Skip to main content

Advertisement

SpringerLink
Log in

IGRA testing in patients with immune-mediated inflammatory diseases: which factors influence the results?

  • Infection and Immunity
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Diagnosis of latent tuberculosis infection in patients with immune-mediated inflammatory chronic diseases (IMIDs) can be challenged as diagnostic test reliability could be impaired by immunosuppression. We retrospectively analyzed the Quantiferon Gold-Test in-Tube (QFT-G-IT) results of all patients with IMIDs seen at the Department of Internal Medicine of Son Llàtzer Hospital, Palma de Mallorca (Spain), looking for the factors related to QFT-G-IT indeterminate results. During the study period (2008–2015), 520 patients met the inclusion criteria. Factors associated with indeterminate QFT-G-IT results in a univariate analysis were inflammatory bowel disease, disease activity, lymphopenia, and medium-to-high doses of corticosteroids. In a subsequent multivariate analysis, only lymphopenia (defined as < 1500 cells) was associated with indeterminate QFT-G-IT results. Lymphocyte count was the only factor independently associated with an increased number of indeterminate QFT-G-IT results in patients with different autoimmune diseases. Others factors such as the use of medium-to-high doses of corticosteroids should be considered before testing with QFT-G-IT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jick SS, Lieberman ES, Rahman MU et al (2006) Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum 55:19–26

    Article  PubMed  Google Scholar 

  2. Carmona L, Hernández-García C, Vadillo C, EMECAR Study Group et al (2003) Increased risk of tuberculosis in patients with rheumatoid arthritis. J Rheumatol 30:1436–1439

    PubMed  Google Scholar 

  3. Iannone F, Cantini F, Lapadula G (2014) Diagnosis of latent tuberculosis and prevention of reactivation in rheumatic patients receiving biologic therapy: international recommendations. J Rheumatol 91:41–46

    CAS  Google Scholar 

  4. Goletti D, Sanduzzi A, Delogu G (2014) Performance of the tuberculin skin test and interferon-γ release assays: an update on the accuracy, cutoff stratification, and new potential immune-based approaches. J Rheumatol 91:24–31

    CAS  Google Scholar 

  5. Maeda T, Banno S, Maeda S et al (2010) Usefulness and limitations of QuantiFERON-TB Gold in Japanese rheumatoid arthritis patients: proposal to decrease the lower cutoff level for assessing latent tuberculosis infection. Mod Rheumatol 20:18–23

    Article  PubMed  Google Scholar 

  6. Takeda N, Nojima T, Terao C et al (2011) Interferon-gamma release assay for diagnosing Mycobacterium tuberculosis infections in patients with systemic lupus erythematosus. Lupus 20:792–800

    Article  CAS  PubMed  Google Scholar 

  7. González-Martín J, García-García JM, Anibarro L et al (2010) Consensus document on the diagnosis, treatment and prevention of tuberculosis. Enferm Infecc Microbiol Clin 28:297e1–297e120

    Article  Google Scholar 

  8. Bartalesi F, Vicidomini S, Goletti D et al (2009) QuantiFERON-TB Gold and the TST are both useful for latent tuberculosis infection screening in autoimmune diseases. Eur Respir J 33:586–593

    Article  CAS  PubMed  Google Scholar 

  9. Matulis G, Jüni P, Villiger PM et al (2008) Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen-specific interferon gamma assay. Ann Rheum Dis 67:84–90

    Article  CAS  PubMed  Google Scholar 

  10. Bélard E, Semb S, Ruhwald M et al (2011) Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection. Inflamm Bowel Dis 17:2340–2349

    Article  PubMed  Google Scholar 

  11. Cho H, Kim YW, Suh CH et al (2016) Concordance between the tuberculin skin test and interferon gamma release assay (IGRA) for diagnosing latent tuberculosis infection in patients with systemic lupus erythematosus and patient characteristics associated with an indeterminate IGRA. Lupus 25:1341–1348

    Article  CAS  PubMed  Google Scholar 

  12. Shovman O, Anouk M, Vinnitsky N et al (2009) QuantiFERON-TB Gold in the identification of latent tuberculosis infection in rheumatoid arthritis: a pilot study. Int J Tuberc Lung Dis 13:1427–1432

    CAS  PubMed  Google Scholar 

  13. Papay P, Eser A, Winkler S et al (2011) Predictors of indeterminate IFN-γ release assay in screening for latent TB in inflammatory bowel diseases. Eur J Clin Investig 41:1071–1076

    Article  CAS  Google Scholar 

  14. Jung HJ, Kim TJ, Kim HS et al (2014) Analysis of predictors influencing indeterminate whole-blood interferon-gamma release assay results in patients with rheumatic diseases. Rheumatol Int 34:1711–1720

