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Clinical and Vaccine Immunology, January 2006, p. 53-58, Vol. 13, No. 1
1071-412X/06/$08.00+0     doi:10.1128/CVI.13.1.53-58.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Comparison of a New ESAT-6/CFP-10 Peptide-Based Gamma Interferon Assay and a Tuberculin Skin Test for Tuberculosis Screening in a Moderate-Risk Population

Emaeil Porsa,1,2* Lee Cheng,1 Michael M. Seale,1 George L. Delclos,2 Xin Ma,3 Robert Reich,3 James M. Musser,3 and Edward A. Graviss3,4

Department of Family and Community Medicine, The University of Texas Health Science Center, Houston, Texas,1 Division of Environmental and Occupational Health, The University of Texas School of Public Health, Houston, Texas,2 Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, Houston, Texas,3 Department of Medicine, Baylor College of Medicine, Houston, Texas4

Received 8 September 2005/ Returned for modification 20 October 2005/ Accepted 1 November 2005

Screening for latent tuberculosis infection (LTBI) with Mantoux tuberculin skin test (TST) has many limitations, including false-positive results due to exposure to Mycobacterium other than tuberculosis (TB) and BCG vaccination. A total of 474 adult inmates in a county jail were screened for LTBI using TST and a new ESAT-6/CFP-10 peptide-based whole-blood gamma interferon (IFN-{gamma}) assay. LTBI prevalence was 9.0 and 5.4% as determined by TST and IFN-{gamma} assay, respectively. Overall, agreement between test results was 90% ({kappa} = 0.25). Positive TST results were significantly associated with increased age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.08), African-American ethnicity (OR, 4.97; 95% CI, 1.58 to 15.68), foreign birth (OR, 20.20; 95% CI, 4.21 to 97.02) and prior incarceration (OR, 6.19; 95% CI, 1.48 to 25.95). Positive IFN-{gamma} assay results were significantly associated with African-American ethnicity (OR, 5.58; 95% CI, 1.16 to 26.74). Factors associated with statistically significant discordance between TST and IFN-{gamma} assay results were African-American ethnicity (OR, 0.29; 95% CI, 0.11 to 0.77), foreign birth (OR, 0.23; 95% CI, 0.07-0.80), and prior incarceration (OR, 0.06; 95% CI, 0.01-0.50). Among subjects born in the United States, African-American ethnicity was the only variable significantly associated with positive test results for both TST (OR, 4.26; 95% CI, 1.38 to 13.16) and IFN-{gamma} assay (OR, 5.74; 95% CI, 1.19 to 27.75) and remained associated with statistically significant discordance between TST and IFN-{gamma} assay results. The reactivity of the new IFN-{gamma} assay is unaffected by prior BCG vaccination or serial TSTs but may be diminished in African-Americans. Future longitudinal studies are needed to assess the sensitivity and specificity of this new assay in detecting LTBI.

* Corresponding author. Mailing address: Department of Family and Community Medicine, MSB-G.150, The University of Texas Health Science Center, Houston, TX 77002. Phone: (713) 755-6541. Fax: (713) 755-6011. E-mail: esmaeil.porsa{at}uth.tmc.edu.

Clinical and Vaccine Immunology, January 2006, p. 53-58, Vol. 13, No. 1
1071-412X/06/$08.00+0     doi:10.1128/CVI.13.1.53-58.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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