472. https://doi.org/10.15403/jgld.2014.1121.244.bcg