Abstract | BACKGROUND:
Interferon-gamma release assays are increasingly being used in low-incidence settings, but there is little information on whether test results influence clinical decisions in children. METHODS: In June 2009, the Montreal Children's Hospital began implementing the QuantiFERON-TB Gold In-Tube (QFT) as a follow-up test to the tuberculin skin test (TST). Pediatric respirologists were asked to document how the QFT result changed their initial clinical management based on the TST. RESULTS: During a 2-year period, 399 children with TST and QFT results were recruited prospectively. The median age was 13 years. In the cohort, 83% were foreign-born and 82% were Bacille Calmette-Guérin vaccinated. The QFT was negative in 5 of 11 (45.5%) children diagnosed with active tuberculosis (TB). Among 55 TST+/QFT- children evaluated as TB contacts, the negative QFT changed the treatment decision in only 3 (5.5%), and isoniazid was prescribed to the remainder. In 201 TST+/QFT- children from targeted school and immigrant screening programs, a negative QFT result was used to withhold isoniazid in 145 (72.1%) children. These children were followed for 1 year, during which no TB cases occurred. In a multivariable analysis, history of TB contact and TST induration ≥20 mm were associated with fewer changes in clinical decisions. CONCLUSIONS: Our cohort study showed that pediatric respirologists used negative QFT results to withhold isoniazid in most low-risk children who were referred for a positive TST found through targeted screening programs. In contrast, in almost all TST-positive children who were evaluated as TB contacts, negative QFT results did not change clinical management.
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Authors | Daphne I Ling, Claire A Crépeau, Marieke Dufresne, Shazia Khan, Caroline Quach, Nandini Dendukuri, Kevin Schwartzman, Dick Menzies, Larry C Lands, Madhukar Pai |
Journal | The Pediatric infectious disease journal
(Pediatr Infect Dis J)
Vol. 31
Issue 12
Pg. 1258-62
(Dec 2012)
ISSN: 1532-0987 [Electronic] United States |
PMID | 22828646
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antitubercular Agents
- Isoniazid
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Topics |
- Adolescent
- Antitubercular Agents
(therapeutic use)
- Child
- Child, Preschool
- Cohort Studies
- Female
- Humans
- Infant
- Infant, Newborn
- Interferon-gamma Release Tests
(methods)
- Isoniazid
(therapeutic use)
- Male
- Tuberculin Test
(methods)
- Tuberculosis
(diagnosis, drug therapy)
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