QuantiFERON-TB gold cut-off value: implications for the management of tuberculosis-related ocular inflammation.

Abstract

PURPOSE:

To evaluate the accuracy of QuantiFERON-TB Gold testing in patients with presumptive tuberculosis-ocular inflammation.

DESIGN:

Prospective nonrandomized case series and clinical laboratory investigation.

METHODS:

Ninety-six consecutive patients presenting with ocular inflammation between January and October 2007 were tested using QuantiFERON-TB Gold. Positive patients received a 6-month anti-tuberculosis treatment. Patient follow-up ranged from 12 months to 24 months. Treatment was considered effective at the end of follow-up, in cases of no or a 2-point decrease of ocular inflammation (SUN criteria) and systemic corticosteroids stopped or tapered to 10 mg/day.

RESULTS:

Mean age was 51 ± 17 years. Types of ocular inflammation included scleritis (n = 7), panuveitis (n = 34), and posterior (n = 15), intermediate (n = 14), and anterior uveitis (n = 15). QuantiFERON-TB Gold was positive in 42 cases (44%), negative in 51 cases (53%), and undetermined in 3 cases (3%). Among positive QuantiFERON-TB Gold patients, 25 received a full anti-tuberculosis treatment, which was effective in 15 cases (60%). Associated systemic steroids were given to 6 patients and tapered to 10 mg/day or less in all cases. Median QuantiFERON-TB Gold value was significantly higher in the group with a successful therapeutic response (7.67 IU/mL [0.46 to 33.37]) compared to the group with treatment failure (1.22 IU/mL [0.61 to 4.4]), P = .026.

CONCLUSION:

Results of anti-tuberculosis treatment were encouraging in QuantiFERON-TB Gold-positive ocular inflammation, especially with values over 2 IU/mL in our study, suggesting that a higher cut-off value than that given by the manufacturer should be considered to better identify ocular inflammation that can benefit from full anti-tuberculosis treatment.

• Authors: Raquel Gineys, Bahram Bodaghi, Ghislaine Carcelain, Nathalie Cassoux, Le Thi Huong Boutin, Zahir Amoura, Phuc Lehoang, Salim Trad
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 152 Issue 3 Pg. 433-440.e1 (Sep 2011) ISSN: 1879-1891 [Electronic] United States
• PMID: 21652022 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Antitubercular Agents
• Glucocorticoids
• Reagent Kits, Diagnostic
• Interferon-gamma

Topics

• Adult
• Aged
• Aged, 80 and over
• Antitubercular Agents (therapeutic use)
• Diagnostic Techniques, Ophthalmological
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Interferon-gamma (blood)
• Male
• Middle Aged
• Prospective Studies
• Reagent Kits, Diagnostic
• Reproducibility of Results
• Scleritis (blood, diagnosis, drug therapy)
• Sensitivity and Specificity
• Tuberculin Test
• Tuberculosis, Ocular (blood, diagnosis, drug therapy)
• Uveitis (blood, diagnosis, drug therapy)
• Young Adult