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Clinical and Vaccine Immunology, June 2007, p. 714-719, Vol. 14, No. 6
1071-412X/07/$08.00+0     doi:10.1128/CVI.00073-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Comparison of an ESAT-6/CFP-10 Peptide-Based Enzyme-Linked Immunospot Assay to a Tuberculin Skin Test for Screening of a Population at Moderate Risk of Contracting Tuberculosis{triangledown}

Esmaeil Porsa,1,2* Lee Cheng,1 and Edward A. Graviss3,4

Department of Family and Community Medicine, The University of Texas Health Science Center, Houston, Texas,1 Center for Clinical Epidemiology and Evidence Based Medicine, The University of Texas Health Science Center, 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 February 2007/ Returned for modification 20 March 2007/ Accepted 10 April 2007

Screening for latent tuberculosis infection (LTBI) with the Mantoux tuberculin skin test (TST) has many limitations including false-positive results due to Mycobacterium bovis bacillus Calmette-Guérin (BCG) vaccination. Three hundred ninety adult inmates with normal screening chest radiographs in a county jail were evaluated for LTBI using TST and an ESAT-6/CFP-10 peptide-based enzyme-linked immunospot assay (T-SPOT.TB). LTBI prevalence rates were 19.0% and 8.5% by T-SPOT.TB and TST, respectively. Overall agreement between test results was 82.8% ({kappa} = 0.29). Positive T-SPOT.TB results were significantly associated with increased age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.06) and intravenous drug use history (OR, 2.92; 95% CI, 1.36 to 6.27). Positive TST results were significantly associated with increased age (OR, 1.06; 95% CI, 1.02 to 1.09) and foreign birth (OR, 6.61; 95% CI, 1.98 to 22.01). Discordant covariates between the assay results included increased age (OR, 0.96; 95% CI, 0.94 to 0.99) and intravenous drug use history (OR, 0.41; 95% CI, 0.19 to 0.88). T-SPOT.TB reactivity is unaffected by prior BCG vaccination. T-SPOT.TB may be more sensitive than TST in diagnosing LTBI among a moderate risk population of inmates, particularly those with intravenous drug use history. Longitudinal studies are needed to assess the positive predictive value of T-SPOT.TB in identifying those most likely to convert to active disease in general populations as well as in high-risk subpopulations.

* Corresponding author. Present address: Parkland Health and Hospital System/Jail Health, 5201 Harry Hines Blvd., Mail Code 7746, Dallas, TX 75235. Phone: (214) 590-1547. Fax: (214) 590-1403. E-mail: Esmaeiporsa{at}yahoo.com

{triangledown} Published ahead of print on 18 April 2007.

Clinical and Vaccine Immunology, June 2007, p. 714-719, Vol. 14, No. 6
1071-412X/07/$08.00+0     doi:10.1128/CVI.00073-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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  • Mack, U., Migliori, G. B., Sester, M., Rieder, H. L., Ehlers, S., Goletti, D., Bossink, A., Magdorf, K., Holscher, C., Kampmann, B., Arend, S. M., Detjen, A., Bothamley, G., Zellweger, J. P., Milburn, H., Diel, R., Ravn, P., Cobelens, F., Cardona, P. J., Kan, B., Solovic, I., Duarte, R., Cirillo, D. M., C. Lange for the TBNET, (2009). LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement. Eur Respir J 33: 956-973 [Abstract] [Full Text]  
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