on Diagnosing Latent TB Infection在诊断结核潜伏感染的更新课件.pptVIP

Indeterminate Results: What to do REPEAT the QFT: SF data ? get a valid result (usually negative) 66% of the time Work with your lab to report runs that have 5% indeterminate Be alert for technical errors (bad batch of tubes, overfill/underfill/poor tube shaking if QGFT-IT) IGRA “grey” areas “Wobble” zone: results near cut-point may have conversions/reversions due to with-in subject variability. True “conversion” not yet defined. Reversions sometimes with rx: implication? No boosting with multiple IGRA tests, but PPD prior to IGRA can boost: relevance? Unclear what to do with indeterminate results, repeat (IGRA or PPD) for now Case 2 50 yo woman, past pulmonary MAC (HIV-) Contact to smear+ TB case PPD 6mm ? (because of transition) gets IGRA IGRA: indeterminate Repeat IGRA is negative, do you believe the PPD+ or IGRA-? (No perfect answer) What if she was HIV+? Summary: HIV and IGRA (to date) Both TST and IGRA have ?positive results as CD4 drops May be more sensitive than TST in HIV (some studies showing T-spot advantage), especially in high-burden settings More “indeterminate” results as CD4? Comparing positive results between TST, QFT, T-spot – often discordance of positives (poor agreement) – any positive using a combination of tests may be best IGRA “grey” areas “Wobble” zone: results near cut-point may have conversions/reversions due to with-in subject variability. True “conversion” not yet defined. Reversions sometimes with rx: implication? No boosting with multiple IGRA tests, but PPD prior to IGRA can boost: relevance? Unclear what to do with indeterminate results, repeat (IGRA or PPD) for now Err on side of ?sensitivity for very high risk (HIV, young children) ? take any positive Key Points IGRA more specific (no false positives due to BCG) “Grey” areas exist with IGRA use: conversions, reversions, results near cut-point, boosting from TST, indeterminates; HIV/young children (any positive will do) Case 3 25 yo male, source case with smear+ TB, day l