Diagnosis of Latent Tuberculosis Infection in Hemodialysis Patients: TST versus T-SPOT.TB
1
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey
2
Department of Nephrology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey
*
Author to whom correspondence should be addressed.
Diagnostics 2023, 13(14), 2369; https://doi.org/10.3390/diagnostics13142369
Submission received: 23 May 2023
/
Revised: 7 July 2023
/
Accepted: 8 July 2023
/
Published: 14 July 2023
(This article belongs to the Special Issue Laboratory Diagnosis in Microbial Diseases)
Abstract
:Hemodialysis (HD) patients should be screened for latent tuberculosis (TB) infection. We aimed to determine the frequency of latent TB infection in HD patients and to compare the effectiveness of the tests used. The files of 56 HD patients followed between 1 January 2021 and 1 October 2022 were retrospectively analyzed. Demographic data, the presence of the Bacillus Calmette-Guerin (BCG) vaccine, whether or not the patients had previously received treatment for TB before, the status of encountering a patient with active TB of patients over 18 years of age, without active tuberculosis and who had a T-SPOT.TB test or a Tuberculin Skin Test (TST) were obtained from the patient files. The presence of previous TB in a posterior–anterior (PA) chest X-ray was obtained by evaluating PA chest X-rays taken routinely. Of the patients, 60.7% (n = 34) were male and their mean age was 60.18 ± 14.85 years. The mean duration of dialysis was 6.43 ± 6.03 years, and 76.8% (n = 43) had 2 BCG scars. The T-SPOT.TB test was positive in 32.1% (n = 18). Only 20 patients (35.7%) had a TST and all had negative results. While the mean age of those with positive T-SPOT.TB results was higher (p = 0.003), the time taken to enter HD was shorter (p = 0.029). T-SPOT.TB test positivity was higher in the group that had encountered active TB patients (p = 0.033). However, no significant difference was found between T-SPOT.TB results according to BCG vaccine, albumin, urea and lymphocyte levels. Although T-SPOT.TB test positivity was higher in patients with a previous TB finding in a PA chest X-ray, there was no statistically significant difference (p = 0.093). The applicability of the TST in the diagnosis of latent TB infection in HD patients is difficult and it is likely to give false-negative results. The T-SPOT.TB test is not affected by the BCG vaccine and immunosuppression. Therefore, using the T-SPOT.TB test would be a more appropriate and practical approach in the diagnosis of latent TB in HD patients.
1. Introduction
Tuberculosis (TB) continues to be one of the main causes of death due to infectious diseases all over the world. The World Health Organization (WHO) has implemented the ‘End tuberculosis’ strategy and in relation to this, it recommends screening and treating latent TB infection (LTBI) [1]. According to the Turkish Ministry of Health’s Tuberculosis Diagnosis and Treatment Guidelines, it is recommended that patients with a high risk of latent TB reactivation, such as hemodialysis (HD) patients, should be screened. Since the risk of transmission will be high in hemodialysis units, the development of tuberculosis disease in this patient group must be prevented [2]. When prior studies are examined, in the systematic reviews conducted by Alemu et al., LTBI and active tuberculosis infection were found to be more common in dialysis patients [3,4]. In the study of ** active TB is higher [38]. In this case, it is important to initiate latent TB treatment without delay in high-risk patients with a positive T-SPOT.TB test.
It has been shown that advanced age, active smoking and close contact with someone who has previously had TB are among the risk factors for latent TB infection in HD patients. In the same study, it was stated that high albumin levels and short HD duration facilitate the detection of latent TB infection [39]. In a study conducted in Japan in hemodialysis patients, the frequency of LTBI was found to be higher, especially in people aged 60 and over [40] and in other studies conducted in China and Lebanon, advanced age was found among the risk factors for latent TB infection [5,41]. In our study, the high mean age of the patients with a positive T-SPOT.TB test and the shorter time to enter HD in patients with a positive T-SPOT.TB test support the literature. The incidence of TB in our country has been decreasing over the years, so that the incidence of TB, which was 29.8% in 2005, decreased to 14.4% in 2018 [42]. This may be the reason why the T-SPOT.TB test gives high positive results in older age groups. In our study, there was no significant difference between positive/negative results in terms of albumin, urea and lymphocyte levels, while the average albumin levels of patients with a T-SPOT.TB positive result were higher. However, the fact that there was no significant correlation between the T-SPOT.TB test results according to the urea levels and lymphocyte counts of the patients suggests that the test is not affected by immunosuppression.
