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Serial Testing of Refugees for Latent Tuberculosis Using the QuantiFERON-Gold In-Tube: Effects of an Antecedent Tuberculin Skin Test

Screening for latent tuberculosis infection (LTBI) in refugee populations immigrating to low-incidence countries remains a challenge. We assessed the characteristics of the QuantiFERON-Gold In-Tube (QFT-GIT) compared with the tuberculin skin test (TST) in 198 refugees of all ages from tuberculosis-endemic countries. Diagnostic agreement between the first QFT-GIT and simultaneous TST was 78% ( = 0.56) and between serial QFT-GITs was 89% ( = 0.76). In serial QFT-GIT testing, 70% of subjects had an increased QFT-GIT value, perhaps the result of an antecedent TST in the setting of previous TB exposure. This boosting seemed to become less prevalent with time from TST and occurred less frequently in those with negative first QFT-GIT readings. Despite small changes in the quantitative results caused by nonspecific variation and boosting, the diagnostic result of the QFT-GIT was reliable. The QFT-GIT shows the potential to replace the TST for LTBI screening in refugees from tuberculosis-endemic areas.

Received June 5, 2008. Accepted for publication November 20, 2008.

Acknowledgments: The authors thank Kathy Kennedy from the Hennepin County Medical Center Microbiology Laboratory for technological expertise.

Financial support: This work was funded, in part, by a research grant from the International Society of Travel Medicine. The QuantiFERON-TB Gold In-Tube tests were provided at no cost by Cellestis.

Disclaimer: The authors state that they have no conflicts of interest.

^* Address correspondence to Cristina A. Baker, Infectious Diseases and International Medicine Division, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455. E-mail: bake0088{at}umn.edu

Authors’ addresses: Cristina A. Baker, William M. Stauffer, Phillip K. Peterson, and Dean T. Tsukayama, Infectious Diseases and International Medicine Division, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, E-mails: bake0088{at}umn.edu, stauf005{at}umn.edu, peter137{at}umn.edu, and tsuka001{at}umn.edu. William Thomas, Division of Biostatistics, School of Public Health University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, E-mail: thoma003{at}umn.edu.