QuantiFERON-TB gold cut-off value: implications for the management of tuberculosis-related ocular inflammation
Gineys R, Bodaghi B, Carcelain G, Cassoux N, Boutin LTH, Amoura Z, Lehoang P, Trad S.
Am J Ophthalmol. 2011 Sep;152(3):433-440
To evaluate the accuracy of QuantiFERON-TB Gold testing in patients with presumptive tuberculosis-ocular inflammation.
Prospective nonrandomized case series and clinical laboratory investigation.
Ninety-six consecutive patients presenting with ocular inflammation between January and October 2007 were tested using QuantiFERON-TB Gold. Positive patients received a 6-month anti-tuberculosis treatment. Patient follow-up ranged from 12 months to 24 months. Treatment was considered effective at the end of follow-up, in cases of no or a 2-point decrease of ocular inflammation (SUN criteria) and systemic corticosteroids stopped or tapered to 10 mg/day.
Mean age was 51 ± 17 years. Types of ocular inflammation included scleritis (n = 7), panuveitis (n = 34), and posterior (n = 15), intermediate (n = 14), and anterior uveitis (n = 15). QuantiFERON-TB Gold was positive in 42 cases (44%), negative in 51 cases (53%), and undetermined in 3 cases (3%). Among positive QuantiFERON-TB Gold patients, 25 received a full anti-tuberculosistreatment, which was effective in 15 cases (60%). Associated systemic steroids were given to 6 patients and tapered to 10 mg/day or less in all cases. Median QuantiFERON-TB Gold value was significantly higher in the group with a successful therapeutic response (7.67 IU/mL [0.46 to 33.37]) compared to the group with treatment failure (1.22 IU/mL [0.61 to 4.4]), P = .026.
Results of anti-tuberculosis treatment were encouraging in QuantiFERON-TB Gold-positive ocular inflammation, especially with values over 2 IU/mL in our study, suggesting that a higher cut-off value than that given by the manufacturer should be considered to better identify ocular inflammation that can benefit from full anti-tuberculosis treatment.
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Update on Immunological Test (Quantiferon-TB Gold) Contribution in the Management of Tuberculosis-Related Ocular Inflammation
Trad S, Bodaghi B, Saadoun D.
Ocul Immunol Inflamm. 2017 Jul 12:1-8. doi: 10.1080/09273948.2017.1332232.
To clarify interferon-gamma release assay (IGRA) contributions to intraocular tuberculosis management, according to related TB endemic prevalence.
Despite extensive investigations, including IGRA, the diagnosis of intraocular tuberculosis (TB) is still challenging and remains mostly presumptive. According to the literature, it appears that management of suspected ocular TB differs significantly based on whether patients are from areas of high TB prevalence or from non-TB-endemic countries. The accuracy and final contribution of chest X-rays, tuberculin skin test and IGRA differ significantly according to low or high endemic TB areas. This work aims to review IGRA test outcomes in the light of these clinical and epidemiological settings. We therefore focused our analysis and its subsequent guidelines proposal based on the TB prevalence where the patient lives.
We believe that distinct guidelines should be determined for managing patients with suspected ocular TB, first taking into consideration the relative TB prevalence.