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Tuberculosis Research and Treatment
Volume 2014 (2014), Article ID 413459, 8 pages
http://dx.doi.org/10.1155/2014/413459
Research Article

Performance of Tuberculin Skin Test Measured against Interferon Gamma Release Assay as Reference Standard in Children

1Paediatric Department, Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton LU4 ODZ, UK
2Department of Infection and Immunology, Brighton & Sussex Medical School, University of Sussex, Brighton, East Sussex BN1 9PX, UK

Received 3 November 2013; Revised 21 December 2013; Accepted 27 December 2013; Published 10 February 2014

Academic Editor: Carlo Garzelli

Copyright © 2014 Michael Eisenhut and Katy Fidler. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. International guidelines differ in the threshold of tuberculin skin test (TST) induration regarded as indicating Mycobacterium (M.) tuberculosis infection. Interferon gamma release assay (IGRA) results were used as reference to assess performance of TST induration thresholds for detection of M. tuberculosis infection in children. Design. Systematic review which included studies containing data on TST, IGRA, and Bacillus Calmette-Guérin (BCG) status in children. Data bases searched were PubMed, EMBASE, and the Cochrane library. Specificities and sensitivities were calculated for TST thresholds 5, 10, and 15 mm and correlated with age and geographical latitude. Results. Eleven studies with 2796 children were included. For BCG immunised children diameters of 5, 10, and 15 mm had median sensitivities of 87, 70, and 75% and specificities of 67, 93, and 90%, respectively. In non-BCG immunised children median sensitivities were 94, 95, and 83% and specificities 91, 95, and 97%. At the 10 mm threshold age correlated negatively with sensitivity of TST ( , ) and latitude correlated positively ( , ). Conclusions. For the 10 mm threshold the sensitivity of the TST is lower in BCG immunised children. Younger age and higher geographical latitude were associated with higher sensitivity of the TST.