Diagnosis of XXXX : Can we do better?

@entity1 @entity66 @entity9178 @entity73 @entity281 @entity1906 @entity272
@entity9178 ( @entity9178 ) is often diagnosed by the @entity272 ( @entity272 ). The latter has several limitations with regard to its sensitivity and specificity. It may be positive in @entity1 with prior bacille Calmette-Gu  rin (BCG) vaccination or exposure to nontuberculous mycobacteria. False negative @entity272 results frequently occur in @entity1 with @entity73 . Therefore @entity272 results have to be interpreted taking into consideration the pretest risk of @entity281 or reactivation. Recently, interferon gamma release assays (IGRA) were introduced for the diagnosis of @entity9178 . These include the @entity1906 and the QuantiFERON((R))-TB Gold tests.These tests measure interferon gamma released in response to T-cell stimulation by specific Mycobacterium tuberculosis antigens. These tests have been shown to be more specific than the @entity272 as they are not affected by BCG vaccination. Their sensitivity was similar to that of the @entity272 and in some studies they correlated better with the degree of exposure. In immune-compromised @entity1 their sensitivity was better than that of the @entity272 . IGRA tests were shown to have better predictive value for the development of @entity66 among individuals with @entity9178 . These tests are expensive. Their most cost-effective utilization is as confirmatory tests in @entity1 with positive @entity272 results, particularly in areas with high rates of BCG vaccination.
