Interferon-gamma release assays in the diagnosis of spinal tuberculosis: a systemic review
Eduardo Laos Plasier, Pedro Aleixo Nogueira, Armando Alpizar Aguirre, Tania Arancibia Baspineiro, Julio Cesar Burgos Flores, Andrei Andrei, Edson Lizarazu-Oroz, Carlos Antonio Llanos-Lucero, Jose Luis López Segales, Thiago Magalhaes de Souza, Juan Felipe Mier-García, Molina Pizarro, Filadelfo Norambuena, María Elizabeth Núñez Castillo, Erika Reyes Quezada, Wilson Quispe-Alanoca, Paulo Gabriel Sacramento da Silva, Byron Salazar Maldonado, Jorge Salazar Flores, Juan Camilo Salcedo Moreno, Josselin-María Sanchez Mamani, Felipe Augusto Santos de Queiroz Chaves, Reddy Atilio Simon Nunes, Manuel Eduardo Soto García, Perla Maria Del Valle Oros, Jose Alberto Israel Romero Rangel, Luis Miguel Duchen Rodríguez, Jose Antonio Soriano Sanchez
Abstract
Introduction: Interferon-gamma release assays are indirect immunological tests used mainly for the diagnosis of latent tuberculosis, their use in active tuberculosis being controversial. This study aims to analyze the usefulness of gamma interferon release assays in the diagnosis of spinal tuberculosis and to obtain a consensus for their use. Methods: A systematized search was carried out in PubMed and Scielo for articles in English, Spanish, or Portuguese from 10/01/2012 to 10/01/2022, eligibility criteria were applied, the papers included were analyzed according to the GRADE methodology and then established the SORT type recommendation. Results: We obtained 27 articles, of which only five we considered suitable for analysis; 4 were of low quality and one very low quality. The interferon-gamma release assays used were T.SPOT-TB and QuantiferonTB Gold in tube, both of which showed high sensitivity and moderate to high specificity for QuantiferonTB Gold in tube and T.SPOT-TB, respectively. Discussion/Conclusion: Despite the low quality of the articles, we consider a type B recommendation (SORT) for the use of IGRA (T.SPOT-TB and QuantiferonTB Gold in tube) as a complementary test in the diagnosis of spinal tuberculosis, in the absence of definitive test results with high clinical imaging suspicion.
Keywords
References
[1] S Rajasekaran, Dilip Chand Raja Soundararajan, Ajoy Prasad Shetty, and Rishi Mugesh Kanna. Spinal tuberculosis: current concepts. Global Spine Journal, 8(4 suppl):96S–108S, 2018.
[2] C. H. Chen, Y. M. Chen, C. W. Lee, Y. J. Chang, C. Y. Cheng, and J. K. Hung. Early diagnosis of spinal tuberculosis. J Formos Med Assoc Taiwan Yi Zhi, 115(10):825–836, 2016.
[3] Ajoy Shetty, Rishi Mugesh Kanna, and S Rajasekaran. Tb spine, current aspects on clinical presentation, diagnosis, and management options. In Seminars in Spine Surgery, volume 28, pages 150–162. Elsevier, 2016.
[4] A. Pandita, N. Madhuripan, S. Pandita, and R. M. Hurtado. Challenges and controversies in the treatment of spinal tuberculosis. J Clin Tuberc Mycobact Dis, 19:100151, 2020.
[5] A. Batirel, H. Erdem, G. Sengoz, F. Pehlivanoglu, E. Ramosaco, S. G¨uls¨un, and et al. The course of spinal tuberculosis (pott disease): Results of the multinational, multicentre backbone-2 study. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis, 21(11):1008.e9–1008.e18, 2015.
[6] M. R. Rasouli, M. Mirkoohi, A. R. Vaccaro, K. K. Yarandi, and V. Rahimi-Movaghar. Spinal tuberculosis: Diagnosis and management. Asian Spine J., 6(4):294–308, 2012.
[7] Krishn Khanna and Sanjeev Sabharwal. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. The Spine Journal, 19(11):1858–1870, 2019.
[8] Vivek Pandey, Kiran Chawla, Kiran Acharya, Sripathi Rao, and Sugandhi Rao. The role of polymerase chain reaction in the management of osteoarticular tuberculosis. International Orthopaedics, 33:801–805, 2009.
[9] Anil M Solanki, Saumyajit Basu, Amitava Biswas, Subhendu Roy, and Aditya Banta. Sensitivity and specificity of gene xpert in the diagnosis of spinal tuberculosis: a prospective controlled clinical study. Global Spine Journal, 10(5):553–558, 2020.
[10] AK Jain. Tuberculosis of the spine: a fresh look at an old disease. The Journal of Bone & Joint Surgery British Volume, 92(7):905–913, 2010.
[11] Kai Yuan, Xueqiong Wu, Qiang Zhang, Zhaoming Zhong, and Jianting Chen. Enzyme-linked immunospot assay response to recombinant cfp-10/esat-6 fusion protein among patients with spinal tuberculosis: implications for diagnosis and monitoring of surgical therapy. International Journal of Infectious Diseases, 17(9):e733–e738, 2013.
