Immune-mediated inflammatory diseases differently affect IGRAs’ accuracy for latent tuberculosis infection diagnosis in clinical practice

Irene Latorre, Sonia Mínguez, José Manuel Carrascosa, Juan Naves, Raquel Villar-Hernández, Beatriz Muriel, Cristina Prat, Esther García-García, Irma Casas, Eugeni Domènech, Carlos Ferrándiz, Lourdes Mateo, Jose Domínguez

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7 Citations (Scopus)

Abstract

© 2017 Latorre et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Clinical accuracy of IGRAs remains unclear on patients with immune-mediated inflammatory diseases (IMIDs). Here, we assess the impact of immunosuppressants and IMIDs on QuantiFERON-TB Gold In-Tube (QFN-G-IT) and T-SPOT.TB accuracy. Methods: Patients with IMIDs who required latent tuberculosis infection (LTBI) screening were enrolled and classified into: (i) 50 patients with inflammatory rheumatic diseases, (ii) 50 patients with psoriasis and (iii) 30 patients with Crohn’s disease. A total of 44 healthy individuals without immunosuppression were also included as controls. Tuberculin skin test (TST), T-SPOT.TB and QFN-G-IT assays were performed. IGRAs were performed following manufacturer’s instructions. Results: Immunosuppressant’s intake was more frequent on patients with Crohn’s disease and psoriasis. Positive IGRAs and TST results were reduced in Crohn’s disease patients, whereas rate of indeterminate T-SPOT.TB results was increased in this group with respect to the other IMIDs analysed and controls. When IFN-γ response was studied, the levels of this cytokine after mitogen stimulation were significantly lower in Crohn’s and inflammatory rheumatic diseases than in psoriasis. Interestingly, psoriatic patients were the only ones not receiving corticosteroids. Furthermore, a negative correlation was observed between the IFN-γ secreted after mitogen stimulation and corticosteroids dose. Conclusions: IMIDs seem to negatively affect the clinical accuracy of IGRAs, being Crohn’s disease patients the most affected individuals due to their concomitant drug-profile and impaired immune response.
Original languageEnglish
Article numbere0189202
JournalPLoS ONE
Volume12
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

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