CHEST Guidelines-Relevance-of-Serial-Interferon-γ-Release-Ass

Relevance-of-Serial-Interferon-γ-Release-Ass

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The letter to the editor from Deepak Aggarwal and colleagues addresses the study by Park et al. on the use of serial interferon-gamma release assays (IGRAs) for diagnosing Mycobacterium tuberculosis (MTB) in healthcare workers. Aggarwal highlights concerns regarding unexplained fluctuations in IFN-gamma levels and the risk of false positives, questioning the utility of monthly IGRAs in healthcare settings. The letter requests follow-up data on individuals diagnosed with MTB via IGRA who then developed active TB, arguing that this could guide the creation of diagnostic and management guidelines for latent and active TB. Additionally, the letter points out the lack of discussion around the reason for IGRA reversion in some patients and calls for an exploration of the causes behind variations in IFN-gamma responses, differentiating non-specific variations from those related to infection dynamics.<br /><br />In response, Dr. Jong Sun Park and colleagues from South Korea acknowledge the issues raised by Aggarwal et al. and provide a brief update. They indicate that none of the participants in their study have progressed to active TB based on IGRA positivity and that participants will be monitored for up to five years to observe any potential development of active TB. They also comment on the ambiguity of IGRA conversion in the context of treating latent TB infection, acknowledging that the clinical implications of such conversions are not well-understood and will require long-term follow-up for clarification. The response underlines the need for continued research and careful evaluation of IGRA results in healthcare workers, emphasizing the complexity of accurately predicting TB development through these assays.

Keywords

Interferon-gamma release assays

Mycobacterium tuberculosis

healthcare workers

false positives

latent TB

active TB

diagnostic guidelines

IGRA reversion

infection dynamics

long-term follow-up