{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T22:21:37Z","timestamp":1767651697091},"reference-count":48,"publisher":"Mark Allen Group","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Nurs"],"published-print":{"date-parts":[[2009,11,1]]},"abstract":"<jats:p> Background: Screening and treatment of latent tuberculosis infection (LTBI) prior to anti-tumour necrosis factor alpha (anti-TNFalpha) therapy has been shown to decrease the incidence of active tuberculosis (TB) by more than 80%, and is recommended by the British Thoracic Society. In the absence of a gold standard test for LTBI, conventional screening currently involves taking a clinical history of risk factors, a chest X-ray and a tuberculin skin test (TST) which can be difficult to interpret in immunosuppressed patients. Alternative cellular immune-based screening tests have been developed to detect Mycobacterium tuberculosis. Aim: To examine, evaluate and summarize the quality of evidence on the use of interferon gamma release assay (the ELISpot test) in the diagnosis of latent tuberculosis prior to initiation of anti-TNF-alpha and examine the agreement with the tuberculin skin test. Methods: Ovid MEDLINE, EMBASE and the Cochrane library were searched using search terms that included tuberculosis, each of the current anti- TNF-alpha biological agents, TST and interferon-gamma release assay. Terms were searched using MeSH (medical subject headings) terms and\/or free text where relevant. Results: Discordance between tuberculin skin test and ELISpot is greater in individuals who have had the bacillus Calmette-Gu\u00e9rin (BCG) vaccination and are taking corticosteroids. ELISpot technique using CFP-10 and ESAT-6 antigens is more sensitive than TST in detecting M. tuberculosis infection in patients taking corticosteroids. ELISpot avoids cross-reaction with BCG, making it a more specific test in this group of patients. Agreement between the tests was found to be fair (72.8% kappa value=0.38). Conclusion: Tuberculosis resulting from reactivation of latent tuberculosis following treatment with anti-TNF is a continuing problem. Screening reduces the risk but does not eliminate it. Further studies are needed into the cost-effectiveness and sensitivity of ELISpot and the tuberculin skin test in routine clinical practice. <\/jats:p>","DOI":"10.12968\/bjon.2009.18.20.45120","type":"journal-article","created":{"date-parts":[[2014,5,23]],"date-time":"2014-05-23T14:22:36Z","timestamp":1400854956000},"page":"1248-1254","source":"Crossref","is-referenced-by-count":8,"title":["Can ELISpot replace the tuberculin skin test for latent tuberculosis?"],"prefix":"10.12968","volume":"18","author":[{"given":"Kay","family":"Greveson","sequence":"first","affiliation":[{"name":"Royal Free Hospital NHS Trust, London"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5130","reference":[{"key":"p_2","volume-title":"also used 141 healthy controls","author":"Murakami","year":"2009"},{"key":"p_12","volume-title":"do not state inclusion\/exclusion","author":"Murakami","year":"2009"},{"key":"p_30","volume-title":"acknowledge","author":"Thoracic Society","year":"2009"},{"key":"p_90","volume-title":"Guidance from the British Thoracic Society","year":"2005"},{"key":"p_93","volume-title":"suggest","author":"Beglinger","year":"2007"},{"key":"p_106","volume-title":"concluded that screening for","author":"Smith","year":"2006"},{"key":"p_114","volume-title":"Important limitations of this review are the heterogeneity","year":"2006"},{"key":"p_127","volume-title":"US","author":"American Thoracic Society","year":"1990"},{"key":"p_128","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.161.supplement_2.a1q4-13"},{"issue":"43","key":"p_129","first-page":"620","volume":"137","author":"Beglinger C","year":"2007","journal-title":"Swiss Med Wkly"},{"key":"p_130","volume-title":"The Research Process in Nursing","author":"Beverley C","year":"2007","edition":"5"},{"key":"p_131","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.19.2275"},{"key":"p_132","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2005.046797"},{"key":"p_133","volume-title":"Systematic reviews. 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