A comparison of test duration for the clinical diagnosis of pediatric tuberculosis using Tuberculin Skin Test (TST) and Interferon Gamma Release Assays (IGRA)
Main Article Content
Keywords
Interferon-y, pulmonary TB, tuberculin, test duration
Abstract
Background: Tuberculosis (TB) remains a major global health challenge, particularly among children. Diagnosing pediatric TB is complicated due to nonspecific symptoms and the difficulty of obtaining sputum samples for microbiological confirmation. Immunological tests, such as the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), are commonly used to support diagnosis. However, TST has several limitations, including the need for multiple patient visits and potential cross-reactivity with Bacillus Calmette-Guérin (BCG) vaccination. This study aimed to compare the efficiency of IGRA and TST in terms of turnaround time and patient compliance.
Methods: A diagnostic time comparison study was conducted in pediatric patients with suspected pulmonary or extrapulmonary TB at Saiful Anwar Hospital, Malang. Patients underwent both TST and IGRA testing. The time required to obtain results and patient compliance was recorded and analyzed. o
Results: A total of 94 pediatric patients were included, with 17 diagnosed with extrapulmonary TB and 77 with pulmonary TB. IGRA demonstrated a significantly shorter turnaround time (25.43 ± 6.31 hours for pulmonary TB, and 25.58 ± 6.37 hours for extrapulmonary TB) compared to TST (50.16 ± 6,93 hours for extrapulmonary TB and 50.34 ± 7.16 hours for pulmonary TB). Additionally, IGRA provided higher positivity rates in both pulmonary and extrapulmonary TB cases.
Conclusion: IGRA offers a faster and more convenient alternative to TST for diagnosing pediatric TB. Despite its higher cost, the efficiency and single-visit requirement of IGRA makes it a preferable diagnostic tool in clinical settings, especially for children suspected of having TB.
References
2. Kaba Ö, Kara M, Odacılar CA, et al. Evaluation of cases of pediatric extrapulmonary tuberculosis: a single center experience. Turk Pediatri Ars. 2019; 54(2):86-92.
3. Soedarsono S. Tuberculosis: Development of new drugs and treatment regimens. J Respirasi. 2021; 7(1):36-45.
4. Triasih R, Helmi R, Laksanawati IS. Clinical profile and outcome of extrapulmonary tuberculosis in children in Indonesia. Pediatr respir Crit Care Med. 2(3):51-5.
5. Gopalaswamy R, Dusthackeer VNA, Kannayan S, Subbian S. Extrapulmonary tuberculosis—an update on the diagnosis, treatment and drug resistance. . J Respir. 2021; 1(2):141-64.
6. Sharma SK, Mohan A, Kohli M. Extrapulmonary tuberculosis. Expert Rev Respir Med. 2021; 15(7):931-48.
7. de Oliveira MCB, Sant’Anna CC, Raggio RL, Kritski AL. Tuberculosis among children and adolescents in Rio de Janeiro, Brazil – Focus on extrapulmonary disease. Int J Infect Dis. 2021; 105:105-12.
8. García-Basteiro AL, Schaaf HS, Diel R, Migliori Giovanni B. Adolescents and young adults: a neglected population group for tuberculosis surveillance. Eur Respir J. 2018; 51(2):1800176.
9. World Health Organization. Global Tuberculosis Report Supplementary Material. 2022.
10. Mandal N, Anand PK, Gautam S, Das S, Hussain T. Diagnosis and treatment of paediatric tuberculosis: An insight review. Crit Rev Microbiol. 2017; 43(4):466-80.
11. Sharma SK, Vashishtha R, Chauhan LS, Sreenivas V, Seth D. Comparison of TST and IGRA in diagnosis of latent tuberculosis infection in a high TB-burden setting. PLoS One. 2017; 12(1):e0169539.
12. Kay AW, Islam SM, Wendorf K, Westenhouse J, Barry PM. Interferon-γ release assay performance for tuberculosis in childhood. Pediatrics. 2018; 141(6).
13. Pai M, Denkinger CM, Kik SV, et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev. 2014; 27(1):3-20.
14. Jørstad MD, Aẞmus J, Marijani M, Sviland L, Mustafa T. Diagnostic delay in extrapulmonary tuberculosis and impact on patient morbidity: A study from Zanzibar. PLoS One. 2018; 13(9):e0203593.
15. Loh SW, Thoon KC, Tan NWH, Li J, Chong CY. Paediatric tuberculosis in Singapore: a retrospective review. BMJ Paediatr Open. 2018; 2(1):e000308.
16. Chiang SS, Swanson DS, Starke JR. New diagnostics for childhood tuberculosis. Infect Dis Clin North Am. 2015; 29(3):477-502.
17. Siqueira RC dan Oréfice F. The potential of the IGRA (interferon gamma release assay) test for the diagnosis of ocular tuberculosis . Review and comparative analysis with the tuberculosis skin test. Rev Bras Oftalmol. 2019; 78(3):202-9.
18. Maulahela H, Simadibrata M, Nelwan EJ, et al. Recent advances in the diagnosis of intestinal tuberculosis. BMC Gastroenterol. 2022; 22(1):89.
19. Elliot C, Marais B, Williams P, et al. Tuberculin skin test versus interferon-gamma release assay in refugee children: A retrospective cohort study. J Paediatr Child Health. 2018; 54(8):834-9.
20. Cruz AT dan Starke JR. Relationship between tuberculin skin test (TST) size and interferon gamma release assay (IGRA) result: when should clinicians obtain IGRAs in children with positive TSTs? Clin Pediatr (Phila). 2014; 53(12):1196-9.
21. Kestler B dan Tyler SK. Latent tuberculosis testing through the ages: the search for a sleeping killer. Am J Physiol Lung Cell Mol Physiol. 2022; 322(3):L412-l9.
22. Lagrange PH, Thangaraj SK, Dayal R, et al. A toolbox for tuberculosis (TB) diagnosis: an Indian multicentric study (2006-2008). Evaluation of QuantiFERON-TB gold in tube for TB diagnosis. PLoS One. 2013; 8(9):e73579.
23. Fukushima K, Akagi K, Kondo A, Kubo T, Sakamoto N, Mukae H. First clinical evaluation of the QIAreach(TM) QuantiFERON-TB for tuberculosis infection and active pulmonary disease. Pulmonol. 2022; 28(1):6-12.
24. Hur YG, Hong JY, Choi DH, et al. A feasibility study for diagnosis of latent tuberculosis infection using an IGRA point-of-care platform in South Korea. Yonsei Med J. 2019; 60(4):375-80.
25. Whitworth HS, Badhan A, Boakye AA, et al. Clinical utility of existing and second-generation interferon-γ release assays for diagnostic evaluation of tuberculosis: an observational cohort study. Lancet Infect Dis. 2019; 19(2):193-202.