Detection of latent tuberculosis infection in household contacts of drug-resistant tuberculosis patients using interferon-gamma release assay: a study at Universitas Indonesia Hospital
Abstract
Background: Drug-resistant tuberculosis (DR-TB) poses significant public health challenges in Indonesia. Household contacts of DR-TB patients face elevated risk of Mycobacterium tuberculosis infection, which may remain latent and asymptomatic.
Objective: This study aimed to assess the prevalence of latent tuberculosis infection (LTBI) among household contacts of DR-TB patients using interferon-gamma release assay (IGRA).
Methods: This cross-sectional study was conducted at Universitas Indonesia Hospital from February to May 2023. Eighteen asymptomatic household contacts from six confirmed DR-TB index cases were enrolled. Participants underwent clinical evaluation, chest radiography, and LTBI screening using the QuantiFERON-TB Gold Plus (QFT-Plus) assay.
Results: Among 18 participants (mean age 33.3 years; 55.6% female), 8 (44.4%) tested positive for LTBI, while 10 (55.6%) tested negative. The highest IGRA positivity rates were observed in adolescents aged 12–16 years (66.7%) and young adults aged 17–25 years (60.0%). All participants were clinically asymptomatic with normal chest radiographs.
Conclusion: This study demonstrates substantial LTBI prevalence among household contacts of DR-TB patients. The findings underscore the importance of systematic contact tracing, IGRA-based screening, and timely tuberculosis preventive therapy to reduce disease transmission and progression in high-risk populations.
References
World Health Organization. Global Tuberculosis Report 2020. Geneva: WHO; 2020. Available from : https://www.who.int/publications/i/item/9789240013131 (11 Jul 2023)
Kementerian Kesehatan Republik Indonesia. TB MDR. Available from : https://tbindonesia.or.id/pustaka-TB/informasi/teknis/tb-mdr/ (07 July 2023)
Maison DP. Tuberculosis pathophysiology and anti-VEGF intervention. J Clin Tuberc Other Mycobact Dis. 2022 Jan 19;27:100300. https://doi.org/10.1016/j.jctube.2022.100300
Ather B, Mirza TM, Edemekong PF. Airborne Precautions. [Updated 2023 Mar 13]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK531468/ (29 Aug 2023)
Ryndak MB, Laal S. Mycobacterium tuberculosis Primary Infection and Dissemination: A Critical Role for Alveolar Epithelial Cells. Front Cell Infect Microbiol. 2019 Aug 21;9:299. https://doi.org/10.3389/fcimb.2019.00299
Heemskerk D, Caws M, Marais B, et al. Tuberculosis in Adults and Children. London: Springer; 2015. Chapter 2, Pathogenesis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK344406/ (10 Sep 2023)
Fox GJ, Barry SE, Britton WJ, Marks GB. Contact investigation for tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2013;41(1):140-156. https://doi.org/10.1183/09031936.00070812
Sari IP, Febrianti N, Nuryastuti A. Deteksi infeksi TB laten pada kontak serumah pasien TB paru menggunakan uji QuantiFERON-TB Gold In-Tube. Jurnal Kedokteran Diponegoro. 2022;11(1):33-40.
Al-Motairi A, Booy R, Rashid H. Interferon-gamma release assays for the diagnosis of latent tuberculosis infection: a systematic review. J Infect Public Health. 2020;13(2):161-170.
Yancey JR, Melchert VE. QuantiFERON-TB Gold+ for the Diagnosis of Mycobacterium tuberculosis Infection. Am Fam Physician. 2021 Feb 1;103(3):177-178.
Reichler MR, Khan A, Yuan Y, Chen B, McAuley J, Mangura B, Sterling TR; Tuberculosis Epidemiologic Studies Consortium Task Order 2 Team. Duration of Exposure Among Close Contacts of Patients With Infectious Tuberculosis and Risk of Latent Tuberculosis Infection. Clin Infect Dis. 2020 Oct 23;71(7):1627-1634. https://doi.org/10.1093/cid/ciz1044
Pai M, Denkinger CM, Kik SV, Rangaka MX, Zwerling A, Oxlade O, Metcalfe JZ, Cattamanchi A, Dowdy DW, Dheda K, Banaei N. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev. 2014 Jan;27(1):3-20. https://doi.org/10.1128/CMR.00034-13
European Centre for Disease Prevention and Control. Use of interferon-gamma release assays in support of TB diagnosis. Stockholm: ECDC; 2011.
Reichler MR, Khan A, Sterling TR, Zhao H, Moran J, McAuley J, et al. Evaluation of Investigations Conducted to Identify the Infectious Source of Primary Multidrug-Resistant Tuberculosis Cases - United States, 2011-2016. Clin Infect Dis. 2020;70(9):1944-52. https://doi.org/10.1093/cid/ciz581
Erawati D, Kusumawati RL, Santoso S, Mustofa M. The Use of IGRA for Detecting Latent TB Infection Among Household Contacts of Tuberculosis Patients in Indonesia. Jurnal Respirologi Indonesia. 2022;42(3):178-84.
Alatas F, Sahiratmadja E, Nasution DA, et al. Gender and Latent Tuberculosis Infection: A Cross-sectional Study Among Household Contacts in Indonesia. Asian Pac J Trop Med. 2018;11(5):340-5. https://doi.org/10.4103/1995-7645.233179
World Health Organization. Global Tuberculosis Report 2023. Geneva: WHO; 2023. Available from: https://www.who.int/publications/i/item/9789240076729
Houben RM, Dodd PJ. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS Med. 2016;13: e1002152. https://doi.org/10.1371/journal.pmed.1002152
Centers For Disease Control and Prevention. The Difference Between Latent TB Infection and TB Disease. Available from: https://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm. (25 Oct 2023)
Kiazyk S, Ball TB. Latent tuberculosis infection: An overview. Can Commun Dis Rep. 2017 Mar 2;43(3-4):62-66. https://doi.org/10.14745/ccdr.v43i34a01
Shea KM, Kammerer JS, Winston CA, Navin TR, Horsburgh CR Jr. Estimated rate of reactivation of latent tuberculosis infection in the United States, overall and by population subgroup.Am J Epidemiol. 2014;179:216-25. https://doi.org/10.1093/aje/kwt246
Centers of Desease Control and Prevention. Latent Tuberculosis Infection : A Guideline For Primary Health Care Providers. Atlanta. U.S. Department of Health and Human Services; 2020.
Iswanti FC, Handayani KM, Kusumaningrum A, Yamazaki T, Handayani D, Sadikin M. Lysosomal enzymes and the oxygen burst capability of monocyte-derived macrophages in active drug-resistant tuberculosis patients in relation to cell attachment. Tuberculosis (Edinb). 2024 May;146:102498. https://doi.org/10.1016/j.tube.2024.102498
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