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Performance of QuantiFERON®-TB Gold In-Tube assay in children receiving disease modifying anti-rheumatic drugs 
 
Performance of QuantiFERON®-TB Gold In-Tube assay in children receiving disease modifying anti-rheumatic drugs
  Francesca Gabriele, Maria Trachana, Maria Simitsopoulou, Polixeni Pratsidou-Gertsi, Elias Iosifi dis, Zoi Dorothea Pana, Emmanuel Roilides
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Background: To evaluate the performance of the Quantiferon®-TB Gold In-Tube (QFT-IT) interferon (IFN)-¶√ assay for the detection of latent tuberculosis infection (LTBI) in children receiving anti-rheumatic treatment in a tertiary referral hospital of Northern Greece.
Methods: A total of 79 consecutive children receiving anti-rheumatic treatment [of which 18 screened prior to antitumor necrosis factor (TNF)-¶Ń treatment] were tested using Mantoux tuberculin skin test (TST) and QFT-IT. Association of both tests with risk factors for latent tuberculosis and Bacillus Calmette-Guerin immunization was determined. Influence of age, TNF-¶Ń inhibitors, systemic corticosteroids, conventional disease modifying anti-rheumatic drugs (DMARDs) and total duration of therapy on the QFT-IT mitogen-induced response was evaluated.
Results: Agreement between TST and QFT-IT results was moderate (k=0.38). Frequency of QFT-IT indeterminate results was low (2.5%). In patients with risk factors for LTBI, the odds of a positive IFN-¶√ assay was increased by a factor of 27.6 (P=0.002), whereas there was no positive TST. There was a significant difference in the mitogen-induced IFN-¶√ secretion among various treatments (P=0.038). TNF-¶Ń inhibitors were associated with increased mitogen-induced IFN-¶√ secretion compared to monotherapy with conventional DMARDs (P=0.008). All children screened prior to anti-TNF-¶Ń treatment exhibited a negative QFT-IT and no active TB disease was detected during a 2-year follow-up.
Conclusions: QFT-IT may be a more reliable test than TST for detection of LTBI in children with rheumatic diseases receiving anti-rheumatic treatment. Drug regimen might influence the mitogen-induced IFN-¶√ secretion and the effect of TNF-¶Ń inhibitors might vary according to the specific agent administered.
 
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World Journal of Pediatric Surgery

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