The Agreement of Immunoglobulin Gamma Release Assay (IGRA)/ T-SPOT Tuberculosis and Tuberculin Skin Test to Detect Latent TB Infection in Diabetes Mellitus Patients
Abstract
Background: WHO identifies diabetes mellitus (DM) as a neglected risk factor for tuberculosis (TB). Currently, there is no gold standard test for latent TB infection (LTBI). Centers for Disease Control and Prevention (CDC) recommends using Tuberculin Skin Test (TST) and Immunoglobulin Gamma Release Assay (IGRA) to diagnose LTBI. TST is an LTBI classic diagnostic tool that has low sensitivity and specificity. But it is still preferred in diagnosing LTBI due to its lower price, and more health facilities can perform the examination compared to IGRA (T-SPOT.TB). The study aimed to measure the agreement of TST and T-SPOT.TB testing in detecting LBTI in DM and the correlation of HbA1c with TST and T-SPOT.TB.
Subjects and Method: Subjects were DM patients who underwent TST and T-SPOT.TB testing. If the results of TST and T-SPOT.TB was positive, the test would be continued with Xpert MTB/RIF microbiological testing. TST used PPD RT23 2TU. T-SPOT.TB was performed toward peripheral blood mononuclear cells. The degree of agreement between TST and T-SPOT.TB testing was calculated using the Test of Agreement (Kappa Cohen). The degree of correlation between the two variables was calculated by using Pearson correlation.
Results: The selected 30 study subjects with DM undergoing antidiabetic therapy showed 6 (20%) detected LTBI and 24 (80%) without LTBI using TST and T-SPOT.TB test. There was a substantial agreement level between TST and T-SPOT.TB testing in detecting LTBI among diabetes mellitus patients undergoing anti-diabetic therapy with kappa value= 0.62 (p<0.001). HbA1c increased T-SPOT (r= 0.07; p= 0.716) and TST (r= 0.11; p= 0.956).
Conclusion: TST testing may substitute T-SPOT.TB to detect LTBI among diabetes patients undergoing antidiabetic therapy.
Keywords: latent tuberculosis infection, diabetes mellitus, TST, Immunoglobulin Gamma Release Assay (IGRA), T-SPOT.TB
Correspondence: Reviono. Department of Pulmonology and Medical Respiratory, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta, Indonesia. Email: reviono@staff.uns.ac.id.
Indonesian Journal of Medicine (2021), 06(03): 298-306
https://doi.org/10.26911/theijmed.2021.06.03.07
References
Alvarez GG, VanDyk DD, Aaron SD (2014). TAIMA (stop) TB: the impact of a multifaceted TB awareness and door-to-door campaign in residential areas of high risk for TB in Iqaluit, Nunavut. PLoS One. 9: e100975. https://doi.org/10.1371/journal.pone.0100975.
Ayub A, Steven H, Reed KD, Nasser RM, Gilbert SR (2004). Testing for latent tuberculosis. Clin Med Res. 2(3): 191–194. https://dx.doi.org/10.3121%2Fcmr.2.3.191.
Baghaei P, Marjani M, Javanmard P, Tabarsi P, Masjedi MR (2013). Diabetes mellitus and tuberculosis facts and controversies. J Diabetes Metab Disord. 12(1): 58. htt://doi.org/10.1186/2251-6581-12-58.
Diel R, Loddenkemper R, Nienhaus A (2010). Evidence-based comparison of commercial Interferon - γ Release Assays for detecting active TB. Chest. 137(4): 952-68. https://doi.org/10.13-78/chest.09-2350.
Getahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Barreira D, Boon SD, et al. (2015). Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J. 46(6): 1563–76. https://doi.org/10.1183/13993003.01245-2015.
Hensel RL, Kempker RR, Tapia J, Oladele A, Blumberg HM, Magee MJ (2016). Increased risk of latent tuberculous infection among persons with pre-DM and DM mellitus. Int J Tuberc Lung Dis. 20(1): 71–8. https://dx.doi.org/10.5588%2Fijtld.15.0457.
Lee PH, Fu H, Lai TC, Chiang CY, Chan CC, Lin HH (2016). Glycemic control and the risk of tuberculosis: A Cohort study. Plos medicine. 13(8): e100-2072. https://doi.org/10.1371/journal.pmed.1002072.
Martinez N, Kornfeld H (2014). DM and immunity to tuberculosis. Eur J Immunol. 44(3): 617–26. https://doi.org/10.1002/eji.201344301.
Meng RL, Ya PH, Yu TK, Chen HL, Yun JS, Chin CS, Jun YW, et al. (2017). Diabetes Mellitus and Latent Tuberculosis Infection: A systemic review and meta analysis. Clin Infect Dis. 64(6):719-27. https://dx.doi.org/10.1093%2Fcid%2Fciw836
Pan SC, Ku CC, Kao D, Ezzati M, Fang CT, Lin HH (2015). Effect of DM on tuberculosis control in 13 countries with high tuberculosis: a modelling study. Lancet DM Endocrinol. 3(5): 323–30. https://doi.org/10.1016/s2213-8587(15)00042-x.
Reviono, Saptawati L, Redhono D, Suryawati B (2019). Good agreement between an interferon gamma release assay and tuberculin skin tests in testing for latent tuberculosis infection among HIV-infected patients in Indonesia. Korean Med Sci. 34(40):e259 https://doi.org/10.3346/jkms.2019.34.e259.
Smirnoff M, Patt C, Seckler B, Adler JJ (1998). Tuberculin and anergy skin testing of patients receiving long-term hemodialysis. Chest. 113(1): 25-7. https://doi.org/10.1378/chest.113.1.25.
Viney K, Cavanaugh J, Kienene T (2015). Tuberculosis and DM mellitus in the Republic of Kiribati: a case-control study. Trop Med Int Health. 20(5): 650–7. https://doi.org/10.1111/tmi.12462.
WHO (World Health Organization) (2020). Global Tuberculosis Report 2019. 20th Ed. [cited 2021 june 19th]. Available: http://www.who.int/iris/handle/10665/191102.
Zhu C, Liu Z, Li Z, Mei S, Hu Z (2014). The performance and limitation on T-SPOT.TB for the diagnosis of TB in a high prevalence setting. J Thorac Dis. 6(6): 713-719. https://dx.doi.org/10.3978%2Fj.issn.2072-1439.2014.04.38
