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Published ahead of print on April 15, 2004, doi:10.1164/rccm.200402-232OC
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American Journal of Respiratory and Critical Care Medicine Vol 170. pp. 65-69, (2004)
© 2004 American Thoracic Society

Comparison of Tuberculin Skin Test and New Specific Blood Test in Tuberculosis Contacts

Inger Brock, Karin Weldingh, Troels Lillebaek, Frank Follmann and Peter Andersen

Department of Infectious Disease Immunology, Statens Serum Institute; and International Reference Laboratory of Mycobacteriology, Statens Serum Institute, Copenhagen, Denmark

Correspondence and reprint requests should be addressed to Peter Andersen, D.V.M., D.M.Sc., Department of Infectious Disease Immunology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. E-mail: pa{at}ssi.dk

The tuberculin skin test used to detect latent Mycobacterium tuberculosis infection has many drawbacks, and a new diagnostic test for latent tuberculosis (QuantiFERON-TB [QTF-TB]) has recently been introduced. This test measures the production of IFN-{gamma} in whole blood upon stimulation with purified protein derivative (PPD). The QTF-TB test addresses the operational problems with the tuberculin skin test, but, as the test is based on PPD, it still has a low specificity in populations vaccinated with the Bacile Calmette-Guérin (BCG) vaccine. We have modified the test to include the antigens ESAT-6 and CFP-10, which are not present in BCG vaccine strains or the vast majority of nontuberculous mycobacteria. This test was used to detect infection in contacts in a tuberculosis outbreak at a Danish high school. The majority of the contacts were BCG-unvaccinated, which allowed a direct comparison of the skin test and the novel blood test in individuals whose skin test was not confounded by vaccination. An excellent agreement between the two tests was found (94%, {kappa} value 0.866), and in contrast to the blood test based on PPD, the novel blood test was not influenced by the vaccination status of the subjects tested.

Key Words: tuberculosis • latent infection • whole blood diagnostic • Bacile Calmette-Guérin vaccine • tuberculin skin test




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