Role of QuantiFERON-TB

TB Gold in diagnosis of Tuberculosis ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)
Original Research Article

Role of QuantiFERON-TB
QuantiFERON TB Gold in diagnosis of
Tuberculosis
Aparna Pandey1*, Jayesh P. Warade2
1
Department of Laboratory Services, Apollo Specialty Hospital, Madurai, Tamilnadu,
Tamil India
2
Department of Laboratory Services,
Services Meenakshi Mission Hospital and Research Centre, Madurai,
Tamilnadu, India
*Corresponding author email: indigo139@gmail.com
How to cite this article: Aparna Pandey,
Pandey Jayesh P. Warade. Role of QuantiFERON-TB
QuantiFERON Gold in
diagnosis of Tuberculosis. IAIM, 2014; 1(3): 9-12.
Available
vailable online at www.iaimjournal.com
Received on: 06-11-2014
2014 Accepted on: 10-11-2014

Abstract
Introduction: The definitive diagnosis of Tuberculosis is established when typical histological
features can be demonstrated or mycobacteria can be isolated from the body fluids or from sputum
or from gastric lavage. Various other methods, such as gel electrophoresis, radiometric assay and
polymerase chain reaction are also available. It is well
well documented that isolation of mycobacteria
m
and culture is difficult and time consuming and other tests are complex and technically more
demanding. In this study, we correlated the results of QuantiFERON-TB
QuantiFERON Gold
old test with tuberculin
tuberculi skin
test and sputum positivity.
Material and methods: Total 150 subjects were included in this study. The clinical features and
detailed history of each case was
wa recorded in a standard format including
ncluding exposure to infection and
physical examination. Patients were tested for QuantiFERON-TB Gold.
Results: The results
lts obtained in this study showed that single method for diagnosis of tuberculosis
patients may not be able to detect all the positive cases of tuberculosis. Whereas combining two
methods for the diagnosis of tuberculosis patients is more advantageous way for the detectiondetec of
tuberculosis patients. The combination of tuberculin skin test along with the QuantiFERON-TB
QuantiFERON Gold
test had yield 96.6% cases as positive in our study which is far better than using a single test.
Conclusion: Use of QuantiFERON-TB
QuantiFERON Gold
old test for the diagnosis of tuberculosis is superior to
conventional methods of diagnosis,
diagno above which the QuantiFERON-TB Gold old test in combination with
tuberculin skin test
est yields the maximum number of true positive cases of tuberculosis. The levels of
new markers, serum interferon gamma (IFN-γ)
( after stimulation by foreign antigen by QFT test and
combining it with tuberculin skin test
test yields a good amount of true positive cases of tuberculosis
even in latent cases.

Key words
Interferon
eron gamma, Sputum, Tuberculin skin test,
t Mycobacterium, Microscopic.

International Archives of Integrated Medicine, Vol. 1, Issue. 3, November, 2014. Page 9

Copy right © 2014, IAIM, All Rights Reserved.
 Role of QuantiFERON-TB
TB Gold in diagnosis of Tuberculosis ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Introduction study. The clinical features and detailed history
of each case wass recorded in a standard format
Tuberculosis (TB) is one off the dreadful diseases including exposure to infection and physical
affecting a number of people in developing examination. Patients were tested for
countries including India. It is one of the most QuantiFERON-TB Gold old and other routine
ro work
common diseases causing a high mortality and up including tuberculin skin test and sputum
morbidity. The total number of cases is rising examination. The method used in our study waswa
every year because of rapidly growing QFTG-IT. The statistical analysis was done
population, socio-cultural
cultural reasons, increasing accordingly with simple mathematical
number of HIV cases, increasing number of poor calculation.
people and non-compliance
compliance to the treatment.
Results
Another emerging issue is widespread
dissemination of multiple drug resistant cases of The results
esults obtained from the study were we
TB, which has raised the eyebrows of public publ tabulated and interpreted as per Table – 1. The
health experts because it not only makes the combination
tion of tuberculin skin test along with
disease condition more lethal, it also required the QuantiFERON-TB TB Gold test had yield 96.6%
very high costs to cure the condition. The cases as positive which wass far better
b than using
definitive diagnosis is established when typical a single test like sputum examination
e (63.3%),
histological features can be demonstrated or tuberculin skin test (68%) and QuantiFERON-TB
QuantiFERON
mycobacteria can be isolatedlated from the body Gold (70%). It had also advantage over
fluids or from sputum or from gastric lavage. combining test like sputum positivity +
Various other methods, such as gel tuberculin skin test
est (84.6%) while QuantiFERON-
electrophoresis, radiometric assay and TB Gold + sputum examination
xamination (76.6%) as per
polymerase chain reaction are also available. It Table - 1.
is welll documented that isolation of
mycobacteria and culture iss difficult
di and time Discussion
consuming and other tests are complex and
technically more demanding, most of the times The results
lts obtained in this study showed that
diagnosis is based on radiological features, single method for diagnosis of tuberculosis
clinical features and positive tuberculin testing patients may not be able to detect all the
[1]. Recently, attempts are on to find most positive cases of tuberculosis. Whereas
simple techniques
iques which are reliable,
reliable more combining two methods for the diagnosis of
feasible; less costly and giving quick results and tuberculosis patients is more advantageous way
are largely comparable with standard for the detection
tion of tuberculosis patients. The
techniques. In this study,, we correlated the combination of tuberculin skin test along with
results of QuantiFERON-TB TB Gold test with the QuantiFERON-TB TB Gold test had yield 96.6%
tuberculin skin
kin test and sputum positivity. cases as positive in our study which is far better
b
than using a single test sputum examination
e
Material and methods (63.3%),, tuberculin skin test t (68%) and
QuantiFERON-TB Gold old (70%). It has also
The present study was carried out in i advantage over combining test like sputum
Department of Pathology of G.S.V.M.
G.S.V. Medical positivity + tuberculin skin test
t (84.6%) while
College, Kanpur from January
uary 2008 to October QuantiFERON-TB TB Gold + sputum examination
e
2010. Total 150 subjects were included in this (76.6%).

