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G/THUR/ALL1 FIRST HEAD-TO-HEAD COMPARISON OF SKIN TESTING AND INTERFERON-GAMMA RELEASE ASSAYS IN CHILDREN WITH ACTIVE AND LATENT TUBERCULOSIS IN THE UK
S. Anderson2, S. Walters1, B. Williams2, A. Williams2, A. Gordon1, N. Martinez-Alier1, B. Kampmann1.1Imperial College, London, UK; 2Northwick Park NHS Trust, London, UK
Background: Many believe that the tuberculin-skin-test (TST) is a blunt tool for diagnosing MTB infection in children. The new NICE Guidelines for tuberculosis recommend the use of IFNGRA in TST positive children. However, there is no guidance on which assay to use and there is a paucity of data regarding the performance of these assays in children. No direct comparison between all 3 available tests for the diagnosis of childhood Tb (active or latent) in UK cohorts has been published.
Aims: To assess the performance of TST and IFNGRA in a UK paediatric cohort.
Methods: Side-by-side comparison of the two commercially available IFNGRA (T-SpotTB and Quantiferon Gold QFG) and the TST in children referred to our paediatric TB clinics in London, plus assessment of a control group (n = 30).
Results: This study is ongoing. Data in 74 children with presumed active (n = 32) or latent TB (n = 42) show that both IFNGRA were highly concordant but differed significantly from the TST read-out. A significantly higher number of patients were treated for both active and latent TB than would have been indicated, if IFNGRA results had guided the decision making process, as summarised in the table.
Conclusion: The concordance between IFNGRA is good, but clinical management of patients should only change once more information about their performance in children is available. Paediatricians who use IFNGRA should strive to combine data from their cohorts to gain a better understanding of the validity of these novel assays for use in paediatric practice, as we may be overtreating assumed MTB infection in UK children.
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