Table 2.
Recommendations for the use of IGRAs in different clinical settings
| Clinical environments | Recommendation | FR | Quality |
|---|---|---|---|
| IGRA for TB patient contact tracing | The panel suggests initiating contact tracing with the TST, but in BCG-vaccinated contacts, positive TST results should be confirmed with an IGRA performed on the date of TST reading. | Weak | Low to very low |
| IGRA for healthcare workers | Use TST for initial and periodic screening of health care workers, but positive TST results should be confirmed with an IGRA performed on the reading date. If TST becomes positive and IGRA remains negative, perform periodic screening with IGRA only if there is no suspicion of active disease or evidence of immunosuppression. | Weak | Moderate (IGRA) Very low (TST) |
| IGRAs for the diagnosis of active TB in children < 5 years old | In < 5 years with suspected active TB, the panel suggests using both TST and an IGRA to complement microbiological and radiographic studies for the diagnosis of active TB. | Weak | Very low |
| IGRA for contact tracing in children | In children > 5 years, initiate contact tracing with TST, but in BCG-vaccinated contacts, positive TST results should be confirmed with an IGRA performed on the date of TST reading. | Weak | Very low |
| In children < 5 years, test with TST and IGRA, regardless of previous BCG vaccination. | |||
| IGRA in HIV-infected persons | Use both TST and an IGRA to detect TB infection in persons with HIV infection. In persons with HIV and a CD4 cell count <200/mL, use only an IGRA. |
Weak | Low to very low |
| IGRAs in patients with chronic inflammatory diseases (prior to initiating biologic therapies) | Use both PT and an IGRA to screen for TB infection in patients with chronic inflammatory disease before starting biologic therapy. | Weak | Low to very low |
| IGRA for patients requiring transplantation (SOT and allogeneic HSCT) | Use both TST and an IGRA to screen for TB infection in patients who will undergo solid organ or allogeneic hematopoietic stem cell transplantation. | Weak | Very low |
| IGRA for active TB | Do not use either IGRAs nor TST as a stand-alone test for the diagnosis of active TB. | Strong | Low |
| The panel suggests using an IGRA as a test for TB infection to support the diagnosis in cases with a well-founded suspicion of active disease. | Weak | Very low | |
TST: tuberculin skin test; BCG: bacillus Calmette-Guerin; IGRA: interferon gamma release assays; HIV: human immunodeficiency virus; SOT: solid organ transplantation; HSCT: hematopoietic stem cell transplantation.
Modified from reference [29]