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Objective: To evaluate the frequency of and factors associated with indeterminate interferon-gamma release assay (IGRA) results in people living with HIV/AIDS (PLWHA). Methods: We tested 81 PLWHA in the central-west region of Brazil, using the tuberculin skin test and an IGRA. Information on sociodemographic and clinical variables was gathered through the use of questionnaires and from medical records. The association of those variables with indeterminate results was analyzed by calculating the adjusted ORs in a multivariate logistic regression model. Concordance was evaluated by determining the kappa statistic. Results: Among the 81 patients evaluated, the tuberculin skin test results were positive in 18 (22.2%) of the patients, and the IGRA results were positive in 10 (12.3%), with a kappa of 0.62. The IGRA results were indeterminate in 22 (27.1%) of the patients (95% CI: 17.8-38.1%). The odds of obtaining indeterminate results were significantly higher in smokers (adjusted OR = 6.0; 95% CI: 1.4-26.7) and in samples stored for less than 35 days (adjusted OR = 14.0; 95% CI: 3.1-64.2). Patients with advanced immunosuppression (CD4+ T-cell count < 200 cells/mm3) were at a higher risk for indeterminate results (OR adjusted for smoking and inadequate duration of sample storage = 4.7; 95% CI: 0.91-24.0), although the difference was not significant. Conclusions: The high prevalence of indeterminate results can be a major limitation for the routine use of IGRAs in PLWHA. The need to repeat the test increases its costs and should be taken into account in cost-effectiveness studies. The processing of samples can significantly alter the results. RESUMO Objetivo: Avaliar a frequência de resultados indeterminados de um interferon-gamma release assay (IGRA, ensaio de liberação de interferon-gama) e os fatores relacionados com esses resultados em pessoas vivendo com HIV/AIDS (PVHA). Métodos: Foram avaliadas 81 PVHA na região Centro-Oeste do Brasil, por meio do teste tuberculínico e de um IGRA. Informações a respeito de variáveis sociodemográficas e clínicas foram obtidas por meio de questionários e prontuários médicos. A relação entre essas variáveis e os resultados indeterminados foi avaliada por meio do cálculo da OR ajustada em um modelo de regressão logística multivariada. A concordância foi avaliada por meio do coeficiente kappa. Resultados: Os resultados do teste tuberculínico e do IGRA foram positivos em 18 (22,2%) e 10 (12,3%), respectivamente, dos 81 pacientes avaliados (κ = 0,62). O resultado do IGRA foi indeterminado em 22 (27,1%) dos pacientes (IC95%: 17,8-38,1%). A chance de resultados indeterminados foi significativamente maior em fumantes (OR ajustada = 6,0; IC95%: 1,4-26,7) e em amostras armazenadas durante menos de 35 dias (OR ajustada = 14,0; IC95%: 3,1-64,2). Pacientes com imunossupressão avançada (contagem de células T CD4+ < 200 células/mm3) apresentaram maior risco de resultados indeterminados (OR ajustada para tabagismo e tempo inadequado de armazenamento das amostras = 4,7; IC95%: 0,91-24,0), embora a diferença não tenha sido significativa. Conclusões: A alta prevalência de resultados indeterminados pode ser um grande obstáculo ao uso rotineiro de IGRAs em PVHA. A necessidade de repetir o teste aumenta seu custo e deve ser levada em conta em estudos da relação entre custo e eficácia. O processamento das amostras pode alterar significativamente os resultados.

