ORIGINAL ARTICLE Year : 2021  |  Volume : 70  |  Issue : 1  |  Page : 40-42

Interferon-gamma assay and tuberculin skin test for screening of latent tuberculosis in patients with inflammatory bowel disease: a summarization study

Rujittika Mungmunpuntipantip1, Viroj Wiwanitkit2
1 26 Medical Center, Bangkok, Thailand
2 Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria

Date of Submission28-Aug-2019Date of Decision22-Oct-2019Date of Acceptance28-Nov-2019Date of Web Publication27-Mar-2021

Correspondence Address:
PhD Rujittika Mungmunpuntipantip
26 Medical Center, Bangkok, 10150
Thailand

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejcdt.ejcdt_176_19

Background Latent tuberculosis is an important clinical problem. This problem might be significant in some specific groups of patients. The screening for latent tuberculosis is recommended for management of those patients at risk. An important group to be screened is patients with inflammatory bowel disease.
Materials and methods This work is a retrospective study. The summarization on the available data from published articles on the comparative study between interferon-gamma assay and tuberculin skin test for screening for latent tuberculosis in inflammatory bowel disease patients was done. The pooled detection rate was calculated for using interferon-gamma assay and tuberculin skin test in screening for latent tuberculosis in patients with inflammatory bowel disease.
Results The pooled detection rates for using tuberculin skin test and interferon-gamma assay in screening for latent tuberculosis in patients with inflammatory bowel disease are equal to 11.67% (95% confidence interval=10.33–13.19%) and 14.64% (95% confidence interval=13.16–16.30%), respectively.
Conclusion It can be shown that interferon-gamma assay has a better efficacy in detection of latent tuberculosis among the patients with inflammatory bowel disease.

Keywords: inflammatory bowel disease, interferon-gamma assay, tuberculin skin test, tuberculosis

How to cite this article:
Mungmunpuntipantip R, Wiwanitkit V. Interferon-gamma assay and tuberculin skin test for screening of latent tuberculosis in patients with inflammatory bowel disease: a summarization study. Egypt J Chest Dis Tuberc 2021;70:40-2
How to cite this URL:
Mungmunpuntipantip R, Wiwanitkit V. Interferon-gamma assay and tuberculin skin test for screening of latent tuberculosis in patients with inflammatory bowel disease: a summarization study. Egypt J Chest Dis Tuberc [serial online] 2021 [cited 2021 Dec 5];70:40-2. Available from: http://www.ejcdt.eg.net/text.asp?2021/70/1/40/312134   Introduction 

Tuberculosis is an important problem seen around the world. The latent infection is an important clinical problem that is difficult to manage [1],[2]. Without laboratory investigation, it is difficult to detect any case with latent asymptomatic tuberculosis. In general situation, there might be no clinical problem owing to latent tuberculosis. Nevertheless, when there is a critical change in health status or immunological change, the patient might manifest clinical presentation.

Therefore, it is recommended to look for latent tuberculosis in many groups of patients. For example, the cancerous patient who will receive chemotherapy requires screening for latent tuberculosis as the chemotherapy will suppress immunity and increase the chance of overt clinical presentation of tuberculosis [3]. Another important group of patients recommended for screening for latent tuberculosis is patients with inflammatory bowel disease.

There are some available reports on the use of screening tools for latent tuberculosis in patients with inflammatory bowel disease [4],[5]. The results are various for the diagnostic performance of different diagnostic tools. The two widely studied screening tools are interferon-gamma assay and tuberculin skin test. In the present report, the authors performed a meta-analysis to retrospectively summarize on the detection rate from using interferon-gamma assay compared with tuberculin skin test.

  Materials and methods 

This work is a retrospective study. The summarization on the available data from published articles on the comparative study between interferon-gamma assay and tuberculin skin test for screening for latent tuberculosis in inflammatory bowel disease patients was done. This work is not a study on patients, animals, or clinical specimens; therefore, it requires no written informed consent or ethical committee approval.

First, the authors performed a search on international database, PubMed (http://www.pubmed.com), using the key words ‘interferon-gamma assay,’ ‘tuberculin skin test,’ ‘tuberculosis,’ and ‘inflammatory bowel disease.’ The identified derived publications that report on the detection rate of tuberculosis by both interferon-gamma assay and tuberculin skin test are recruited for further analysis. Any publication without complete data or did not focus on only the patients with inflammatory bowel disease was excluded.

The summative analysis on the derived data is done. The pooled detection rate was calculated for using interferon-gamma assay and tuberculin skin test in screening for latent tuberculosis in patients with inflammatory bowel disease. The range of detection rate was also calculated using 95% confidence interval (95% CI) calculation.

  Results 

According to the literature search, there are 27 determined publications [6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32]. Of these 27 publications, there are only six reports [6],[7],[11],[13],[15],[17],[29] containing the complete data required for further summative analysis. Based on the summarization study, there are 1953 patients with inflammatory bowel disease in whom the screening for latent tuberculosis by interferon-gamma assay and tuberculin skin test was performed. Regarding the detection for tuberculosis, tuberculin skin test, and interferon-gamma assay result in detection in 228 cases and 286 cases, respectively ([Table 1]).

Table 1 Comparison on results from interferon-gamma assay and tuberculin skin test for screening of latent tuberculosis in patients with inflammatory bowel disease.

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The pooled detection rates for using tuberculin skin test and interferon-gamma assay in screening for latent tuberculosis in patients with inflammatory bowel disease are 11.67% (95% CI=10.33–13.19%) and 14.64% (95% CI=13.16–16.30%), respectively.

  Discussion 

Latent tuberculosis screening is a necessary process in the management of patients at risk. Those patients who will receive specific clinical treatment that affect the immunological status usually require the screening. The patients with inflammatory bowel disease is a group of patient that requires specific clinical treatment that can result in change of immunological status. The modification of tumor necrotic factor owing to treatment is observable, and this is an important pathophysiological process that can result in unwanted complication of treatment.The effect of drug treatment can result in increased chance to have clinical tuberculosis [4],[33]. In fact, there is also the chance for other unwanted superimposed condition such as malignancy [34].

If there is an emergence of tuberculosis during treatment, the patient with inflammatory disease will get a poor clinical course. The disseminate tuberculosis might occur [35]. The screening for tuberculosis among patients with inflammatory bowel disease undergoing drug treatment is necessary. There are many choices for screening. To select an appropriate choice is important. The important considerations for selection include the efficacy and cost of the test. Indeed, there are many reports regarding a comparison between detection rates of tuberculosis by using interferon-gamma assay versus tuberculin skin test. The results are various, and the conclusion requires a systematic summative analysis. Based on the present report, a comparative comparison between interferon-gamma assay and tuberculin skin test is retrospectively analyzed. The pooled analysis can show that the interferon-gamma assay gives a better detection rate. These data are important information for further comparative assessment between the two options. The cost-effectiveness analysis is further recommended.

  Conclusion 

The detection rate by interferon-gamma assay is better than that of tuberculin skin test. If we focus only on the efficacy, the interferon-gamma assay is appropriate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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  [Table 1]