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The QuantiFERON-TB Gold In-Tube Assay in Neuro-Ophthalmology

Little, Leanne M. BS; Rigi, Mohammed MD; Suleiman, Ayman MD; Smith, Stacy V. MD; Graviss, Edward A. PhD, MPH; Foroozan, Rod MD; Lee, Andrew G. MD

doi: 10.1097/WNO.0000000000000487
Original Contribution

Background: Although QuantiFERON-TB Gold In-Tube (QFT-GIT) testing is regularly used to detect infection with Mycobacterium tuberculosis, its utility in a patient population with a low risk for tuberculosis (TB) has been questioned. The following is a cohort study analyzing the efficacy of QFT-GIT testing as a method for detection of active TB disease in low-risk individuals in a neuro-ophthalmologic setting.

Methods: Ninety-nine patients from 2 neuro-ophthalmology centers were identified as having undergone QFT-GIT testing between January 2012 and February 2016. Patients were divided into groups of negative, indeterminate, and positive QFT-GIT results. Records of patients with positive QFT-GIT results were reviewed for development of latent or active TB, as determined by clinical, bacteriologic, and/or radiographic evidence.

Results: Of the 99 cases reviewed, 18 patients had positive QFT-GIT tests. Of these 18 cases, 12 had documentation of chest radiographs or computed tomography which showed no evidence for either active TB or pulmonary latent TB infection (LTBI). Four had chest imaging which was indicative of possible LTBI. None of these 18 patients had symptoms of active TB and none developed active TB within the follow-up period.

Conclusions: Based on our results, we conclude that routine testing with QFT-GIT in a low-risk cohort did not diagnose active TB infection. We do not recommend routine QFT-GIT testing for TB low-risk individuals, as discerned through patient and exposure history, ocular examination, and clinical judgment, in neuro-ophthalmology practice.

Baylor College of Medicine (LML), Houston, Texas; Department of Ophthalmology (MR, AS, SVS), Department of Ophthalmology (EAG), Blanton Eye Institute, Houston Methodist Hospital; Department of Ophthalmology (RF), Baylor College of Medicine, Houston, Texas; Blanton Eye Institute of Houston Methodist Hospital (AGL), Houston, Texas; Department of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medical College; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology (AGL), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Ophthalmology (AGL), Baylor College of Medicine, Houston, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Address correspondence to Andrew G. Lee, MD, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Suite 450, Houston, TX 77030; E-mail: aglee@houstonmethodist.org

E. A. Graviss verifies that there are no potential conflicts of interest regarding the publication of this manuscript. E. A. Graviss reports monetary reimbursement as a former member of Qiagen's QuantiFERON Speakers Bureau, outside the submitted work. The remaining authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal's Web site (www.jneuro-ophthalmology.com).

This study was reviewed and approved by both the Houston Methodist Hospital and Baylor College of Medicine Institutional Review Boards (IRBs), and is in compliance with the guidelines of the Declaration of Helsinki.

© 2017 by North American Neuro-Ophthalmology Society