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Test combo makes for swift TB diagnosis

A new blood test could enable doctors to rule out tuberculosis infection within days rather than weeks, according to a new study.

The study, by researchers from Imperial College London and the University of Oxford, shows it can be determined that a patient does not have tuberculosis (TB) with 99% accuracy when using the new blood test, ELISpot-Plus, in conjunction with a skin test known as tuberculin skin testing, already in use.

Professor Ajit Lalvani, from the National Heart and Lung Institute at Imperial College London, who led the study team, said: "Our new test could revolutionise the way we manage people with suspected TB. At the moment, it can take quite a long time to figure out whether or not a patient has the disease, because it can mimic many different conditions and present in many different ways.

"Our study shows that by using the new blood test, together with the old skin test, we could establish if someone does not have TB within two days of them coming in for tests, allowing doctors to focus on other possible diagnoses."

The tuberculin skin test commonly gives false positive results if a patient has previously been vaccinated against TB, because vaccination causes a reaction in the immune system which looks very similar to its reaction against actual TB infection. ELISpot-Plus is able to distinguish TB infection from BCG vaccination because it uses special antigens that only pick out the T cells that are induced by TB infection, and not those induced by vaccination.

The new test is useful in determining a patient's TB status but the results are not able to accurately reveal whether a patient with TB has it the active form, which causes symptoms, or the dormant latent form, which does not. This means that patients with a positive result would need further testing. However, the new test combination should allow doctors to establish which patients require further TB testing and which do not.

The ELISpot-Plus device is not yet licensed, however it is hoped that it could be made available to as large a number of TB patients as possible, including those in the developing world who carry the largest burden of TB.

The study appeared in the journal Annals of Internal Medicine.