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Published ahead of print on August 4, 2005, doi:10.1164/rccm.200505-748OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 9, November 2005, 1161-1168

A more recent version of this article appeared on November 1, 2005
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Submitted on May 12, 2005
Accepted on August 4, 2005

Enzyme-Linked Immunospot and Tuberculin Skin Testing to Detect Latent Tuberculosis Infection

Homayoun Shams1, Stephen E Weis2, Peter Klucar3, Ajit Lalvani4, Patrick K Moonan2, Janice M Pogoda5, Katie Ewer4, and Peter F Barnes6*

1 Center for Pulmonary and Infectious Disease Control, University of Texas Health Center, Tyler, TX, United States; Department of Microbiology and Immunology, University of Texas Health Center, Tyler, TX, USA, 2 Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA, 3 Center for Pulmonary and Infectious Disease Control, University of Texas Health Center, Tyler, TX, United States, 4 Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom, 5 Statology, Ventura, CA, USA, 6 Center for Pulmonary and Infectious Disease Control, University of Texas Health Center, Tyler, TX, United States; Department of Microbiology and Immunology, University of Texas Health Center, Tyler, TX, USA; Department of Medicine, University of Texas Health Center, Tyler, TX, USA

* To whom correspondence should be addressed. E-mail: peter.barnes{at}uthct.edu.

Rationale: Diagnosis of latent tuberculosis infection (LTBI) is currently based on the tuberculin skin test. The enzyme-linked immunospot (ELISPOT) is a new blood test to diagnose LTBI. Objective: To compare the ELISPOT and the tuberculin skin test for detecting LTBI in contacts of tuberculosis patients. Methods: Prospective study of 413 contacts of tuberculosis patients. Measurements and Main Results: Because there is no gold standard for LTBI, the sensitivity and specificity of the ELISPOT and tuberculin skin test cannot be directly measured. For each contact, we therefore estimated the likelihood of having LTBI by calculating a contact score that quantified exposure to and infectiousness of the index case. We analyzed the relationship of contact score to ELISPOT and tuberculin skin test results. The likelihood of a positive ELISPOT (p = 0.0005) and a tuberculin skin test (p = 0.01) increased significantly with rising contact scores. The contact score was more strongly related to the ELISPOT than to the tuberculin skin test results, although this difference was not statistically significant. Among United States-born persons and those who were not vaccinated with BCG, approximately 30% had positive ELISPOT or tuberculin skin test results. Foreign-born, BCG-vaccinated persons were significantly more likely to have a positive tuberculin skin test than a positive ELISPOT result (p <0.0001). Conclusions: Compared to the tuberculin skin test, the ELISPOT appears to be at least as sensitive for diagnosis of LTBI in contacts of tuberculosis patients.
Key words: diagnosis, contact investigation, blood test




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