Queensland Health - on the critical list

Amongst the comments on forrestthinks was this one from Thumbs Up;

The Australian National Tuberculosis Advisory Committee recommends tuberculin skin testing as the standard test for latent tuberculosis infection with targeted use of interferon gamma release assays (Quantiferon Gold) when high specificity is desired.

These tests have no role in initial investigations for active tuberculosis because negative results do not exclude disease and positive results may not necessarily indicate disease.

This statement was made by Anastasios Konstantinos, Director of Queensland TB Control Centre (Specialised Health Services), Queensland Health, Brisbane and can be found here.

Those with experience of TB would argue differently. The most reliable method of diagnosing active TB (pulmonary) is through sputum culture however this can take many weeks. Non pulmonary TB requires specific analysis which can also be unclear. Therefore the reality is that it is

common practice to initiate antituberculous treatment on the basis of initial clinical diagnosis, independent of subsequent culture confirmation. For those in whom infection is confirmed by culture, treatment is obviously continued, but in some patients confirmation is not possible; consequently, the accuracy of the initial clinical diagnosis is of paramount importance.

Nobody is saying that QuantiFERON is 100% for active TB, what they are saying is that

a positive QFT result is not a diagnostic standard for active TB; it is simply another aid towards diagnosis that can be highly effective in many situations.

Anastasios Konstantinos appears to dismiss QuantiFERON on the grounds that it is not 100% reliable however he does recommend radiology

a normal chest X-ray almost excludes pulmonary tuberculosis

"Almost excludes" is an inconclusive term suggesting that X-rays are inconclusive. Japan is a country with a long history of X-rays and TB and their experience is that

Sensitivity of chest X-ray for early diagnosis of recurrent pulmonary tuberculosis is not very high, and bacteriological examinations are more important irrespective of chest X-ray finding..

..usefulness of chest X-ray is considerably limited

Logically in its early stages TB would be difficult to pick up with a chest X-ray and with non pulmonary TB chest X-rays are totally ineffective. This point was made by epidemiologists employed by Australian Government(s) and published in the Medical Journal of Australia

Control of TB in Australia is facilitated through entry screening of migrants using chest x-ray, and contact tracing of people with active TB.11 However, this strategy is inadequate for detecting latent and non-pulmonary disease and is unlikely to identify migrants whose TB will be diagnosed many years after their arrival.

Mr Konstantinos may wish to speak with his Doctor.