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Koch To Quantiferon

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jamieritchey

Emerging Infectious Disease Epidemiology at University of South Carolina

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Koch to Quantiferon: An Overview of Tuberculosis testing in the United States Jamie Ritchey, MPH April 28, 2008 EPID 755: Emerging Infectious Diseases
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TB Basics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CDC. Questions and Answers About TB, 2007. http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro1
History of TB up to Tuberculin test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Basics of Screening Test Validity ,[object Object],[object Object],[object Object],[object Object],Gordis, 2000; Szklo and Nieto, 2007 203 Specificity 182/200= 91% Sensitivity 2/3 = 66.7% Total NPV 182 / 183= 99.5% True negative 182 False negative Type II error 1 Negative Test PPV 2 / 2+18= 10% False positive Type I error 18 True positive 2 Positive test Predictive value “ False” “ True” Screening Test result
Basics of Screening Test Validity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],56% 31% 20% 50% PPV 90% 50% 50% 50% Specificity 50% 90% 50% 50% Sensitivity 20% 20% 20% 50% Prevalence Test 4 Test 3 Test 2 Test 1 Measure
Tuberculin skin test Background ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculin skin test Specificity ,[object Object],[object Object],[object Object]
Tuberculin skin test Specificity: Historic Misclassification due to Pulmonary calcifications ***Lowers the NPV, specificity, and sensitivity Specificity 182 / 200= 91% 2/20= 10% Sensitivity 2/3= 66.7% 2 / 182= 1% Total NPV 182/183= 99.5% 2 / 182= 1% ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Negative PPV = 10% False positive 18 True positive 2 Positive Predictive Value False True Test Result
Tuberculin skin test Specificity: False positive test results ***Lowers the NPV, specificity, and sensitivity Specificity 182 / 200= 91% 2 / 200= 1% Sensitivity 2/3= 66.7% Total NPV 182/183= 99.5% 2 / 3= 66.7% True negative 182 180 2 False negative 1 Negative PPV = 10% 2 / 200= 1% False positive 18 180 198 True positive 2 Positive Predictive Value False True Test Result
Tuberculin skin test Sensitivity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculin skin test Sensitivity: inability to mount an immune response (HIV +, malnutrition, chemo) **False negative results cause a drop in sensitivity, PPV and NPV Specificity 182 / 200= 91% Sensitivity 2/3= 66.7% 1/3= 33.3% Total NPV 182/183= 99.5% 182/184= 98.9% True negative 182 False negative 1 1 2 Negative PPV 2/18= 10% 1/18= 5.6% False positive 18 True positive 2 1 Positive Predictive Value False True Test Result
Tuberculin skin test Cost ,[object Object],[object Object],[object Object],[object Object]
Tuberculin skin test Strengths and Weaknesses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quantiferon-TB in a tube test Background ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quantiferon-TB in a tube test Specificity and Sensitivity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quantiferon-TB in a tube test Cost ,[object Object],[object Object],[object Object]
Quantiferon-TB in a tube test Strengths and Limitations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recommendations ,[object Object],[object Object],[object Object],[object Object]
Acknowledgements ,[object Object],[object Object]
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Koch To Quantiferon

  • 1. Koch to Quantiferon: An Overview of Tuberculosis testing in the United States Jamie Ritchey, MPH April 28, 2008 EPID 755: Emerging Infectious Diseases
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  • 10. Tuberculin skin test Specificity: False positive test results ***Lowers the NPV, specificity, and sensitivity Specificity 182 / 200= 91% 2 / 200= 1% Sensitivity 2/3= 66.7% Total NPV 182/183= 99.5% 2 / 3= 66.7% True negative 182 180 2 False negative 1 Negative PPV = 10% 2 / 200= 1% False positive 18 180 198 True positive 2 Positive Predictive Value False True Test Result
  • 11.
  • 12. Tuberculin skin test Sensitivity: inability to mount an immune response (HIV +, malnutrition, chemo) **False negative results cause a drop in sensitivity, PPV and NPV Specificity 182 / 200= 91% Sensitivity 2/3= 66.7% 1/3= 33.3% Total NPV 182/183= 99.5% 182/184= 98.9% True negative 182 False negative 1 1 2 Negative PPV 2/18= 10% 1/18= 5.6% False positive 18 True positive 2 1 Positive Predictive Value False True Test Result
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