Reasons for requesting an interferon gamma release test from internal medicine and rheumatology clinics and evaluation of the results

Evaluation of interferon gamma release test results

Authors

Keywords:

Interferon gamma release test, tuberculosis, biological agent

Abstract

Background/Aim: Tuberculosis is a disease involving many systems, such as the lung, gastrointestinal system, genitourinary system, etc. Detecting this disease in its latency significantly reduces the morbidity and mortality associated with tuberculosis. One of the tests used in latent TB screening is the interferon gamma release test. In rheumatology practices, it is routinely used to screen for latent tuberculosis infections before treatment with biological agents and Janus kinase (JAK) inhibitors, and it can also be used to exclude tuberculosis infection in clinical practice. In our study, we aimed to evaluate the reasons for requesting interferon gamma release tests and the results of this test in patients who requested it.

Methods: Patients admitted to internal medicine and rheumatology outpatient clinics were retrospectively screened within the retrospective cohort study. In total, 364 patients who requested interferon gamma release testing were included in the study. Nine patients with unclear test results were excluded. Laboratory results, demographic data, reasons for requesting the interferon gamma release test, and results were evaluated.

Results: The interferon gamma release test was requested by 355 patients. Of these, 266 patients (74.9%) asked for latent tuberculosis screening before treatment with biological agents and JAK inhibitors. This was followed by patients with peripheral lymphadenopathy-lung nodules, patients with unexplained elevated acute phase reactants, and patients with constitutional symptoms, respectively. Ten out of 107 patients (9.3%) had an active tuberculosis infection, while six out of ten patients (60%) had pulmonary tuberculosis, and four (40%) had extrapulmonary tuberculosis.

Conclusion: The most common reason for requesting the interferon gamma release test in internal medicine and rheumatology clinics was screening for latent tuberculosis before treatment with biologic agents and JAK inhibitors. In internal medicine, it has been observed that this test can also be requested by patients with constitutional symptoms, unexplained elevated acute phase reactants, and a preliminary diagnosis of tuberculosis in order to rule out or strengthen the preliminary diagnosis.

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References

Van Soolingen D, Hoogenboezem T, de Haas PE, Hermans PW, Koedam MA, Teppema KS, et al. A novel pathogenic taxon of the Mycobacterium tuberculosis complex, Canetti: characterization of an exceptional isolate from Africa. Int J Syst Bacteriol. 1997;47(4):1236–45. DOI: https://doi.org/10.1099/00207713-47-4-1236

van Ingen J, Rahim Z, Mulder A, Boeree MJ, Simeone R, Brosch R, et al. Characterization of Mycobacterium orygis as M. tuberculosis complex subspecies. Emerg Infect Dis. 2012;18(4):653–5. DOI: https://doi.org/10.3201/eid1804.110888

Akdağ R, editors. Tüberküloz tanı ve tedavi rehberi. Ankara: Sağlık Bakanlığı Yayınları; 2011.

Matteelli A, Sulis G, Capone S, D’Ambrosio L, Migliori GB, Getahun H. Tuberculosis elimination and the challenge of latent tuberculosis. Press Medicale. 2017;46(2):13–21. DOI: https://doi.org/10.1016/j.lpm.2017.01.015

Çalışkan E, Öztürk C, Öksüz Ş, Akar N. Gamma interferon salınım testi ile latent tüberküloz infeksi̇yonunun araştırılması. Konuralp Tıp Derg. 2017;9(3):57–60. DOI: https://doi.org/10.18521/ktd.334151

Pai M, Denkinger CM, Kik S V. Rangaka MX, Zwerling A, Oxlade O, et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev. 2014;27(1):3–20. DOI: https://doi.org/10.1128/CMR.00034-13

World Health Organization. Global tuberculosis report. Eur Respir J. 2016;44(1):23–63.

Seong SS, Choi CB, Woo JH, Kang WB, Joung CL, Uhm WS, et al. Incidence of tuberculosis in Korean patients with Rheumatoid Arthritis (RA): Effects of RA itself and of tumor necrosis factor blockers. J Rheumatol. 2007;34(4):706–11.

