Comparison of Sensitivity and Specificity between Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA) for Latent TB Infection (LTBI) in Household Contacts of Drug-Sensitive TB Patients in Medan
Downloads
Latent Tuberculosis Infection (LTBI) is a condition characterized by the absence of clinical symptoms of active disease, yet it carries the risk of progressing to active tuberculosis (TB), particularly within the first two years following infection. The diagnosis of LTBI relies on immunological tests, such as the Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), each with its own strengths and limitations. To compare the sensitivity and specificity of TST and IGRA in the diagnosis of LTBI in household contacts of drug-sensitive TB patients in Medan. This study is an analytical observational study with a cross-sectional design involving 105 subjects who were household contacts of drug-sensitive TB patients. All subjects underwent chest X-ray, TST, IGRA, and Xpert MTB/RIF examination when indicated. Data were statistically analyzed using the Chi-Square test. Among 105 participants, 93 did not have pulmonary TB. Of 93 subjects, 24.7% tested positive by TST and 32.3% by IGRA. TST's calculated sensitivity and specificity compared to IGRA were 76.7% and 63.5%, respectively. TST demonstrates lower sensitivity and specificity than IGRA in diagnosing LTBI. However, TST remains a valuable screening tool, particularly in resource-limited settings.
World Health Organization. Global tuberculosis report 2023. Geneva: WHO; 2023.
Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis infection. N Engl J Med. 2015;372(22):2127–2135.
World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: WHO; 2018.
Houben RM, Dodd PJ. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS Med. 2016;13(10):e1002152.
Uplekar M, Weil D, Lönnroth K, et al. WHO's new end TB strategy. Lancet. 2015;385(9979):1799–1801.
Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;64(2):111–115.
Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria?. Int J Tuberc Lung Dis. 2006;10(11):1192–1204.
Mazurek GH, Jereb J, Vernon A, et al. IGRA use in the diagnosis of Mycobacterium tuberculosis infection in the United States. MMWR Recomm Rep. 2005;54(RR-15):49–55.
Pai M, Zwerling A, Menzies D. Systematic review: TST versus IGRA for latent tuberculosis infection in low- and high-risk populations. Ann Intern Med. 2008;149(3):177–184.
Diel R, Loddenkemper R, Nienhaus A. Predictive value of interferon-? release assays and tuberculin skin test for progression from latent TB infection to disease state: a meta-analysis. Chest. 2012;142(1):63–75.
Rangaka MX, Wilkinson KA, Glynn JR, et al. Predictive value of TST and IGRA for TB disease in South African adults: a longitudinal cohort study. Lancet Infect Dis. 2012;12(1):45–52.
Ahn JG, Lee SS, Kim MJ, et al. Cost-effectiveness of latent tuberculosis infection screening strategies before starting biologic therapy in South Korea. Medicine (Baltimore). 2019;98(36):e16930.
WHO. WHO consolidated guidelines on tuberculosis: module 1: prevention–tuberculosis preventive treatment. Geneva: WHO; 2020.
Fox GJ, Barry SE, Britton WJ, Marks GB. Contact investigation for tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2013;41(1):140–156.
Lalvani A, Pareek M. Interferon gamma release assays: principles and practice. Enferm Infecc Microbiol Clin. 2010;28(4):245–52.
Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis. 1993;17(6):968–75.
Zwerling A, Behr MA, Verma A, Brewer TF, Menzies D, Pai M. The cost-effectiveness of tuberculosis screening using IGRA vs. TST in different groups of people. PLoS One. 2013;8(3):e59365.
Denkinger CM, Dheda K, Pai M. Guidelines on interferon-gamma release assays for tuberculosis infection: concordance, discordance or confusion?. Clin Microbiol Infect. 2011;17(6):806–14.
Kang YA, Lee HW, Yoon HI, Cho B, Han SK, Shim YS, et al. Discrepancy between the tuberculin skin test and the whole-blood interferon ? assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA. 2005;293(22):2756–61.
Menzies D, Gardiner G, Farhat M, et al. Thinking in three dimensions: a web-based algorithm to aid the interpretation of TB diagnostics. Int J Tuberc Lung Dis. 2008;12(8):998–1004.
Hoa NB, Sy DN, Nhung NV, et al. National survey of tuberculosis prevalence in Vietnam. Bull World Health Organ. 2010;88(4):273–80.
Wood R, Lawn SD, Johnstone-Robertson S, Bekker LG. Tuberculosis control has failed in South Africa—time to reappraise strategy. S Afr Med J. 2011;101(2):111–4.
Detjen AK, Keil T, Roll S, Hauer B, Mauch H, Wahn U, et al. Interferon-? release assays improve the diagnosis of tuberculosis and nontuberculous mycobacterial disease in children: a meta-analysis. Clin Infect Dis. 2007;45(3):322–34.
Copyright (c) 2025 Rina Sundari, Bintang Yinke Magdalena Sinaga, Delores Elisabeth Sormin, Arlinda Sari Wahyuni
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