    Article  CAS  PubMed  Google Scholar 

  15. Kobashi Y, Sugiu T, Mouri K et al (2009) Indeterminate results of QuantiFERON TB-2G test performed in routine clinical practice. Eur Respir J 33:812–815

    Article  CAS  PubMed  Google Scholar 

  16. Cattamanchi A, Smith R, Steingart KR et al (2011) Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis. J Acquir Immune Defic Syndr 56:230–238

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Aichelburg MC, Tittes J, Breitenecker F et al (2012) Prognostic value of indeterminate IFN-γ release assay results in HIV-1 infection. J Clin Microbiol 50:2767–2769

    Article  PubMed  PubMed Central  Google Scholar 

  18. Oni T, Gideon HP, Bangani N et al (2012) Risk factors associated with indeterminate gamma interferon responses in the assessment of latent tuberculosis infection in a high-incidence environment. Clin Vaccine Immunol 19:1243–1247

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Karam F, Mbow F, Fletcher H et al (2008) Sensitivity of IFN-gamma release assay to detect latent tuberculosis infection is retained in HIV-infected patients but dependent on HIV/AIDS progression. PLoS ONE 3:e1441

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sester M, van Leth F, Bruchfeld J, TBNET et al (2014) Risk assessment of tuberculosis in immunocompromised patients. A TBNET study. Am J Respir Crit Care Med 190:1168–1176

    Article  PubMed  Google Scholar 

  21. Herold MJ, McPherson KG, Reichardt HM (2006) Glucocorticoids in T cell apoptosis and function. Cell Mol Life Sci 63:60–72

    Article  CAS  PubMed  Google Scholar 

  22. Helwig U, Müller M, Hedderich J et al (2012) Corticosteroids and immunosuppressive therapy influence the result of QuantiFERON TB Gold testing in inflammatory bowel disease patients. J Crohns Colitis 6:419–424

    Article  PubMed  Google Scholar 

  23. Kleinert S, Kurzai O, Elias J et al (2010) Comparison of two interferon-gamma release assays and tuberculin skin test for detecting latent tuberculosis in patients with immune-mediated inflammatory diseases. Ann Rheum Dis 69:782–784

    Article  CAS  PubMed  Google Scholar 

  24. Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S et al (2008) Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol 35:776–781

    PubMed  Google Scholar 

  25. Martin J, Walsh C, Gibbs A et al (2010) Comparison of interferon gamma release assays and conventional screening tests before tumour necrosis factor alpha blockade in patients with inflammatory arthritis. Ann Rheum Dis 69:181–185

    Article  CAS  PubMed  Google Scholar 

  26. Hradsky O, Ohem J, Zarubova K et al (2014) Disease activity is an important factor for indeterminate interferon-γ release assay results in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 58:320–324

    Article  PubMed  Google Scholar 

  27. Lee H, Park HY, Jeon K et al (2015) QuantiFERON-TB Gold In-Tube assay for screening arthritis patients for latent tuberculosis infection before starting anti-tumor necrosis factor treatment. PLoS ONE 10:e0119260

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mariette X, Baron G, Tubach F et al (2012) Influence of replacing tuberculin skin test with ex vivo interferon γ release assays on decision to administer prophylactic antituberculosis antibiotics before anti-TNF therapy. Ann Rheum Dis 71:1783–1790

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internal Medicine Department, Hospital Son Llàtzer, Carretera de Manacor Km4, 07198, Palma, Baleares, Spain

    Juan González-Moreno, Mercedes García-Gasalla, Inés Losada-López, Carmen Cifuentes Luna, Araceli Serrano & Antoni Payeras Cifre

  2. Pneumology Department, Hospital Son Llàtzer, Palma, Spain

    Isabel Mir Viladrich

  3. Microbiology Department, Hospital Son Llàtzer, Palma, Spain

    Victoria Fernández-Baca

  4. Rheumatology Department, Hospital Son Llàtzer, Palma, Spain

    Antonio Juan Mas

  5. Digestive Department, Hospital Son Llàtzer, Palma, Spain

    Joan Riera-Oliver

Authors
  1. Juan González-Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mercedes García-Gasalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Inés Losada-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carmen Cifuentes Luna
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Isabel Mir Viladrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victoria Fernández-Baca
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Araceli Serrano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonio Juan Mas
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joan Riera-Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Antoni Payeras Cifre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan González-Moreno.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

González-Moreno, J., García-Gasalla, M., Losada-López, I. et al. IGRA testing in patients with immune-mediated inflammatory diseases: which factors influence the results?. Rheumatol Int 38, 267–273 (2018). https://doi.org/10.1007/s00296-017-3852-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-017-3852-9

Keywords

Search

Navigation