The TST was performed by trained personnel on all study participants, using PPD as the antigen, in accordance with the standard intradermal Mantoux method protocol. The test reading was conducted 72 h after the subcutaneous injection, based on the size of induration measured. The individuals were scored as non-reactive (0–4 mm), low reactive (5–9 mm) and strongly reactive (>10 mm). The study protocol was approved by the Ethics Committee of the Centro de Pesquisas Aggeu Magalhães – FIOCRUZ (number 55/02) and by the Instituto Materno Infantil Professor Fernando Figueira, and informed consent was obtained from the parents or legal representatives of the participants.

Cell preparation and culture.  Blood samples (3 ml) were taken with heparin (10 U/ml) by venipuncture. The whole blood was cultivated in an RPMI 1640 medium with penicillin/streptomycin (100 U/ml, 100 μg/ml) and incubated with ESAT-6 (3 μg/ml), CFP-10 (3 μg/ ATM inhibitor ml), PPD (5 μg/ml) or PMA/Iono (Phorbol Miristate Acetate, 5 μg/ml/ Ionomicin, 1 μg/ml) at 37 °C in a humidified CO2 atmosphere for 120 h. This time period was chosen after kinetic selleck inhibitor study of INF-γ. The supernatants were harvested and immediately frozen at −70 °C until analysis. ESAT-6

and CFP-10 were obtained by donations from FIOCRUZ and Statens Serum Institute (Copenhagen, Denmark), respectively. PPD in vitro (1 mg/ml) was commercially obtained by FIOCRUZ. The interferon-γ release assay.  The concentration of IFN-γ in duplicate samples was determined using the Quantikine kit (R&D Systems, Minneapolis, Cytidine deaminase MN, USA) ELISA (enzyme-linked immunosorbent assay) as described in the manufacturer’s instructions, and the results were processed using Microplate Manager, version 4.0 (BIORAD laboratories, Hercules, CA, USA) and expressed as pg/ml with detection limits ranging from 15.6 to 1000.00 pg/ml. Statistical analysis

and determination of sensitivity and specificity.  The differences between the mean IFN-γ levels of the groups were evaluated using an unpaired Student’s t-test. P values of <0.05 were considered significant. The receiver operating characteristic (ROC) curve, cut-off, sensitivities and specificities for each antigen were estimated using the specific spss Base software, version 13 (Chicago, IL, USA), with a confidence interval of 95%. The areas under the curve (AUC) show the sensitivity versus 1-specificity, having values between 0.5 and 1.0, with those closer to 1.0 possessing better discriminatory power. The Kappa statistic represents the level of agreement between the clinical classifications of the children and the test results and was obtained using Epi Info, Version 6.04 (Centers for Disease Control and Prevention, Atlanta, GA, USA). The likelihood ratios for each test were calculated as described by Sackett et al.