The small number of patients and the fact that many patients did not have a TST are the limitations of the study.
In conclusion, HD patients should be screened for latent TB infection as soon as possible. Although it is recommended to perform a TST first in screening, the applicability of the test is not easy and the possibility of false-negative results is high, which limits its use. The most important advantage of the T-SPOT.TB test is that it is not affected by immunosuppression and it is studied with a single measurement from blood. Therefore, the use of the T-SPOT.TB test would be a more practical and accurate approach to screen for latent TB infection in HD patients.
Author Contributions
Concept and design: U.D.B., A.V.K., F.K. and O.B.; Data collection: U.D.B. and A.V.K.; Data analysis and interpretation: U.D.B., A.V.K., F.K. and O.B.; Draft of the article: U.D.B. and A.V.K.; Revision of the article: U.D.B., A.V.K., F.K. and O.B. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Erzincan Binali Yildirim University Clinical Research Ethics Committee (Date: 10 November 2022/Decision No: 05/09).
Informed Consent Statement
Since it is a retrospective study, patient consent was not obtained.
Data Availability Statement
Data will be shared upon request.
Conflicts of Interest
The authors declare no conflict of interest.
References
- World Health Organization. WHO Operational Handbook on Tuberculosis (Module 1—Prevention): Tuberculosis Preventive Treatment; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- Er, A.G.; Süer, A.İ.; Yurteri, A.Ş.; Babalık, A.; Yıldırım, A.; Öztomurcuk, D.; İnce, E.; Kabasakal, E.; Çakır, E.; İlhan, F.; et al. Tüberküloz Tanı ve Tedavi Rehberi, 2nd ed.; Artı6 Medya Tanıtım Matbaa Ltd. Şti.: Ankara, Turkey, 2019; pp. 1–344. ISBN 978-975-590-717-8. [Google Scholar]
- Alemu, A.; Bitew, Z.W.; Diriba, G.; Seid, G.; Moga, S.; Abdella, S.; Gashu, E.; Eshetu, K.; Tollera, G.; Dangisso, M.H.; et al. The prevalence of latent tuberculosis infection in patients with chronic kidney disease: A systematic review and meta-analysis. Heliyon 2023, 9, e17181. [Google Scholar] [CrossRef]
- Alemu, A.; Bitew, Z.W.; Diriba, G.; Seid, G.; Eshetu, K.; Chekol, M.T.; Berhe, N.; Gumi, B. Tuberculosis incidence in patients with chronic kidney disease: A systematic review and meta-analysis. Int. J. Infect. Dis. 2022, 122, 188–201. [Google Scholar] [CrossRef]
- **a, Y.; Fan, Q.; Zhang, J.; Jiang, L.; Huang, X.; **ong, Z.; **ong, Z. Risk factors and prognosis for latent tuberculosis infection in dialysis patients: A retrospective cohort study at a single tertiary care center. Semin. Dial. 2023, 1–6. [Google Scholar] [CrossRef] [PubMed]
- Park, S.; Park, S.; Kim, J.E.; Yu, M.Y.; Kim, Y.C.; Kim, D.K.; Joo, K.W.; Kim, Y.S.; Han, K.; Lee, H. Risk of active tuberculosis infection in kidney transplantation recipients: A matched comparative nationwide cohort study. Am J Transplan. 2021, 21, 3629–3639. [Google Scholar] [CrossRef] [PubMed]
- Romanowski, K.; Rose, C.; Cook, V.J.; Sekirov, I.; Morshed, M.; Djurdjev, O.; Levin, A.; Johnston, J.C. Effectiveness of Latent TB Screening and Treatment in People Initiating Dialysis in British Columbia, Canada. Can. J. Kidney Health Dis. 2020, 7, 2054358120937104. [Google Scholar] [CrossRef] [PubMed]
- Grant, J.; Jastrzebski, J.; Johnston, J.; Stefanovic, A.; Jastrabesky, J.; Elwood, K.; Roscoe, D.; Balshaw, R.; Bryce, E. Interferon-gamma release assays are a better tuberculosis screening test for hemodialysis patients: A study and review of the literature. Can. J. Infect. Dis. Med. Microbiol. 2012, 23, 114–116. [Google Scholar] [CrossRef]
