J Korean Surg Soc.  2011 Mar;80(3):189-193. 10.4174/jkss.2011.80.3.189.

Usefulness of Interferon-Gamma Release Assay for Diagnosis of Tuberculous Fistulae in Ano

• Kim SH
• Hwang DY
• Song SG
• Kwon HJ
• Cho SY
• Park DH
• Lee JD
• Lee JK

• KMID: 1963582
• DOI: http://doi.org/10.4174/jkss.2011.80.3.189

Abstract

PURPOSE
Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula.
METHODS
We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed.
RESULTS
Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively.
CONCLUSION
QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.

Keyword

Tuberculous anal fistula; Interferon-gamma; Granuloma

MeSH Terms

Diagnosis*
Drug Therapy
Fistula*
Granuloma
Humans
Interferon-gamma
Interferon-gamma Release Tests*
Rectal Fistula
Retrospective Studies
Sensitivity and Specificity
Tuberculosis
Tuberculosis, Pulmonary
Victoria
Interferon-gamma

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