Usefulness of Enzyme-Linked Immunospot Assay (Elispot) Compared to Tuberculin Skin Testing for Latent Tuberculosis Screening in Rheumatic Patients Scheduled for Anti-Tumor Necrosis Factor Treatment

摘要: ### Objective Treatment with tumor necrosis factor (TNF) antagonists in patients rheumatic diseases has been associated increased rates of tuberculosis due to reactivation latent Mycobacterium ( MTb ) infection (LTBI). Diagnosis LTBI is based mainly on the tuberculin skin test (TST), which certain limitations. ### Methods We compared TST an enzyme-linked immunospot interferon-γ (IFN-γ) release assay (Elispot; T SPOT® TB) for diagnosis 70 various starting treatment anti-TNF agents. All underwent a standard initial evaluation including clinical examination, chest radiograph, and TST. Freshly isolated peripheral blood mononuclear cells were stimulated ex vivo -specific antigens (ESAT-6 CFP10), IFN-γ-producing counted (Elispot assay). ### Results Twenty-seven (38.6%) TST+ 16 Elispot+ (22.8%). The overall level agreement between 2 tests was 72.8%, being much higher who TST− (39/43, 90.6%) than those (12/27, 44.4%). Discordant results observed 19 (27.1%). Among (n = 43), 4 (9.3%); we also identified 15 Elispot− among 27 (55.6%). Multivariate analysis showed that history bacillus Calmette-Guerin (BCG) vaccination TST+/Elispot− discordant (p 0.01), whereas steroid use linked TST−/Elispot+ 0.04). ### Conclusion Elispot useful scheduled therapy identification false-positive previous BCG vaccination.