Tuberculosis contact investigation using interferon-gamma release assay with chest x-ray and computed tomography

Akira Fujikawa, Tatsuya Fujii, Satoshi Mimura, Ryota Takahashi, Masao Sakai, Shinya Suzuki, Yukishige Kyoto, Yasuhide Uwabe, Shinji Maeda, Toru Mori, Akira Fujikawa, Tatsuya Fujii, Satoshi Mimura, Ryota Takahashi, Masao Sakai, Shinya Suzuki, Yukishige Kyoto, Yasuhide Uwabe, Shinji Maeda, Toru Mori

Abstract

Between September 2009 and January 2010, 6 members of the Japanese Eastern Army, who had completed the same training program, were diagnosed with active tuberculosis (TB) on different occasions. The Ministry of Defense conducted a contact investigation of all members who had come into contact with the infected members. The purpose of this study was to verify the efficacy of the TB screening protocol used in this investigation. A total of 884 subjects underwent interferon-gamma release assay (IGRA) and chest X-ray. The 132 subjects who were IGRA positive or with X-ray findings suggestive of TB subsequently underwent chest computer tomography (CT). Chest CT was performed for 132 subjects. Based on CT findings, 24 (2.7%) subjects were classified into the active TB group, 107 (12.1%) into the latent tuberculosis infection (LTBI) group, and 753 (85.2%) into the non-TB group. The first 2 groups underwent anti-TB therapy, and all 3 groups were followed for 2 years after treatment. Although one subject in the active TB group experienced relapse during the follow-up period, no patient in the LTBI or non-TB groups developed TB. IGRA and chest X-ray, followed by chest CT for those IGRA positive or with suspicious X-ray findings, appears to be an effective means of TB contact screening and infection prevention.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Contact investigation protocol for tuberculosis.
Figure 1. Contact investigation protocol for tuberculosis.
The subjects were stratified into 3 groups according to the results of QFT-3G, chest X-ray, and chest CT.
Figure 2. CT findings of active TB.
Figure 2. CT findings of active TB.
A chest CT image of the left upper lobe of the lung in a 19-year-old subject demonstrated clustered non-calcified nodules associated with dilated peripheral airways (thin arrows) and a cavitation (arrow head) with dilated and thickened subsegmental bronchus (white arrow).
Figure 3. Bacteriologically positive cases of active…
Figure 3. Bacteriologically positive cases of active tuberculosis diagnosed by the investigation protocol.
Ten of 24 subjects diagnosed with active TB in the protocol showed positive culture for M. tuberculosis. Of these 10 subjects, 3 were missed by chest X-ray.
Figure 4. Comparison of QFT-3G values at…
Figure 4. Comparison of QFT-3G values at screening between the active TB group and latent (LTBI) group.
Comparison showed a statistically significantly higher value in the active TB group than in the LTBI group.
Figure 5. Comparison of QFT-3G values between…
Figure 5. Comparison of QFT-3G values between the positive and negative culture groups at diagnosis of active TB.
Comparison showed no significant difference between the 2 groups.
Figure 6. Comparison of QFT-3G values at…
Figure 6. Comparison of QFT-3G values at diagnosis and after treatment of active TB.
Comparison showed a statistically significant reduction of QFT-3G values after treatment.
Figure 7. Comparison of QFT-3G values at…
Figure 7. Comparison of QFT-3G values at diagnosis and after treatment of latent TB.
Comparison showed a statistically significant reduction of the QFT-3G values after treatment.

