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Archives de pédiatrie
Volume 17, n° 1
pages 77-85 (janvier 2010)
Doi : 10.1016/j.arcped.2009.07.021
Difficultés du diagnostic de la tuberculose chez l’enfant : intérêt du test QuantiFÉRON TB Gold® In-Tube
Difficulties of TB diagnosis in children: QuantiFERON TB Gold® In-Tube as useful tool
 

M. Grare a, , J. Derelle b, M. Dailloux a, C. Laurain a
a Laboratoire de bactériologie, CHU de Nancy, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France 
b Médecine infantile 3, secteur 3, CHU de Nancy, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France 

Auteur correspondant.
Résumé

Le diagnostic de la tuberculose (TB), maladie ou infection, est difficile chez l’enfant : absence de signes cliniques et radiologiques spécifiques, bactériologie souvent peu contributive. L’intradermoréaction (IDR) n’apporte qu’une aide partielle (difficulté de l’injection intradermique chez l’enfant, manque de sensibilité et de spécificité). L’arrêt de la vaccination systématique par le BCG depuis juillet 2007, en France, nous laisse craindre, si les recommandations ne sont pas appliquées, une augmentation de l’incidence de la TB chez l’enfant. Il est indispensable de trouver de nouveaux outils diagnostiques sensibles, spécifiques, rapides, de lecture objective et peu coûteux. Cette place pourrait être occupée par les tests interféron-γ, mais les données de la littérature sont encore insuffisantes en pédiatrie et parfois contradictoires. L’étude menée au CHU de Nancy sur 51 enfants à risque de TB infection ou lors d’une suspicion de TB maladie nous a permis de confirmer l’intérêt du test QuantiFÉRON TB Gold® In-Tube (QFT-IT), mais a soulevé diverses questions : nombreux résultats indéterminés sans explications préanalytiques ou cliniques, discordances IDR/QFT-IT, y compris chez les cas confirmés de TB maladie. Nous manquons encore de recul et de données sur les tests INF-γ pour statuer sur leur réelle place dans le diagnostic de la TB en pédiatrie.

The full text of this article is available in PDF format.
Abstract

Diagnosis of childhood tuberculosis (TB), active TB or latent tuberculosis infection (LTBI), is complicated by uncommon clinical, radiological and bacteriological features. The tuberculin skin test (TST) is imperfect: difficulty of the intradermal injection for the child, lack of sensibility and specificity. The stop of the systematic inoculation by the BCG since July 2007, in France, could lead to an increase of the incidence of the childhood TB. It is urgent to find new diagnostic tools: sensitive, specific, fast, of objective reading and little expensive. Interferon-γ assays could be useful but the data are still insufficient in paediatrics and sometimes contradictory. A prospective study which compared the usefulness of QuantiFERON TB Gold® In-Tube (QFT-IT) assay with TST to detect LTBI or active disease in 51 children was realised in University Hospital of Nancy. This allowed us to confirm interest of QFT-IT; however, surprisingly, very discordant QFT-IT and TST results were obtained (only five children were QFT-IT+/TST+). A high number (14%) of indeterminate QFT-IT occurred, without explanation by pre-analytical or clinical parameters. Further studies are needed to demonstrate the usefulness of this assay in diagnosing LTBI and particularly active TB in children.

The full text of this article is available in PDF format.

Mots clés : Tuberculose, Pédiatrie, Intradermoréaction, Test interféron-γ




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