Publication: Estudio de la utililidad del test IGRA (Quantiferón TB gold) en un hospital general
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2017-02-21
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Universidad Complutense de Madrid
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Abstract
La tuberculosis (TB) constituye un problema de salud mundial de primer orden. La OMS en su informe de 2013 estimaba que cada año aparecen 9 millones de nuevas infecciones por Mycobaterium tuberculosis (MTBC) y que se producen 1,5 millones de muertes debido a esta enfermedad (1). La prevalencia de TB en España asciende a 11,88 casos /100.000 habitantes (1). En muchas personas expuestas a MTBC, su sistema inmune contiene la infección, pero los bacilos permanecen viables en el interior de los macrófagos. A esta situación se la conoce por infección tuberculosa latente (ITL). A lo largo de la vida del individuo, la infección tuberculosa puede reactivarse y pasar enfermedad activa por proliferación del MTBC en los tejidos y diseminación al resto del organismo. Se calcula que la probabilidad de reactivación de ILT en los sujetos inmunocompetentes es más alta durante los 2 años posteriores a la primoinfección (10%). Pero este porcentaje se incrementa de forma exponencial en los pacientes inmunodeprimidos, como se ha demostrado ampliamente en los infectados por el VIH, y en los pacientes tratados con fármacos anti-TNF alfa (2)...
Unlike tuberculin skin test (TST), Interferon gamma relay assays (IGRAS), such as Quantiferon Tb gold in tube (QFT), are specific of MTBC (Mycobacterium tuberculosis complex) infection and more sensitive than TST in some immunocompromised patients to detect latent tuberculosis infection (LTI). However, the introduction of these tests has not been generalized among Spanish hospitals. The interpretation of both tests, TST and IGRAS is dependent on the type of population being screened and the TB country burden. Health economic studies are recommended before introducing this new technique. Our aim was to identify the discrepancies between QFT and TST for the screening of LTI in different situations: prior to therapy with TNFα inhibitors in rheumatic patients, and in close contacts with an active case of TB. With our data, we evaluated the cost-effectiveness of different TB-screening strategies in these situations. Patients and Methods: We performed an open prospective study. Costeffectiveness was calculated based on the current health prices. Study 1: Every patient who attended the Rheumatology clinic in different therapeutic phases: 1-without treatment, 2- with DMARD (disease-modifying antirheumatic drug), 3- on biologic therapy. Study 2: Contacts of TB patients diagnosed in our hospital who accepted to be included...
Unlike tuberculin skin test (TST), Interferon gamma relay assays (IGRAS), such as Quantiferon Tb gold in tube (QFT), are specific of MTBC (Mycobacterium tuberculosis complex) infection and more sensitive than TST in some immunocompromised patients to detect latent tuberculosis infection (LTI). However, the introduction of these tests has not been generalized among Spanish hospitals. The interpretation of both tests, TST and IGRAS is dependent on the type of population being screened and the TB country burden. Health economic studies are recommended before introducing this new technique. Our aim was to identify the discrepancies between QFT and TST for the screening of LTI in different situations: prior to therapy with TNFα inhibitors in rheumatic patients, and in close contacts with an active case of TB. With our data, we evaluated the cost-effectiveness of different TB-screening strategies in these situations. Patients and Methods: We performed an open prospective study. Costeffectiveness was calculated based on the current health prices. Study 1: Every patient who attended the Rheumatology clinic in different therapeutic phases: 1-without treatment, 2- with DMARD (disease-modifying antirheumatic drug), 3- on biologic therapy. Study 2: Contacts of TB patients diagnosed in our hospital who accepted to be included...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Inmunología, leída el 10/02/2016