[12] Xiaojiang Hu, Hongqi Zhang, Yanbin Li, Guang Zhang, Bo Tang, Dongcheng Xu, Mingxing Tang, Chaofeng Guo, Shaohua Liu, and Qile Gao. Analysis of the diagnostic efficacy of the quantiferon-tb gold in-tube assay for preoperative differential diagnosis of spinal tuberculosis. Frontiers in Cellular and Infection Microbiology, 12:983579, 2022.
[13] Kai Yuan, Zhao-ming Zhong, Qiang Zhang, Shu-chai Xu, and Jian-ting Chen. Evaluation of an enzyme-linked immunospot assay for the immunodiagnosis of atypical spinal tuberculosis (atypical clinical presentation/atypical radiographic presentation) in china. The Brazilian Journal of Infectious Diseases, 17(5):529–537, 2013.
[14] Sungim Choi, Kyung Hwa Jung, Hyo-Ju Son, Seung Hyun Lee, Jung Min Hong, Min Chul Kim, Min Jae Kim, Yong Pil Chong, Heungsup Sung, Sang-Oh Lee, et al. Diagnostic usefulness of the quantiferon-tb gold in-tube test (qft-git) for tuberculous vertebral osteomyelitis. Infectious Diseases, 50(5):346–351, 2018.
[15] M. J. Page, J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, and et al. The prisma 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372:n71, 2021.
[16] J. L. Bro˙zek, E. A. Akl, E. Compalati, J. Kreis, L. Terracciano, A. Fiocchi, and et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. the grade approach to developing recommendations. Allergy, 66(5):588–595, 2011.
[17] J. L. Brozek, E. A. Akl, P. Alonso-Coello, D. Lang, R. Jaeschke, J. W. Williams, and et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. part 1 of 3. an overview of the grade approach and grading quality of evidence about interventions. Allergy, 64(5):669–677, 2011.
[18] J. L. Brozek, E. A. Akl, R. Jaeschke, D. M. Lang, P. Bossuyt, P. Glasziou, and et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. the grade approach to grading quality of evidence about diagnostic tests and strategies. Allergy, 64(8):1109–1116, 2009.
[19] Mark H Ebell, Jay Siwek, Barry D Weiss, Steven H Woolf, Jeffrey Susman, Bernard Ewigman, and Marjorie Bowman. Strength of recommendation taxonomy (sort): a patient-centered approach to grading evidence in the medical literature. The Journal of the American Board of Family Practice, 17(1):59–67, 2004.
[20] E Vanino, M Tadolini, G Evangelisti, E Zamparini, L Attard, K Scolz, S Terzi, G Barbanti Brodano, M Girolami, V Pipola, et al. Spinal tuberculosis: proposed spinal infection multidisciplinary management project (simp) flow chart revision. European Review for Medical and Pharmacological Sciences, 24(3):1428–1434, 2020.
[21] A. Shafeque, J. Bigio, C. A. Hogan, M. Pai, and N. Banaei. Fourth-generation quantiferon-tb gold plus: What is the evidence? J Clin Microbiol, 58(9):e01950–19, 2020.
[22] Madhukar Pai, Claudia M Denkinger, Sandra V Kik, Molebogeng X Rangaka, Alice Zwerling, Olivia Oxlade, John Z Metcalfe, Adithya Cattamanchi, David W Dowdy, Keertan Dheda, et al. Gamma interferon release assays for detection of mycobacterium tuberculosis infection. Clinical Microbiology Reviews, 27(1):3–20, 2014.
[23] Jun-Chi Xu, Ze-Yi Li, Xin-Nian Chen, Cui-Lin Shi, Mei-Ying Wu, Hui Chen, Xiao-Yan Zhu, Hua-Feng Song, Min-Juan Wu, and Ping Xu. More significance of tb-igra except for the diagnosis of tuberculosis. Journal of Clinical Laboratory Analysis, 32(1):e22183, 2018.
[24] Linchuan Wang, Xu-dong Tian, Yan Yu, and Wei Chen. Evaluation of the performance of two tuberculosis interferon gamma release assays (igra-elisa and tspot.tb) for diagnosing mycobacterium tuberculosis infection. Clinica Chimica Acta, 479:74–78, 2018.
[25] Wan-Li Kang, Gui-Rong Wang, Mei-Ying Wu, Kun-Yun Yang, Shu-Cai Wu, Shu-Jun Geng, Zhi-Hui Li, Ming-Wu Li, Liang Li, and Shen-Jie Tang. Interferon-gamma release assay is not appropriate for the diagnosis of active tuberculosis in high-burden tuberculosis settings: a retrospective multicenter investigation. Chinese Medical Journal, 131(03):268–275, 2018.
[26] Quantiferon-tb gold in-tube test in active tuberculosis patients and healthy adults. Rev Inst Med Trop Sao Paulo, 60:e56, 2018.
[27] Yuanyuan Yu, Yidian Liu, Lan Yao, Yanheng Shen, Qin Sun, and Wei Sha. Factors influencing false-negative results of quantiferon-tb gold in-tube (qftgit) in active tuberculosis and the desirability of resetting cutoffs for different populations: A retrospective study. Tropical Medicine and Infectious Disease, 7(10):278, 2022.
Publication date:
10/22/2026
Facebook
LinkedIn
Mendeley
Reddit
Email