Cilj: Otkrivanje latentne tuberkuloze sukladno nacionalnim smjernicama uključuje procjenu rizika, radiografsku pretragu, izvođenje tuberkulinskog kožnog / PPD testa (PPD – purificirani proteinski derivat) i/ili novijeg ex vivo testa otpuštanja interferona gama (engl. Interferon Gamma Release Assay – IGRA). U radu je analizirana dinamika izvođenja i rezultati dobiveni dijagnostičkom primjenom imunoenzimske IGRA pretrage na M. tuberculosis. Metode: Izvršena je retrospektivna analiza rezultata Quantiferon-TB Gold In-Tube (QFT-GIT) testiranja provedenih u Laboratoriju za dijagnostiku tuberkuloze Nastavnog zavoda za javno zdravstvo Primorsko-goranske županije (Hrvatska). Rezultati: U sedmogodišnjem razdoblju (2007. – 2013.) u Laboratoriju za dijagnostiku tuberkuloze primjenom QFT-GIT testa analizirano je 2.110 uzoraka krvi pacijenata koji su pripadali različitim dobnim skupinama (od dobi od mjesec dana do 95 godina; x̄ = 41,9 godina; SD = 29,1; mod 56 godina). Rezultati analize su bili pozitivni u 585 (27,7 %), negativni u 1.498 (71 %) uzoraka, a u 27 (1,3 %) izvršenih pretraga su bili neodredivi. Pozitivni nalazi podjednako su zastupljeni u pretragama izvršenim za muškarce (29 % od 1.058 pretraga) i žene (26 % od 1.052 pretrage). Veća zastupljenost pozitivnih nalaza zabilježena je u osoba starijih od 56 godina, napose u dobnoj skupini od 81 do 85 godina (61 % od 44 pretrage). Prema uputnoj dijagnozi pozitivni nalazi su zastupljeniji kod hiperreaktora (40,5 % od 84 analize), TB kontakata (35,1 % od 464 analize) i zdravstvenih radnika (34,9 % od 43 analize). Rasprava i zaključci: Primjena in vitro IGRA QFT-GIT testa u kombinaciji s konvencionalnim metodama danas je prepoznata kao dijagnostički postupak koji ima značajnu ulogu u otkrivanju LTB-a, što predstavlja važan korak u prevenciji tuberkuloze, posebice kod rizičnih skupina., Aim: Tuberculosis (TB) remains a major global public health problem. Screening for latent tuberculosis infection (LTB) usually involves risk assessment, chest X-ray, the tuberculin skin/PPD (Purified Protein Derivate) test, and/or interferon-gamma release assay (IGRA), according to country-specific guidelines. This paper describes the frequency of application and the results obtained by enzyme-linked immunosorbent IGRA assay for M. tuberculosis. Methods: We conducted a retrospective analysis of the results obtained using Quantiferon-TB Gold In-Tube (QFT-GIT) analysis at the Laboratory for the diagnosis of tuberculosis – Teaching Institute of Public Health County Primorsko-goranska (Croatia). Results: In the seven-year period (2007–2013) QFT-GIT analysis were processed in 2110 blood samples of patients from different age groups (aged 1 month-95 years; x̄ = 41.9 years; SD = 29.1; mode 56 years). Results were positive in 585 (27.7 %) samples, whereas negative results were found in 1498 (71 %) cases, and in 27 (1.3 %) samples the results were indeterminate. Positive results were distributed equally among males (29 % of 1058 samples) and females (26 % of 1052 samples). Higher incidence of positive results was observed in people over the age of 56, especially in the age group between 81-85 years (61 % of 44 tests). Positive results were most common in the group of hyperreactors (40.5 % of 84 tests) then in TB contacts (35.1 % of 464 tests), as well as health workers (34.9 % of 43 tests). Discussion and Conclusions: Applying in vitro IGRA QFT-GIT test in combination with conventional methods is recognized as a diagnostic method that plays an important role in uncovering LTB and as such represents an important step in prevention of tuberculosis, especially in high-risk groups.

Objective: To evaluate the accuracy of an interferongamma release assay (QuantiFERON-TB Gold in Tube) for diagnosing Mycobacterium tuberculosis infection in a young pediatric population. Methods: 195 children previously vaccinated with BCG were evaluated, being 184 healthy individuals with no clinical or epidemiological evidence of mycobacterial infection, and 11 with Mycobacterium tuberculosis infection, according to clinical, radiological, and laboratory parameters. A blood sample was obtained from each child and processed according to the manufacturer's instructions. The assay performance was evaluated by a Receiver Operating Characteristic (ROC) curve. Results: In the group of 184 non-infected children, 130 (70.6%) were under the age of four years (mean age of 35 months). In this group, 177 children (96.2%) had negative test results, six (3.2%) had indeterminate results, and one (0.5%) had a positive result. In the group of 11 infected children, the mean age was 58.5 months, and two of them (18%) had negative results. The ROC curve had an area under the curve of 0.88 (95%CI 0.82-0.92; p

ResumoOs autores reportam o caso de uma doente de 38 anos de idade com um quadro clínico de odinofagia, dor retroesternal e emagrecimento. Os exames complementares de diagnóstico revelaram a presença de uma lesão ulcerada no esófago, como forma de manifestação de tuberculose primária do esófago.A Tuberculose esofágica é uma doença pouco frequente, sendo responsável por 0,15% da mortalidade por tuberculose. A Tuberculose primária do esófago, sem envolvimento de outros órgãos, como o nosso caso clínico, é ainda mais raro.A maioria dos casos é tratada de forma eficaz com tuberculostáticos, sendo que o atraso no diagnóstico e início da terapêutica dita um mau prognóstico.AbstractThe authors present a case of 38 year old woman with symptoms of odynophagia, retrosternal pain and weight loss. Diagnostic workup revealed the presence of an esophageal ulcer as the first manifestation of primary esophageal tuberculosis.Esophageal tuberculosis is a rare disease, estimated to account for 0,15% of deaths from tuberculosis. Moreover, primary esophageal tuberculosis without active extraesophageal tuberculosis, just like our case, is even more uncommon.Most cases of primary tuberculosis of the esophagus can be treated successfully with antituberculous chemotherapy and delay in diagnosis and in the start of treatment may cause a poor prognosis.