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Igras

In: English and Literature

Submitted By sethisunil
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The Controversy of Quantiferon Gold

Dr.Sunil Sethi MD,MNAMS.
Vice chairman, IUSTI Asia Pacific South Asia subregion
Nodal officer, RNTCP Accredited Lab
Additional Professor,STD and TB division ,
Deptt of Medical Microbiology,PGIMER, Chandigarh,India 160012
Ph-91 1722755161 , 09872882609( Mobile) Fax-91 172 2744401

Diagnosis of TB is mainly depends upon clinical h/o and Chest X-Ray 2) microbiological detection of AFB 3) Nucleic acid amplification assays 4) Detection of mycobacteria specific immune responses in Tuberculin skin test (TST) and Interferon gamma release assay (IGRA,s) (QuantiFERON-TB-Gold, In tube-QFT-GIT, T-SPOT.TB test ) 5) serological diagnosis have limited role.
In Various studies, it has been found that IGRA (ex-vivo) is more specific than TST (in-vivo) in BCG vaccinated persons- reason is in contrast to mixture of Ags (>200) used in TST (shared by NTM, M. bovis strain-BCG vaccination), IGRA measure immune response to limited no. of specific RD-1 peptides ex. ESAT-6, CFP-10, TB-7 (highly specific to M.tb and limited no. of NTM) So better is to combine both tests to increase the specificity and to overcome the limitation of BCG vaccination. There are some controversies regarding use of IGRA in various studies like- QFT-G test can’t completely discriminate active TB disease from LTBI because an overlap in the IFN levels between active TB disease and LTBI groups. Also controversy regarding its value in immunocompromised in various studies.Limited value to screen and rule out Extra pulmonary TB specially as diagnostic tool esp. in low/middle income countries. In study, sensitivity was 72-86% in high income countries and 14-48% in low/middle income countries. Some studies showing that IGRA increases the likelihood of conversion /reversion over time but no validation criteria available

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