International Archives of Integrated Medicine, Vol. 1, Issue. 3, November, 2014. Page 10

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 Role of QuantiFERON-TB
TB Gold in diagnosis of Tuberculosis ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
IFN-γ release assays (IGRAs) are exciting new with a high risk of LTBI or TB diseasedis were
developments in TB infection testing. IGRAs are enrolled in the study [4]. Nahid P, P et al. (2006)
based on the ability of the mycobacterium proposed review on alternatives to the
tuberculosis antigens for early secretory antigen tuberculin skin test: IFN-γ assays in the diagnosis
target 6 (ESAT-6) and culture filtrate
iltrate protein 10 of mycobacterium TB infection. ThereThe were no
(CFP-10) to stimulate host production of IFN-γ IFN alternatives to the tuberculin skin test t for
[2]. Because these antigens are not present in diagnosing latent TB infection. Because of
non-tuberculous
tuberculous mycobacteria or in any BCG B advances in immunology and genomics, for the
vaccine variant, these tests can distinguish first time, an alternative has emerged in the
latent TB infection (LTBI).. The blood tests QFT form of T cell based IFN-γ IFN assays, a new
Gold in Tube and TSPOT. TB use these antigens generation of in vitro tests of cellular immunity.
to detect people with TB. Lymphocytes from the These assays measure cell mediated immune
patient's blood are incubated with the antigens. response by quantifying IFN--γ released by T cells
These tests are called IFN-γ tests and are not in response to stimulation by mycobacterium TB
equivalent. If the patient has been exposed to antigens. A review of current evidence on the
TB before, T lymphocytes produce IFN-γ IFN in performance of IFN-γ assays and an Tuberculin Skin
response. The QFT Gold in Tube uses an ELISA Test suggests that both the Tuberculin Skin Test
format to detect the whole blood production of and IFN-γ assays have advantages and
IFN-γ with great sensitivity (89%). The distinction
distin limitations, and both tests appear
ap to be useful at
between the tests is that QFT Gold quantifies this time [5]. Inoue, et al. (2009) in their study
the total amount of IFN-γ when whole blood is found that all eight active TB patients had
exposed to the antigens (ESAT-6, 6, CFP-10
CFP and TB positive
ve QFT results, and none of the 95 patients
7.7(p4)). with negative results had active any TB. The
sensitivity of the QFT reported is 100% (8 of 8)
Due to this working principle inciple of the and the specificity
city is 89.7% (87 of 97 cases) [6].
QuantiFERON-TB Gold old test, it is possible to
Archip, et al. (2008) compared the QFT test with
detect even the latent nt infection in the so called microscopic examination smear. They found that
healthy subjects. Miguel,, et al. (2007) studied the test is more useful than microscopic studies
clinical utility of IFN-γ Assay in the diagnosis of
of the smear. More ever it is also a faster and
TB [3]. This study discussed the potential easier method for the diagnosis of TB [7]. All the
benefits and drawbacks in patients, including above evidences shows ws that use of
those who are immune compromised. This Thi tests
QuantiFERON-TB Gold old test for the diagnosis of
that measure the production of IFN-γIFN by T-cells tuberculosis is superior to conventional methods
after sensitization with mycobacterium TB of diagnosis,
sis, above which the QuantiFERON-TB
QuantiFERON
antigens are available and, at least theoretically,
gold test in combination with tuberculin skin
may overcome some of the limitations of the test
est yields the maximum number of true positive
tuberculin skin test. Connell,, et al. (2006)
cases of tuberculosis.
studied performance ce of a whole blood IFN-γIFN
assay for detecting latent infection with Conclusion
mycobacterium
ycobacterium TB in children. The study was
undertaken to compare the performance of the The levels of new markers, serum IFN-γ
IFN after
whole blood IFN-γ assay with the tuberculin skin stimulation by foreign antigen by QFT test and
test
est in diagnosing LTTB infection or TB disease in combining it with tuberculin skin test
t yields a
children in routine clinical practice 106 children

International Archives of Integrated Medicine, Vol. 1, Issue. 3, November, 2014. Page 11

Copy right © 2014, IAIM, All Rights Reserved.
 Role of QuantiFERON-TB
TB Gold in diagnosis of Tuberculosis ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
good amount of true positive cases of 5. Nahid P, Pai M, Hopewell P. Advances in
tuberculosis even in latent cases. the diagnosis and treatment of
tuberculosis. Proc Am Thorac Soc, 2006;
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Table – 1: Results of various tests for diagnosing TB.

T

Various tests for diagnosing TB Positive Negative

Sputum examination 95 (63.3%) 55

Tuberculin skin test 102 (68%) 48

QuantiFERON-TB Gold 105 (70%) 45

Tuberculin
erculin skin test + QuantiFERON-TB
QuantiFERON Gold 145 (96.6%) 05

Sputum examination + Tuberculin skin test 127 (84.6%) 23

QuantiFERON-TB Gold
old + Sputum examination 115 (76.6%) 35

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