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Evaluation of the tuberculin skin test and the interferon-γ release assay for TB screening in French healthcare workers

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Author(s): Tripodi Dominique | Brunet-Courtois Benedicte | Nael Virginie | Audrain Marie | Chailleux Edmond | Germaud Patrick | Naudin Frederique | Muller Jean-Yves | Bourrut-Lacouture Martine | Durand-Perdriel Marie-Henriette | Gordeeff Claire | Guillaumin Guyonne | Houdebine Marietherese | Raffi Francois | Boutoille David | Biron Charlotte | Potel Gilles | Roedlich Claude | Geraut Christian | Schablon Anja | Nienhaus Albert

Journal: Journal of Occupational Medicine and Toxicology
ISSN 1745-6673

Volume: 4;
Issue: 1;
Start page: 30;
Date: 2009;
Original page

ABSTRACT
Abstract Introduction Using French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-γ Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients. Methods Between May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST ≥ 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered. Results All HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST ≥ 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation. Conclusion The introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.
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