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Using Tests for Latent Tuberculous Infection to Diagnose Active Tuberculosis: Can We Eat Our Cake and Have It Too?

Dick Menzies, MD, MSc
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From McGill University, Montreal, Quebec, Canada H2X 2P4.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Dick Menzies, MD, MSc, Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, 3650 St. Urbain Street, Room K1.24, Montreal, Quebec H2X 2P4, Canada; e-mail, dick.menzies@mcgill.ca.


Ann Intern Med. 2008;148(5):398-399. doi:10.7326/0003-4819-148-5-200803040-00011
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Rapid diagnosis of active tuberculosis is challenging. The only rapid test for active tuberculosis is smear microscopy, which has poor sensitivity for both extrapulmonary and less extensive pulmonary forms of tuberculosis (1). Nucleic acid amplification tests have somewhat better but still suboptimal sensitivity (2), whereas mycobacterial cultures are sensitive but require several weeks before results are available (1). The tuberculin skin test (TST) and the new interferon-γ release assays (34) detect a cellular immune response to tuberculosis antigens. On the basis of numerous longitudinal studies (5), the TST is considered to have good sensitivity for the detection of latent tuberculous infection. The interferon-γ release assays appear to have similar sensitivity but improved specificity for latent infection (4, 6). Use of these tests for the diagnosis of active tuberculosis is based on the logic that one must have tuberculous infection in order to have tuberculosis disease.

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