- Carranza, C.; Pedraza-Sanchez, S.; de Oyarzabal-Mendez, E.; Torres, M. Diagnosis for latent tuberculosis infection: New alternatives. Front. Immunol. 2020, 11, 2006. [Google Scholar] [CrossRef]
- Jonas, D.E.; Riley, S.R.; Lee, L.C.; Coffey, C.P.; Wang, S.H.; Asher, G.N.; Berry, A.M.; Williams, N.; Balio, C.; Voisin, C.E.; et al. Screening for latent tuberculosis infection in adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2023, 329, 1495–1509. [Google Scholar] [CrossRef]
- Zhou, G.; Luo, Q.; Luo, S.; Teng, Z.; Ji, Z.; Yang, J.; Wang, F.; Wen, S.; Ding, Z.; Li, L.; et al. Interferon-γ release assays or tuberculin skin test for detection and management of latent tuberculosis infection: A systematic review and meta-analysis. Lancet Infect. Dis. 2020, 20, 1457–1469. [Google Scholar] [CrossRef]
- Ho, C.S.; Feng, P.J.I.; Narita, M.; Stout, J.E.; Chen, M.; Pascopella, L.; Garfein, R.; Reves, R.; Katz, D.J.; Flood, J.; et al. Comparison of three tests for latent tuberculosis infection in high-risk people in the USA: An observational cohort study. Lancet Infect. Dis. 2022, 22, 85–96. [Google Scholar] [CrossRef]
- Akbar, A.A.; Islam, M.N.; Rahman, M. Comparison of Mantoux test with quantiFERON-TB gold plus assay for detection of tuberculosis infection among chronic kidney disease patients in a tertiary care hospital in Dhaka city. Bangladesh Med. Coll. J. 2021, 26, 24–29. [Google Scholar]
- Setyawati, A.; Reviono, R.; Putranto, W. The Compability Level of Tuberculin Skin Test and T-SPOT. TB, Sensitivity and Spesifisity of T-SPOT. TB in Detecting Latent Tuberculosis in Hemodialysis Patients. J. Respirol. Indones. 2021, 41, 19–27. [Google Scholar] [CrossRef]
- Southern, J.; Sridhar, S.; Tsou, C.Y.; Hopkins, S.; Collier, S.; Nikolayevskyy, V.; Lozewicz, S.; Lalvani, A.; Abubakar, I.; Lipman, M. Discordance in latent tuberculosis (TB) test results in patients with end-stage renal disease. Public Health 2019, 166, 34–39. [Google Scholar] [CrossRef] [PubMed]
- Wang, P.H.; Lin, S.Y.; Lee, S.S.; Lin, S.W.; Lee, C.Y.; Wei, Y.F.; Shu, C.C.; Wang, J.Y.; Yu, C.J. CD4 response of QuantiFERON-TB Gold Plus for positive consistency of latent tuberculosis infection in patients on dialysis. Sci. Rep. 2020, 10, 21367. [Google Scholar] [CrossRef] [PubMed]
- Putri, D.U.; Chen, C.L.; Wang, C.H.; Sue, Y.M.; Tseng, P.C.; Lin, C.F.; Tsai, C.W.; Liu, Y.J.; Lee, C.H. Hemodialysis acutely altered interferon-gamma release assay test result and immune cell profile. J. Microbiol. Immunol. Infect. 2022, 55, 332–335. [Google Scholar] [CrossRef]
- Park, H.; Kang, Y.-J.; Kim, Y.N.; Park, S.-B.; Lim, J.; Park, J.Y.; Kang, Y.A.; Lee, H.; Kim, J.; Kim, S. Predictors for False-Negative Interferon-Gamma Release Assay Results in Hemodialysis Patients with Latent Tuberculosis Infection. Diagnostics 2023, 13, 88. [Google Scholar] [CrossRef]
- Nasiri, M.J.; Pormohammad, A.; Goudarzi, H.; Mardani, M.; Zamani, S.; Migliori, G.B.; Sotgiu, G. Latent tuberculosis infection in transplant candidates: A systematic review and meta-analysis on TST and IGRA. Infection 2019, 47, 353–361. [Google Scholar] [CrossRef]
- Zhou, G.; Luo, Q.; Luo, S.; He, J.; Chen, N.; Zhang, Y.; Yang, R.; Qiu, Y.; Li, S.; **, Q.; et al. Positive rates of interferon-γ release assay and tuberculin skin test in detection of latent tuberculosis infection: A systematic review and meta-analysis of 200, 000 head-to-head comparative tests. Clin. Immunol. 2022, 245, 109132. [Google Scholar] [CrossRef]
