Role of the quantiferon-TB gold in tube in ruling out tuberculosis in end stage renal disease patients receiving hemodialysis

ABSTRACT

It is difficult to diagnose tuberculosis [TB] in dialysis patients because of the high rate of extrapulmonary TB in these patients compared with the general population. Recently, a new diagnostic test called QuantiFERON[QFT] has been developed and shown promise as a diagnostic tool for active TB diseases and latent TB infection. The aim of the present study was to analyze the performance of QuantiFERON-TB Gold in tube [QFT-G] in end stage renal disease patients receiving hemodialysis. QuantiFERON Gold in tube [QFT-GIT] were prospectively performed in 50 end stage renal disease [ESRD] cases undergoing hemodialysis [HD], including 6 patients with active TB and evaluated the utility of this test in dialysis patients. Among 50 dialysis patients, positive QFT results occurred in 10 [20%], negative QFT results occurred in 25 [50%] and indeterminate QFT results occurred in 15 [30%]. All six active TB patients had positive QFT results, and none of the 25 patients with negative results had active TB. Among 7 patients with a history of active TB, 2 [28.5%] had positive results. Although the indeterminate rate was relatively high, no patient with an indeterminate result had active TB. Among 30 cases after excluding the patients with previous TB and indeterminate results, the sensitivity of the QFT is 100% [6 of 6] and the specificity is 91.6% [22 of 24 cases]. Our data suggest that the QFT test is a useful supplementary tool for the diagnosis of active TB even in dialysis patients. Negative and indeterminate results on this test may be used to exclude the presence of active TB