In routine UK hospital practice T-SPOT.TB™ is useful in some patients with a modest pre-test probability of active tuberculosis.

European Journal of Internal Medicine
Lance TurtleMichael B J Beadsworth

Abstract

to assess the usefulness of the T-SPOT.TB™ interferon-gamma release assay (IGRA), as used in a regional hospital infectious diseases unit in Northwest England, for the diagnosis of active tuberculosis. Retrospective case series. T-SPOT.TB™ test was applied to a group of 64 patients, 20 of whom had tuberculosis (mostly extra-pulmonary tuberculosis). The T-SPOT.TB™ test had a sensitivity of 83.3% and a specificity of 75% for the diagnosis of active tuberculosis, compared with culture. A positive IGRA approximately doubled the pre-test probability of disease from 0.23 to 0.5. This doubling of probability was true regardless of HIV status, though for HIV+ patients the sensitivity was lower (sensitivity 66.7%, post test probability 0.4 for a positive IGRA result). When extrapolated to the local population the test was most useful for exclusion of disease; post test probability 0.006 (or 1 in 167) for a negative IGRA result. Although it can add weight to a clinical diagnosis, T-SPOT.TB™ assay is not reliable for the diagnosis of active tuberculosis in a real world setting where the test is often used in patients with smear negative or extra-pulmonary disease. The test is useful for ruling out disease in HIV negative patients.

References

Jul 21, 2004·Transactions of the Royal Society of Tropical Medicine and Hygiene·C J F MundyC F Gilks
Aug 26, 2006·The Lancet Infectious Diseases·Karen R SteingartMadhukar Pai
Apr 11, 2008·Journal of Clinical Microbiology·Cynthia B E CheeYee T Wang
Feb 3, 2009·The American Journal of Medicine·Sung-Han KimKang-Won Choe
May 30, 2009·PloS One·Basirudeen Syed Ahamed KabeerAlamelu Raja
Apr 20, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Susan E Dorman

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Citations

Aug 13, 2013·Clinics in Laboratory Medicine·Robert F Luo, Niaz Banaei
Nov 1, 2016·Current Infectious Disease Reports·Richard P T EvansSimon R Bramhall

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