- Soysal, A.; Torun, T.; Efe, S.; Gencer, H.; Tahaoglu, K.; Bakir, M. Evaluation of cut-off values of interferon-gamma- based assays in the diagnosis of M. tuberculosis infection. Int. J. Tuberc. Lung Dis. 2008, 12, 50–56. [Google Scholar]
- Kılınç, O. Tüberkülin Deri Testi (TDT), Yorumu Ve Son Gelişmeler. In Proceedings of the 21. Yüzyılda Tüberküloz Sempozyumu ve II. Tüberküloz Laboratuvar Tanı Yöntemleri Kursu, Samsun, Turkey, 11–14 June 2003; pp. 203–207. [Google Scholar]
- Kiazyk, S.; Ball, T.B. Latent tuberculosis infection: An overview. Can. Commun. Dis. Rep. 2017, 43, 62–66. [Google Scholar] [CrossRef]
- Moran, E.; Baharani, J.; Dedicoat, M.; Robinson, E.; Smith, G.; Bhomra, P.; Thien, O.S.; Ryan, R. Risk factors associated with the development of active tuberculosis among patients with advanced chronic kidney disease. J. Infect. 2018, 77, 291–295. [Google Scholar] [CrossRef]
- Dobler, C.C.; McDonald, S.P.; Marks, G.B. Risk of tuberculosis in dialysis patients: A nationwide cohort study. PLoS ONE 2011, 6, e29563. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chung, W.K.; Zheng, Z.L.; Sung, J.Y.; Kim, S.; Lee, H.H.; Choi, S.J.; Yang, J. Validity of interferon-γ-release assays for the diagnosis of latent tuberculosis in haemodialysis patients. Clin. Microbiol. Infect. 2010, 16, 960–965. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bandiara, R.; Indrasari, A.; Rengganis, A.D.; Sukesi, L.; Afiatin, A.; Santoso, P. Risk factors of latent tuberculosis among chronic kidney disease with routine haemodialysis patients. J. Clin. Tuberc. Other Mycobact. Dis. 2022, 27, 100302. [Google Scholar] [CrossRef]
- Hayuk, P.; Boongird, S.; Pornsuriyasak, P.; Bruminhent, J. Interferon-gamma release assays for diagnosis of latent TB infection in chronic kidney diseases and dialysis patients. Front. Cell. Infect. Microbiol. 2022, 12, 1046373. [Google Scholar] [CrossRef] [PubMed]
- Lemrabott, A.T.; Faye, M.; Faye, M.; Kane, Y.; Cisse, M.M. Contribution of an Interferon Gamma Released Assay to the Detection of Latent Tuberculosis in Chronic Dialysis Patients in Sub-Saharan Africa. J. Nephrol. Ther. 2019, 9, 2161-0959. [Google Scholar] [CrossRef]
- Doğru, G.; Şahin, M. Romatoid Artrit ve Ankilozan Spondilit Hastalarında Anti-TNF Alfa Tedavi Öncesi Latent Tüberküloz Taramasında Tüberkülin Deri Testi ve İnterferon Gama Salınım Testinin Karşılaştırılması. Süleyman Demirel Üniversitesi Sağlık Bilim. Derg. 2021, 12, 70–76. [Google Scholar]
- Say, İ.; Küçük, B.; Orak, F.; Aral, M.; Doğaner, A. Latent Tüberküloz Enfeksiyonu Araştırılan Hastalarda QuantiFERON-TB GOLD Testi ile Tüberkülin Deri Testinin Karşılaştırılması. Türk Mikrobiyoloji Cemiy. Derg. 2021, 51, 271–275. [Google Scholar]
- Binay, U.D.; Fincanci, M.; Fersan, E.; Karakecili, F. Comparison of Tuberculin Skin Test (TST) and T-SPOT. TB Tests for Diagnosis of Latent Tuberculosis Infection (LTBI) in HIV-infected Patients. Mikrobiyol. Bul. 2019, 53, 388–400. [Google Scholar] [CrossRef]
- Richardson, R.M. The diagnosis of tuberculosis in dialysis patients. Semin. Dial. 2012, 25, 419–422. [Google Scholar] [CrossRef]
- Zhang, X.; Chen, P.; Xu, G. Update of the mechanism and characteristics of tuberculosis in chronic kidney disease. Wien. Klin. Wochenschr. 2022, 134, 501–510. [Google Scholar] [CrossRef]
- Wardani, H.R.; Wicaksi, D. Detection of Latent Tuberculosis Infection in Haemodialysis Patients: A Systematic Review. Unej E-Proceeding 2021, S.I., 55–62. [Google Scholar]
