Article information
Abstract
Interferon-γ-based assays, collectively known as IFN-γ release assays (IGRAs), have emerged as a reliable alternative to the old tuberculin skin test (TST) for the immunodiagnosis of tuberculosis (TB) infection. The 2 commercially available tests, the enzyme-linked immunosorbent assay (ELISA), QuantiFERON-TB Gold Intube (QFT-IT), and the enzyme-linked immunospot assay (ELISPOT), T-SPOT.TB, are more accurate than TST for the diagnosis of TB, since they are highly specific and correlate better with the existence of risk factors for the infection. According to the available data, T-SPOT.TB obtains a higher number of positive results than QFT-IT, while its specificity seems to be lower. Although the sensitivity of the IFN-γ -based assays may be impaired to some extent by cellular immunosuppression and extreme ages of life, they perform better than TST in these situations. Data from longitudinal studies suggest that IFN-γ-based tests are better predictors of subsequent development of active TB than TST; however this prognostic value has not been consistently demonstrated. This review focuses on the clinical use of the IFN-γ -based tests in different risk TB groups, and notes the main limitations and areas for future development.
Keywords:
Tuberculosis
Latent tuberculosis infection
Interferon γ-based assays
QuantiFERON-TB Gold In-Tube
T-SPOT.TB
Resumen
Las técnicas de detección de la liberación de interferón-γ conocidas como IFN-γ release assays (IGRA), constituyen una alternativa fiable a la clásica prueba de la tuberculina (PT) para el inmunodiagnóstico de la infección tuberculosa. Las 2 pruebas comerciales disponibles, QuantiFERON-TB Gold In-tube (QFT-IT) y T-SPOT.TB, son más precisas que la PT para el diagnóstico de tuberculosis (TB), ya que son muy específicas y presentan una mejor correlación con la existencia de factores de riesgo para la infección tuberculosa. Con los datos disponibles, T-SPOT.TB detecta mayor número de positivos que QFT-IT, pero parece ser menos específica. Aunque pueden verse afectadas en determinadas situaciones de inmunosupresión celular y en las edades extremas de la vida, estas técnicas siguen siendo superiores a la PT en estas situaciones. Estudios longitudinales sugieren que las pruebas de liberación de IFN-γ son mejores predictores de la progresión a enfermedad tuberculosa; sin embargo, este hecho no ha sido demostrado completamente. Esta revisión trata el uso de los test de liberación de IFN-γ en diferentes grupos de riesgo de TB. Asimismo, remarca sus principales limitaciones y las áreas de desarrollo futuro.
Palabras clave:
Tuberculosis
Infección tuberculosa
Determinación de liberación de interferón-γ
QuantiFERON-TB Gold In-Tube
T-SPOT.TB
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