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“Introduction The increased risk of tuberculosis (TB) in healthcare workers is well known (Seidler et al. 2005). Therefore,

screening HCWs for latent TB infection (LTBI) and preventive chemotherapy is a cornerstone of TB prevention programs (CDC 2005). However, the conventional tuberculin skin test (TST) has known limitations in accuracy and reliability. Furthermore, interpretation of serial TST results is complicated by non-specific variation and because of its intradermal application, by potential boosting very from precedent tests (Pai et al. 2007). The development of the interferon-γ (INF-γ) release assays (IGRA) is

welcomed as a means of overcoming this problem. The IGRAs allow ex-vivo testing and therefore are not prone to boosting. In addition, the IGRAs are highly specific, giving them valuable advantages over the TST especially in Bacillus Calmette-Guérin (BCG)-vaccinated populations (Diel et al. 2006; Nienhaus et al. 2008). As with the TST, IGRA results are determined by several factors: precision of measurement technique, intrapersonal biological variation, new infection (conversion), transient infection (Ewer et al. 2006) or transition of Mycobacterium tuberculosis (MTB) from replication to a dormant state no longer stimulating cell-mediated immune response (reversion). MTB cannot be directly observed in the body. Therefore, its presence and replication activity can only be measured indirectly by antigen-specific response in TST or IGRA. For the TST, it is common sense that test interpretation in serial testing should be based on a comparison between actual and previous TST results.