- Sargın, G.; Şentürk, T.; Ceylan, E.; Telli, M.; Çildağ, S.; Doğan, H. TST, QuantiFERON-TB Gold test and T-SPOT. TB test for detecting latent tuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy. Tuberk. Toraks 2018, 66, 136–143. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Park, J.Y.; Park, S.B.; Park, H.; Kim, J.; Kim, Y.N.; Kim, S. Cytokine and Chemokine mRNA Expressions after Mycobacterium tuberculosis-Specific Antigen Stimulation in Whole Blood from Hemodialysis Patients with Latent Tuberculosis Infection. Diagnostics 2021, 11, 595. [Google Scholar] [CrossRef] [PubMed]
- Abubakar, I.; Drobniewski, F.; Southern, J.; Sitch, A.J.; Jackson, C.; Lipman, M.; Deeks, J.J.; Griffiths, C.; Bothamley, G.; Lynn, W.; et al. Prognostic value of interferon-γ release assays and tuberculin skin test in predicting the development of active tuberculosis (UK PREDICT TB): A prospective cohort study. Lancet Infect. Dis. 2018, 18, 1077–1087. [Google Scholar] [CrossRef] [Green Version]
- Shu, C.C.; Wu, V.C.; Yang, F.J.; Pan, S.C.; Lai, T.S.; Wang, J.Y.; Wang, J.T.; Lee, L.N. Predictors and prevalence of latent tuberculosis infection in patients receiving long-term hemodialysis and peritoneal dialysis. PLoS ONE 2012, 7, e42592. [Google Scholar] [CrossRef] [Green Version]
- Ogawa, Y.; Harada, M.; Hashimoto, K.; Kamijo, Y. Prevalence of latent tuberculosis infection and its risk factors in Japanese hemodialysis patients. Clin. Exp. Nephrol. 2021, 25, 1255–1265. [Google Scholar] [CrossRef]
- Ismail, M.B.; Zarriaa, N.; Osman, M.; Helfawi, S.; Kabbara, N.; Chatah, A.N.; Kamaleddine, A.; Alameddine, R.; Dabboussi, F.; Hamze, M. Prevalence of Latent Tuberculosis Infection among Patients Undergoing Regular Hemodialysis in Disenfranchised Communities: A Multicenter Study during COVID-19 Pandemic. Medicina 2023, 59, 654. [Google Scholar] [CrossRef]
- Yıllara GöRe Toplam Tb Olgu Sayısı, Toplam Olgu Hızı Ve İNsiDans HızI, 2005–2018. Available online: https://hsgmdestek.saglik.gov.tr/depo/birimler/tuberkuloz_db/dosya/Istatistikler/Yeni/2-Yllara_Gore_Toplam_TB_Olgu_Hz_ve_TB_Insidans_2005-2018.pdf (accessed on 2 July 2023).
Table 1.
Demographic Characteristics and Distribution of Laboratory and Imaging Results of the Patients.
Table 1.
Demographic Characteristics and Distribution of Laboratory and Imaging Results of the Patients.
| Min-Max (Median) | Mean ± Sd | ||
|---|---|---|---|
| Age (year) | 20–81 (63) | 60.18 ± 14.85 | |
| Time of dialysis (years) | 1–27 (4) | 6.43 ± 6.03 | |
| n | % | ||
| Gender | Female | 22 | 39.3 |
| Male | 34 | 60.7 | |
| Presence of Comorbidity | Yes | 37 | 66.1 |
| No | 19 | 33.9 | |
| Type of comorbidities | Type 2 DM | 12 | 32.4 |
| Hypertension | 29 | 78.4 | |
| Other * | 17 | 45.9 | |
| History of active tuberculosis | Yes | 2 | 3.6 |
| No | 54 | 96.4 | |
| Encounter with active tuberculosis patient | Yes | 5 | 8.9 |
| No | 51 | 91.1 | |
| BCG scar | 0 | 5 | 8.9 |
| 1 | 8 | 14.3 | |
| 2 | 43 | 76.8 | |
| Leukocyte count (mm3) | 2800–25,400 (6250) | 6992.86 ± 3842.15 | |
| Lymphocyte count (mm3) | 440–21,020 (1185) | 1981.43 ± 3533.68 | |
| Albumin (g/dL) | 2.1–41 (3.8) | 17.42 ± 16.16 | |
| Urea (mg/dL) | 85–238 (147.5) | 149.18 ± 28.91 | |
| n | % | ||
| Previous TB finding on PA chest X-ray | Yes | 4 | 7.1 |
| No | 52 | 92.9 | |
| T-SPOT.TB test | Negative | 38 | 67.9 |
| Positive | 18 | 32.1 | |
| TST | Negative | 20 | 35.7 |
| Unknown | 36 | 64.3 | |
* Chronic Obstructive Pulmonary Disease, Alport Syndrome, Chronic Lymphoproliferative Leukemia, Coronary Artery Disease, Rheumatoid Arthritis.
