Aktuelle Fragestellungen zum Tuberkulose-Screening mit Interferon-Gamma-Release Assays (IGRAs)

Zusammenfassung

Ein positiver IGRA-Test ist nicht per se gleichbedeutend mit einer latenten Tuberkuloseinfektion (LTBI), sondern die Interpretation der Testergebnisse hängt wesentlich von der Prävalenz der LTBI im jeweils getesteten Kollektiv ab. Bei wiederholtem Testen von Beschäftigten im Gesundheitswesen (BiG) ist vermehrt mit Variabilitäten des Testergebnisses (Konversionen und Reversionen) zu rechnen. Es ist daher sinnvoll, nur diejenigen Personen zu testen, bei denen ein erhöhtes Risiko für eine vorausgehende Infektion mit Mycobacterium tuberculosis (M.tb.) besteht bzw. eine signifikante Exposition gegenüber einem Patienten mit infektiöser Tuberkulose (TB) angenommen werden kann. Positive IGRA-Befunde können die Entwicklung zur aktiven Erkrankung nur unbefriedigend vorhersagen. Bei Kleinkindern sind IGRAs dem Tuberkulinhauttest (THT) nach aktuellem Kenntnisstand nicht überlegen.

Abstract

A positive IGRA test does not always indicate a latent tuberculosis infection (LTBI); the prevalence of LTBI in the tested collective must be carefully considered in test interpretation. When IGRAs are performed repeatedly in healthcare workers (BiG), variabilities of test results (conversions and reversions of the respective previous negative or positive result) can be expected. Therefore only individuals for whom there is an established risk of being infected by Mycobacterium tuberculosis (M.tb.), i. e. significantly prolonged direct exposure to an infectious TB case, should be tested.

Positive IGRA results alone do not reliably predict subsequent progression to active TB disease. According to the current body of scientific knowledge, IGRAs are not superior to the tuberculin skin test (TST) in the case of young children.

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