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Inflammatory Bowel Diseases:
doi: 10.1097/01.MIB.0000438429.38423.62
Original Basic Science Articles

T-Cell Profiling and the Immunodiagnosis of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease

Arias-Guillén, Miguel MD*; Riestra, Sabino MD, PhD; de Francisco, Ruth MD; Palacios, Juan José MD, PhD; Belda, José MD, PhD§; Escalante, Patricio MD, MSc; Pérez-Martínez, Isabel MD; Molinos, Luis M. PhD; Garcia-Clemente, Marta MD, PhD*; Pando-Sandoval, Ana MD*; Rodrigo, Luis MD, PhD; Prieto, Amador MD; Martínez-Camblor, Pablo PhD**; Losada, Ana RN*; Casan, Pere MD, PhD*

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Abstract

Background:

Factors associated with performance of interferon-γ release assays (IGRA) and the tuberculin skin test (TST) in screening for latent tuberculosis infection in patients with inflammatory bowel diseases (IBD) are still poorly understood. The influence of peripheral T-cell subset counts on the results also remain unclear.

Methods:

Prospective single-center study in 205 patients with IBD. Latent tuberculosis infection screening included a chest radiograph, TST (retest if negative), and 2 IGRAs: QuantiFERON-TB Gold In-Tube (QFT-GIT) and TSPOT-TB (TSPOT). T-cell subpopulations were determined by flow cytometry.

Results:

Twenty-one (10.2%) patients had an abnormal chest radiograph, 55 (26.8%) had a positive TST, 16 (7.8%) had a positive QFT-GIT, and 25 (12.6%) had a positive TSPOT. TST positivity was lower in patients on ≥2 immunosuppressants compared with the controls (5-aminosalicylic acid treatment) (10.4% versus 38.2%, respectively) (P = 0.0057). No other drugs influenced TST or IGRA positivity. In patients on corticosteroid treatment, anti-TNF treatment, or ≥2 immunosuppressants, IGRAs detected 10 cases of latent tuberculosis infection not identified by TST. TSPOT and QFT-GIT increased yield by 56% and 22%, respectively. No significant differences in T-cell subpopulations were found between patients with positive or negative TST or TSPOT results. However, patients with positive QFT-GIT findings had more CD8+ T cells (mean, 883 ± 576 versus 484 ± 385 cells per microliter in patients with negative results) (P = 0.022).

Conclusions:

IGRAs can improve TST-based screening in patients with IBD on immunosuppressive therapy. A low CD8+ count can affect QFT-GIT results. We suggest combining TSPOT and TST screening in patients with IBD on immunosuppressants.

Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.

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