Table 2.
Relationship between Descriptive Characteristics and T-SPOT.TB Results.
| T-SPOT.TB Test | p | |||
|---|---|---|---|---|
| Negative (n = 38) | Positive (n = 18) | |||
| Age (year) | Min-Max (Median) | 20–80 (57) | 38–81 (71) | a 0.003 * |
| Mean ± Sd | 56.26 ± 15.08 | 68.44 ± 10.6 | ||
| Time of dialysis (year) | Min-Max (Median) | 1–27 (5) | 1–20 (3) | b 0.029 * |
| Mean ± Sd | 7.45 ± 6.37 | 4.28 ± 4.71 | ||
| Gender | Female | 18 (81.8) | 4 (18.2) | c 0.072 |
| Male | 20 (58.8) | 14 (41.2) | ||
| Presence of Comorbidity | Yes | 27 (73) | 10 (27) | c 0.253 |
| No | 11 (57.9) | 8 (42.1) | ||
| Type of comorbidities (n = 37) | ||||
| Type 2 DM | Yes | 8 (66.7) | 4 (33.3) | d 0.696 |
| No | 19 (76) | 6 (24) | ||
| Essential HT | Yes | 20 (69) | 9 (31) | d 0.404 |
| No | 7 (87.5) | 1 (12.5) | ||
| Other * | Yes | 13 (76.5) | 4 (23.5) | d 0.725 |
| No | 14 (70) | 6 (30) | ||
| Encounter with active tuberculosis patient | Yes | 1 (20) | 4 (80) | d 0.033 * |
| No | 37 (72.5) | 14 (27.5) | ||
| BCG scar | 0 | 3 (60) | 2 (40) | e 1.000 |
| 1 | 6 (75) | 2 (25) | ||
| 2 | 29 (67.4) | 14 (32.6) | ||
a Student’s t-Test; b Mann–Whitney U Test; c Pearson’s Chi-Squared Test; d Fisher’s Exact Test; e Fisher–Freeman–Halton Test; * Chronic Obstructive Pulmonary Disease, Alport Syndrome, Chronic Lymphoproliferative Leukemia, Coronary Artery Disease, Rheumatoid Arthritis.
Table 3.
Relationship between Laboratory and Imaging Results and T-SPOT.TB Test Results.
| T-SPOT.TB | p | |||
|---|---|---|---|---|
| Negative (n = 38) | Positive (n = 18) | |||
| Leukocyte (mm3) | Min-Max (Median) | 2800–13,300 (6350) | 4000–25,400 (5400) | b 0.352 |
| Mean ± Sd | 6602.63 ± 2108.09 | 7816.67 ± 6085.11 | ||
| Lymphocyte (mm3) | Min-Max (Median) | 440–2710 (1165) | 660–21,020 (1275) | b 0.516 |
| Mean ± Sd | 1322.11 ± 562.14 | 3373.33 ± 6057.06 | ||
| Albumin (g/dL) | Min-Max (Median) | 2.9–41 (3.8) | 2.1–39 (17.9) | b 0.853 |
| Mean ± Sd | 16.46 ± 16.06 | 19.46 ± 16.65 | ||
| Urea (mg/dL) | Min-Max (Median) | 85–238 (152) | 103–180 (142.5) | a 0.230 |
| Mean ± Sd | 152.39 ± 31.85 | 142.39 ± 20.61 | ||
| Previous TB finding on PA chest X-ray | Yes | 1 (25) | 3 (75) | d 0.093 |
| No | 37 (71.2) | 15 (28.8) | ||
a Student’s t-Test; b Mann–Whitney U Test; d Fisher’s Exact Test.
