The Agreement Level of Tuberculin Skin Test (TST) and T-SPOT.TB Examinations in Detecting Latent Tuberculosis Infection in Illicit Drug Users


World Health Organization (WHO) reported that a third of the world’s populations develop latent tuberculosis infection (LTBI). Illicit drug users are at risk of suffering LTBI which potentially developing into active tuberculosis (TB). There is no gold standard diagnostic for LTBI and it is presumed that immune responses play an important role in LTBI. This study aimed o evaluate the ideal diagnostic tool to fill the absence of a gold
standard and the effect of illicit drugs on the immune system. This was a cross sectional study conducted in illicit drug clinic, Methadone Maintenance Therapy (MMT) program of Dr. Moewardi Hospital, and MMT program of Puskesmas Manahan Surakarta, from February to March 2018. Total subjects were 24 respondents consisting of 5 respondents with TST (+) and 4 with T-SPOT.TB (+). We measured the agreement level of TST and T-SPOT.TB was moderate (k= 0.591, p= 0.003), the relationship of absolute cluster of differentiation 4 (CD4) to TST induration (r= 0.077, p= 0.719), the relationship between absolute CD4 and T-SPOT.TB spot-forming units (SFUs) ESAT-6 (r= -0.238, p= 0.262); CFP-10 (r= -0.117, p= 0.585); and the highest ESAT-6/CFP-10 (r= -0.033, p= 0.879). Tuberculin skin test and T-SPOT.TB have their own strengths and weaknesses, but in this study TST is slightly superior to T-SPOT.TB with moderate agreement level.

Keywords: LTBI, TST, T-SPOT.TB, illicit drug

[1] Perhimpunan Dokter Paru Indonesia (PDPI) 2016 Pedoman tata laksana infeksi TB laten ( Jakarta: Perhimpunan Dokter Paru Indonesia) 1-36

[2] Lin P L, Flynn J L 2010 J Immunol 185(1) 15-22

[3] World Health Organization 2018 Latent tuberculosis infection: updated and consolidated guidelines for programmatic management (Geneva: World Health Organization) 1-50

[4] Deiss R G, Rodwell T C and Garfein R S 2009 Clin Infect Dis 48(1) 72-82

[5] Pusat Data dan Informasi Kementerian Kesehatan RI 2014 Gambaran umum penyalahgunaan NARKOBA di Indonesia. In: Primadi O, Budijanto D, Kurniasih N, eds. Buletin jendela data dan informasi kesehatan ( Jakarta: Kementerian Kesehatan RI) pp 1-52

[6] Kiboi N G, Nebere S N 2016 J Pulm Respir Med 6(2) 1-6

[7] Brack A, Rittner H L and Stein C 2011 J Neuroimmune Pharmacol 6(4) 490-502

[8] Grimes C Z, Hwang L Y, Williams M L, Austin C M and Graviss E A 2007 Int J Tuberc Lung Dis.11(11)1183-9

[9] European Centre for Disease Prevention and Control 2011 Use of interferon-gamma release assays in support of TB diagnosis. Solna: European Centre for Disease prevention and control pp 1-32

[10] World Health Organization 2010 The alcohol smoking and substance involvement screening test (ASSIST) Manual for Use in Primary Care (Geneva: WHO Press) pp 1-74

[11] Center for Disease Control and Prevention 2013 Mantoux tuberculin skin test facilitator guide (Atlanta: Centers for Disease Control and Prevention National) pp 2-30

[12] Oxford Immunotec 2012 T-SPOT.TB training guide (Marlborough: Oxford Immunotec, Inc) pp 1-33

[13] World Health Organization 2014 Xpert MTB/RIF implementation manual: technical and operational ‘how-to’; practical considerations (Geneva: WHO Press) pp 1-39

[14] Landis J R, Koch G G 1977 Biometrics 33(1)159

[15] Dahlan M S 2014 Hipotesis korelatif In: Dahlan MS, ed. Statistik untuk kedokteran dan kesehatan 6th ed ( Jakarta: SalembaMedika) pp 223-44

[16] Brassard P, Bruneau J, Schwartzman K, Sénécal M and Menzies D 2004 Int J Tuberc Lung Dis. 8(8) 988-93

[17] Duarte R, Santos A, Mota M, Carvalho A, Marques A and Barros H 2011 Public Health 125(1) 60-2

[18] Yen Y-F, Hu B-S, Lin Y-S, et al. 2013 Scand J Infect Dis 45(7) 504-11

[19] United Nations Office Drugs and Crime 2015 World drug report 2015 (New York: United Nations Publication) pp 1-64

[20] Getahun H, Matteelli A, Abubakar I, et al. 2015 Eur Respir J. 46(6) 1563-76

[21] Centers for Disease Control and Prevetion 2005 Guidelines for the investigation of contacts of persons with infectious tuberculosis recommendations from the National Tuberculosis Controllers Association and CDC (Atlanta: Centers for Disease Control and Prevention National) pp 1-62

[22] Centers for Disease Control and Prevention 2013 Core curriculum on tuberculosis: what the clinician should know. 6th ed (Atlanta: Centers for Disease Control and Prevention National) pp 1-320

[23] Alonzo N C, Bayer B M 2002 Infect Dis Clin North Am. 16(3) 553-69

[24] Salomon N, Perlman D C, Friedmann P, Ziluck V, Jarlais D C Des 2000 Int J Tuberc Lung Dis.4 47-54

[25] Boyle N T, Connor T J 2010 Br J Pharmacol 61(1) 17-32

[26] Nayak S, Acharjya B 2012 Indian Dermatol Online J 3(1) 2-6

[27] Rutjes A W S, Reitsma J B, Coomarasamy A, Khan K S and Bossuyt P M M 2007 Health Technol Assess. 11(50)1-69

[28] Leidl L, Mayanja-Kizza H, Sotgiu G, Baseke J, Ernst M, Hirsch C, et al. 2010 Eur Respir J. 35 619-26