1. Interferon-Gamma Release Assays Differentiate between Mycobacterium avium Complex and Tuberculous Lymphadenitis in Children
- Author
-
Miguel Ángel Roa, Teresa Hernández, Carmelo Gutiérrez, Mireia Arroyo, César Gavilán, Inés Gale, Javier Alvarez, Enrique Villalobos Pinto, Olga Calavia, Marta Illán Ramos, Daniel Blázquez-Gamero, Antonio Cepillo, María José Cilleruelo, María José Mellado, Borja Guarch, Pere Soler-Palacín, Marc Tebruegge, Ana Méndez-Echevarría, Carmelo Guerrero, David Moreno-Pérez, Anna Canet, Miguel Lillo, Fernando Baquero-Artigao, Marta Velázquez, Antoni Noguera-Julian, Teresa Vallmanya, José Javier Korta Murua, Jakko van Ingen, Pablo Rojo, Esmeralda Núñez Cuadros, Antoni Soriano-Arandes, Lourdes Garcia, Federico Martinón-Torres, Mar Santos, Matilde Bustillo-Alonso, Claudia Fortuny, Ana Isabel Piqueras, Aina Martínez-Planas, Francisco José Sanz-Santaeufemia, Lola Falcón-Neyra, Santiago Rueda, Miguel Lafuente Hidalgo, Zulema Lobato, Beatriz Pérez-Gorricho, Begoña Santiago, Cristina Calvo, Mercedes Herranz, Ana Morales, Andrea Martín-Nalda, Teresa Del Rosal, Laura Minguell, Isabel Villanueva, Maria Montero, Enrique Otheo, María Espiau, Cristina Álvarez, and Olaf Neth
- Subjects
Male ,medicine.medical_specialty ,Tuberculosis ,Tuberculosis, Lymph Node ,Gastroenterology ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,All institutes and research themes of the Radboud University Medical Center ,Peripheral lymphadenitis ,Predictive Value of Tests ,030225 pediatrics ,Internal medicine ,Interferon-gamma release assays ,medicine ,Humans ,Mycobacterium avium complex ,Interferon gamma ,030212 general & internal medicine ,Child ,Nontuberculous mycobacteria ,Mycobacterium avium-intracellulare Infection ,biology ,Tuberculin skin test ,business.industry ,POSITIVE TUBERCULIN ,Skin test ,Mycobacterium tuberculosis ,medicine.disease ,biology.organism_classification ,Mycobacterium avium Complex ,Mycobacterium bovis ,Tuberculous lymphadenitis ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Cross-Sectional Studies ,Spain ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Differential diagnosis ,business ,Interferon-gamma Release Tests ,medicine.drug - Abstract
Spanish Pediatric TB Research Network (pTBred) and the European NontuberculouS MycoBacterial Lymphadenitis in childrEn (ENSeMBLE) Study., [Objectives] To assess the performance of interferon-gamma release assays (IGRAs) in the differential diagnosis between Mycobacterium avium complex (MAC) and tuberculosis (TB) in children affected with subacute/chronic submandibular/cervical lymphadenitis., [Study design] Multicenter observational study comparing children with microbiologically confirmed MAC lymphadenitis from the European NontuberculouS MycoBacterial Lymphadenitis in childrEn study with children with TB lymphadenitis from the Spanish Network for the Study of Pediatric TB database., [Results] Overall, 78 patients with MAC and 34 with TB lymphadenitis were included. Among MAC cases, 44 out of 74 (59.5%) had positive tuberculin skin test (TST) results at the 5-mm cut-off, compared with 32 out of 33 (97%) TB cases (P < .001); at the 10-mm cut-off TST results were positive in 23 out of 74 (31.1%) vs 26 out of 31 (83.9%), respectively (P < .001). IGRA results were positive in only 1 out of 32 (3.1%) patients with MAC who had undergone IGRA testing, compared with 21 out of 23 (91.3%) TB cases (P < .001). Agreement between TST and IGRA results was poor in MAC (23.3%; κ = 0.017), but good in TB cases (95.6%; κ = 0.646). IGRAs had a specificity of 96.9% (95% CI 84.3%-99.8%), positive predictive value of 95.4% (95% CI 78.2%-99.8%), and negative predictive value of 93.9% (95% CI 80.4%-98.9%) for TB lymphadenitis., [Conclusions] In contrast to TST, IGRAs have high specificity, negative predictive value, and positive predictive value for TB lymphadenitis in children with subacute/chronic lymphadenopathy, and consequently can help to discriminate between TB and MAC disease. Therefore, IGRAs are useful tools in the diagnostic work-up of children with lymphadenopathy, particularly when culture and polymerase chain reaction results are negative.
- Published
- 2021
- Full Text
- View/download PDF