Table 4.
Logistic Regression Results of Factors Affecting T-SPOT.TB Test.
| p | ODDS | 95% C.I.ODDS | ||
|---|---|---|---|---|
| Lower | Upper | |||
| Age | 0.018 * | 1.101 | 1.016 | 1.192 |
| Gender (F) | 0.128 | 3.937 | 0.674 | 23.003 |
| Previous TB finding on PA chest X-ray (+) | 0.311 | 3.766 | 0.290 | 48.857 |
| Time of dialysis (year) | 0.827 | 1.017 | 0.875 | 1.182 |
| Encounter with active tuberculosis patient (+) | 0.027 * | 59.762 | 1.599 | 2233.422 |
* p < 0.05,
Table 5.
Distribution of the Descriptive Characteristics of the Patients who had TST.
| N = 20 | Min-Max (Median) | Mean ± Sd | |
|---|---|---|---|
| Age (year) | 20–81 (64) | 61.85 ± 17.10 | |
| Time of dialysis (year) | 1–20 (3.5) | 6.40 ± 6.08 | |
| n | % | ||
| Gender | Female | 6 | 30 |
| Male | 14 | 70 | |
| Presence of Comorbidity | Yes | 10 | 50 |
| No | 10 | 50 | |
| Type of comorbidities (n = 10) | Type 2 DM | 2 | 20 |
| HT | 9 | 90 | |
| Other * | 5 | 50 | |
| History of active tuberculosis | Yes | 1 | 5 |
| No | 19 | 95 | |
| Encounter with active tuberculosis patient | Yes | 4 | 20 |
| No | 16 | 80 | |
| BCG scar | 0 | 2 | 10 |
| 1 | 3 | 15 | |
| 2 | 15 | 75 | |
* Chronic Obstructive Pulmonary Disease, Alport Syndrome, Chronic Lymphoproliferative Leukemia, Coronary Artery Disease, Rheumatoid Arthritis.
Table 6.
Distribution of Laboratory and Imaging Results of the Patients who had TST.
| N = 20 | Min-Max (Median) | Mean ± Sd | |
|---|---|---|---|
| Leukocyte (mm3) | 2800–21,900 (5400) | 7000 ± 4336.87 | |
| Lymphocyte (mm3) | 660–18,850 (1285) | 2209 ± 3951.76 | |
| Albumin (g/dL) | 2.1–39 (3.7) | 16.39 ± 16.41 | |
| Urea (mg/dL) | 100–180 (142.5) | 141.95 ± 22.97 | |
| n | % | ||
| Previous TB finding on PA chest X-ray | Yes | 2 | 10 |
| No | 18 | 90 | |
| T-SPOT.TB test | Negative | 4 | 20 |
| Positive | 16 | 80 | |
| T-SPOT.TB test | p | ||
| Negative (n = 4) | Positive (n = 16) | ||
| Leukocyte (mm3) | 2800–13,300 (6350) | 4200–21,900(5400) | b 0.892 |
| 7175.0 ± 4593.7 | 6956.3 ± 4426.4 | ||
| Lymphocyte (mm3) | 800–2210 (1285) | 660–18,850 (1275) | b 0.963 |
| 1395.0 ± 590.6 | 2412.5 ± 4414.7 | ||
b Mann–Whitney U Test.
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Binay, U.D.; Kara, A.V.; Karakeçili, F.; Barkay, O. Diagnosis of Latent Tuberculosis Infection in Hemodialysis Patients: TST versus T-SPOT.TB. Diagnostics 2023, 13, 2369. https://doi.org/10.3390/diagnostics13142369
AMA Style
Binay UD, Kara AV, Karakeçili F, Barkay O. Diagnosis of Latent Tuberculosis Infection in Hemodialysis Patients: TST versus T-SPOT.TB. Diagnostics. 2023; 13(14):2369. https://doi.org/10.3390/diagnostics13142369
Chicago/Turabian StyleBinay, Umut Devrim, Ali Veysel Kara, Faruk Karakeçili, and Orçun Barkay. 2023. "Diagnosis of Latent Tuberculosis Infection in Hemodialysis Patients: TST versus T-SPOT.TB" Diagnostics 13, no. 14: 2369. https://doi.org/10.3390/diagnostics13142369
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