The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities
Objectives: In the USA, tuberculosis disease rates are highest in older adults. Diagnostic testing for latent tuberculosis infection (LTBI) has not been evaluated carefully in this group. The aim of this study was to define the relationship between tuberculin skin test (TST) results, T-SPOT.TB resul...
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doaj-483ef327a56d4bf99d24c5c2ed7ad3032020-11-24T23:16:58ZengElsevierInternational Journal of Infectious Diseases1201-97121878-35112016-03-0144C374310.1016/j.ijid.2016.01.007The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilitiesNatasha S. Hochberg0Sergey Rekhtman1Julianne Burns2Lisa Ganley-Leal3Sina Helbig4Nathaniel S. Watts5Gary H. Brandeis6Jerrold J. Ellner7C. Robert Horsburgh Jr8Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USADepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USADepartment of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USADepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Medicine, Section of Geriatric Medicine, Boston University School of Medicine, Boston, Massachusetts, USADepartment of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USADepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USAObjectives: In the USA, tuberculosis disease rates are highest in older adults. Diagnostic testing for latent tuberculosis infection (LTBI) has not been evaluated carefully in this group. The aim of this study was to define the relationship between tuberculin skin test (TST) results, T-SPOT.TB results, and T-cell responses to Mycobacterium tuberculosis antigens. Methods: Long-term care facility residents with known prior TST results (positive or negative) were retested with TSTs and T-SPOT.TB. Prior exposure to M. tuberculosis was assessed by quantifying T-cell activation to mycobacterial antigens in vitro. Results: The median age of the 37 participants was 77 years (range 57–98 years). Among 18 participants with a prior positive TST, three (16.7%) had a negative TST when retested (TST reversion); two had a negative T-SPOT.TB. Of the 15 who were historically and currently TST-positive, four (26.7%) had a negative T-SPOT.TB and one (6.7%) had a borderline result. Percentages of CD4+ T-cells responding to mycobacterial antigens were higher in participants with positive TST and T-SPOT.TB (18.2%) compared to those with a positive TST but negative T-SPOT.TB (6.4%, p = 0.16) and negative TST and T-SPOT.TB (5.9%, p < 0.001). Conclusions: LTBI testing in older adults is complicated by TST reversion and TST-positive/T-SPOT.TB-negative discordance, which may reflect clearance of infection or waning immunity.http://www.sciencedirect.com/science/article/pii/S1201971216000084Latent tuberculosisInterferon-gamma release assaysNursing homesLong-term care facility |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Natasha S. Hochberg Sergey Rekhtman Julianne Burns Lisa Ganley-Leal Sina Helbig Nathaniel S. Watts Gary H. Brandeis Jerrold J. Ellner C. Robert Horsburgh Jr |
spellingShingle |
Natasha S. Hochberg Sergey Rekhtman Julianne Burns Lisa Ganley-Leal Sina Helbig Nathaniel S. Watts Gary H. Brandeis Jerrold J. Ellner C. Robert Horsburgh Jr The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities International Journal of Infectious Diseases Latent tuberculosis Interferon-gamma release assays Nursing homes Long-term care facility |
author_facet |
Natasha S. Hochberg Sergey Rekhtman Julianne Burns Lisa Ganley-Leal Sina Helbig Nathaniel S. Watts Gary H. Brandeis Jerrold J. Ellner C. Robert Horsburgh Jr |
author_sort |
Natasha S. Hochberg |
title |
The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities |
title_short |
The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities |
title_full |
The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities |
title_fullStr |
The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities |
title_full_unstemmed |
The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities |
title_sort |
complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities |
publisher |
Elsevier |
series |
International Journal of Infectious Diseases |
issn |
1201-9712 1878-3511 |
publishDate |
2016-03-01 |
description |
Objectives: In the USA, tuberculosis disease rates are highest in older adults. Diagnostic testing for latent tuberculosis infection (LTBI) has not been evaluated carefully in this group. The aim of this study was to define the relationship between tuberculin skin test (TST) results, T-SPOT.TB results, and T-cell responses to Mycobacterium tuberculosis antigens.
Methods: Long-term care facility residents with known prior TST results (positive or negative) were retested with TSTs and T-SPOT.TB. Prior exposure to M. tuberculosis was assessed by quantifying T-cell activation to mycobacterial antigens in vitro.
Results: The median age of the 37 participants was 77 years (range 57–98 years). Among 18 participants with a prior positive TST, three (16.7%) had a negative TST when retested (TST reversion); two had a negative T-SPOT.TB. Of the 15 who were historically and currently TST-positive, four (26.7%) had a negative T-SPOT.TB and one (6.7%) had a borderline result. Percentages of CD4+ T-cells responding to mycobacterial antigens were higher in participants with positive TST and T-SPOT.TB (18.2%) compared to those with a positive TST but negative T-SPOT.TB (6.4%, p = 0.16) and negative TST and T-SPOT.TB (5.9%, p < 0.001).
Conclusions: LTBI testing in older adults is complicated by TST reversion and TST-positive/T-SPOT.TB-negative discordance, which may reflect clearance of infection or waning immunity. |
topic |
Latent tuberculosis Interferon-gamma release assays Nursing homes Long-term care facility |
url |
http://www.sciencedirect.com/science/article/pii/S1201971216000084 |
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