References

    1. Diel R, Loddenkemper R, Meywald-Walter K, Gottschalk R, Nienhaus A (2009) Comparative performance of tuberculin skin test, quantiferon-tb-gold in tube assay, and t-spot.tb test in contact investigations for tuberculosis. Chest 135: 1010–1018.
    1. Ewer K, Deeks J, Alvarez L, Bryant G, Waller S, et al. (2003) Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet 361: 1168–1173.
    1. Higuchi K, Harada N, Mori T, Sekiya Y (2007) Use of QuantiFERON®-TB Gold to investigate tuberculosis contacts in a high school. Respirology 12: 88–92.
    1. Kang YA, Lee HW, Yoon HI, Cho B, Han SK, et al. (2005) Discrepancy between the tuberculin skin test and the whole-blood interferon γ assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 293: 2756–2761.
    1. Kipfer B, Reichmuth M, Buehler M, Meisels C, Bodmer T (2008) Tuberculosis in a Swiss army training camp: contact investigation using an Interferon gamma release assay. Swiss Med Wkly 138: 267.
    1. Toyota M, Morioka S (2001) Tuberculosis outbreak in a junior high school in Kochi City–studies on factors relating to extent of tuberculosis infection and the efficacy of isoniazid chemoprophylaxis. Kekkaku 76: 625–634.
    1. Horsburgh CR, Rubin EJ (2011) Latent tuberculosis infection in the United States. N Engl J Med 364: 1441–1448.
    1. Kang YA, Lee HW, Hwang SS, Um S-W, Han SK, et al. (2007) Usefulness of whole-blood interferon-γ assay and interferon-γ enzyme-linked immunospot assay in the diagnosis of active pulmonary tuberculosis*. Chest 132: 959–965.
    1. Yoshiyama T, Ogata H (2008) CT screening before treatment of latent tuberculous infection for the diagnosis of clinical TB among contacts. Kekkaku 83: 411–416.
    1. Im JG, Itoh H, Shim YS, Lee JH, Ahn J, et al. (1993) Pulmonary tuberculosis: CT findings–early active disease and sequential change with antituberculous therapy. Radiology 186: 653–660.
    1. Mori T, Harada N, Higuchi K, Sekiya Y, Uchimura K, et al. (2007) Waning of the specific interferon-gamma response after years of tuberculosis infection. Int J Tuberc Lung Dis 11: 1021–1025.
    1. Diel R, Loddenkemper R, Meywald-Walter K, Niemann S, Nienhaus A (2008) Predictive value of a whole blood IFN-γ assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis. Am J Respir Crit Care Med 177: 1164–1170.
    1. Diel R, Loddenkemper R, Niemann S, Meywald-Walter K, Nienhaus A (2011) Negative and positive predictive value of a whole-blood interferon-γ release assay for developing active tuberculosis: an update. Am J Respir Crit Care Med 183: 88–95.
    1. Chee CBE, Barkham TMS, KhinMar KW, Gan SH, Wang YT (2009) Quantitative T-cell interferon-gamma responses to Mycobacterium tuberculosis-specific antigens in active and latent tuberculosis. Eur J Clin Microbiol Infect Dis 28: 667–670.
    1. Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies D, et al. (2012) Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 12: 45–55.
    1. Wilkinson KA, Kon OM, Newton SM, Meintjes G, Davidson RN, et al. (2006) Effect of treatment of latent tuberculosis infection on the T cell response to Mycobacterium tuberculosis antigens. J Infect Dis 193: 354–359.
    1. Greenbaum M, Beyt Jr B, Murray P (1980) The accuracy of diagnosing pulmonary tuberculosis at a teaching hospital. Am Rev Respir Dis 121: 477–481.
    1. Levy H, Feldman C, Sacho H, Van der Meulen H, Kallenbach J, et al. (1989) A reevaluation of sputum microscopy and culture in the diagnosis of pulmonary tuberculosis. Chest 95: 1193–1197.
    1. Lee SW, Jang YS, Park CM, Kang HY, Koh W-J, et al. (2010) The role of chest CT scanning in TB outbreak investigation. Chest 137: 1057–1064.
    1. McCollough CH, Chen GH, Kalender W, Leng S, Samei E, et al. (2012) Achieving routine submillisievert CT scanning: report from the Summit on Management of Radiation Dose in CT. Radiology 264: 567–580.
    1. Kowada A (2013) Cost effectiveness of high resolution computed tomography with interferon-gamma release assay for tuberculosis contact investigation. Eur J Radiol 82: 1353–1358.

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