Özdemir T, Tuna S, Karataş Ö, Arman Mİ. Variations of tuberculin skin test in patients with rheumatologic disorders and under anti-TNF treatment. J Surg Med. 2019;3(3):254–7. DOI: https://doi.org/10.28982/josam.537201

Tracey D, Klareskog L, Sasso EH, Salfeld JG, Tak PP. Tumor necrosis factor antagonist mechanisms of action: A comprehensive review. Pharmacol Ther. 2008;117(2):244–79. DOI: https://doi.org/10.1016/j.pharmthera.2007.10.001

Philips JA, Ernst JD. Tuberculosis pathogenesis and immunity. Annu Rev Pathol Mech Dis. 2012;7:353–84. DOI: https://doi.org/10.1146/annurev-pathol-011811-132458

Souto A, Maneiro JR, Salgado E, Carmona L, Gomez-Reino JJ. Risk of tuberculosis in patients with chronic immune-mediated inflammatory diseases treated with biologics and tofacitinib: a systematic review and meta-analysis of randomized controlled trials and long-term extension studies. Rheumatology (Oxford). 2014;53(10):1872–85. DOI: https://doi.org/10.1093/rheumatology/keu172

T.C. Sağlık Bakanlığı. Anti-TNF Kullanan Hastalarda Tüberküloz Rehberi. Ankara: Sağlık Bakanlığı Yayınları; 2016. p. 1–22.

Cagatay T, Aydın M, Sunmez S, Cagatay P, Gulbaran Z, Gul A, et al. Follow-up results of 702 patients receiving tumor necrosis factor-alpha antagonists and evaluation of risk of tuberculosis. Rheumatol Int. 2010;30(11):1459–63. DOI: https://doi.org/10.1007/s00296-009-1170-6

Doğru G, Şahin M. Romatoid artrit ve ankilozan spondilit hastalarında anti-tnf alfa tedavi öncesi latent tüberküloz taramasında tüberkülin deri testi ve interferon gama salınım testinin karşılaştırılması. Suleyman Demirel University Journal of Health Sciences. 2021;12(1):70–6.

Zhou G, Luo Q, Luo S, Teng Z, Ji Z, Yang J, et al. Interferon-γ release assays or tuberculin skin test for detection and management of latent tuberculosis infection: a systematic review and meta-analysis. Lancet Infect Dis. 2020 Dec;20(12):1457–69. DOI: https://doi.org/10.1016/S1473-3099(20)30276-0

Nazlıgül T. Concordance between the tuberculin skin test and interferon gamma release assays for diagnosing latent tuberculosis infection in patients with chronic inflammatory arthritis. Boğaziçi Tıp Dergisi. 2020;8(2):69–73. DOI: https://doi.org/10.14744/bmj.2021.93823

Lee H, Park HY, Jeon K, Jeong BH, Hwang JW, Lee J, et al. Quantiferon-TB gold in-tube assay for screening arthritis patients for latent tuberculosis infection before starting anti-tumor necrosis factor treatment. PloS One. 2015;10(3):1–12. DOI: https://doi.org/10.1371/journal.pone.0119260

Tubach F, Salmon D, Ravaud P, Allanore Y, Goupille P, Bréban M, et al. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French Research Axed on Tolerance of Biotherapies registry. Arthritis Rheum. 2009 Jul;60(7):1884-94. doi: 10.1002/art.24632. Erratum in: Arthritis Rheum. 2009 Aug;60(8):2540. Lorthololary, O [corrected to Lortholary, O]. PMID: 19565495; PMCID: PMC2921546.. DOI: https://doi.org/10.1002/art.24632

Dixon WG, Hyrich KL, Watson KD, Lunt M, Galloway J, Ustianowski A, et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy : results from the British Society for Rheumatology Biologics Register (BSRBR). 2010;522–8. DOI: https://doi.org/10.1136/ard.2009.118935

Kurt A, Poyrazoğlu G, Turgut M, Akarsu S, Neşe A, Kurt Ç, et al. Tüberküloz tanısı ile izlenen hastaların klinik ve laboratuar özellikleri. Fırat Tıp Derg. 2006;11(1):55–7.

Gülbay BE, Erkekol FÖ, Önen ZP, Tarakçi N, Gürkan ÖU, Acican T. The importance of symptoms, symptom duration and chest X-ray in the diagnosis of active pulmonary tuberculosis. Turk Toraks Derg. 2011;12(2):57–61. DOI: https://doi.org/10.5152/ttd.2011.13

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Published

2023-04-25

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Research Article

How to Cite

1.
Sari A, Ertürk A, Şarlak Konya P. Reasons for requesting an interferon gamma release test from internal medicine and rheumatology clinics and evaluation of the results: Evaluation of interferon gamma release test results. J Surg Med [Internet]. 2023 Apr. 25 [cited 2024 Feb. 21];7(4):295-8. Available from: https://jsurgmed.com/article/view/7759