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PubMed1968

Tuberculin test in children with malnutrition.

Tuberculin tests with Heaf's multiple-puncture method, as well as intradermal tests with varying strengths of old tuberculin, were carried out on 402 children with severe malnutrition. From the radiological and bacteriological findings 51 children (12.5%) were considered to have active tuberculosis. The Heaf test was positive in only 11 of these children, but the intradermal test using 100 tuberculin units was positive in a further 18. This confirms previous findings that tuberculin sensitivity is impaired in malnourished children, and suggests that a higher dose of tuberculin is more likely to elicit a positive response.

Child↗
PubMed2003

Tuberculosis screening in dialysis patients--is the tuberculin test effective?

AIM: Patients with end-stage renal disease are at increased risk for tuberculosis (TB). The Centers for Disease Control and Prevention (CDC) has recommended annual skin testing for TB, with tuberculin-purified protein derivative (PPD), in patients with chronic renal failure. The aim of this study was to identify the incidence and prevalence oftuberculin positivity and assess the utility of the tuberculin test in an inner city dialysis population. METHODS: All patients on chronic hemodialysis at a center affiliated to the University of Chicago, who were tuberculin-tested between 1997 and 2000 or had previously documented PPD positivity precluding retesting, were included. Demographics, comorbidity, and tuberculin and anergy reactivity were recorded. A positive PPD was an induration of > 10 mm in response to 5 tuberculin units of PPD, and anergy an induration of < 2 mm in response to the anergy antigens (Candida and Mumps), at 48 h. PPD-positive patients were compared with PPD-negative patients; Fisher's exact test and t-test were used, p < 0.05 was considered significant. RESULTS: Of 131 patients at the dialysis center, 118 were studied. The remaining 13 refused consent to PPD testing. 41 (35%) were PPD-positive, 77 (65%) were negative. Of the 77 PPD-negative patients, 62 (81%) were anergic. None of the PPD-positive patients had clinical or radiographic signs of active TB. Only 20 patients received INH prophylaxis, the others refused or had contraindications to therapy. The conversion rate ranged from 3 - 8% per year. Demographics, nutritional parameters, comorbidity and adequacy of dialysis did not help predict PPD positivity. CONCLUSION: There is a high prevalence of PPD positivity and anergy among dialysis patients. As the diagnostic utility of the time-tested PPD test is unclear in an anergic dialysis population, the need for a high index of suspicion for active tuberculosis and timely diagnostic work up should be reinforced and not replaced by total dependence on the tuberculin test.

Female↗
PubMedDate not supplied

[Experiences with the intracutaneous Mendel-Mantoux tuberculin test in routine screening in a public health office].

The intracutaneous tuberculin test according to Mendel-Mantoux is internationally recognised as a standard testing method in all countries of the globe. In routine everyday working of the Public Health Office of the German provincial capital Stuttgart the Mendel-Mantoux tuberculin test was examined in respect of practicability, acceptance and economy and was compared against the multipuncture-stamp test. 2,710 persons for whom the tuberculin test was prescribed according to the German infectious diseases law were tested for tuberculosis by the Stuttgart Public Health Office between August 1995 and February 1996, using the Mendel-Mantoux test with Behring 5 TE GT. Of these, 154 persons did not return for checking the result. Checking was effected on 2,556 persons. The tested persons were 28.4 years old on the average, the majority being female (59.5% against 40.5% males) and of German nationality (60.7% against 39.3% other nationals). A positive reaction was seen in 37% (induration > 6 mm), in 23.3% Germans against 57.5% other nationals. In 65% of the positive results the indurations had a diameter of more than 10 mm, in 29.2% more than 15 mm. 80 probands, i.e. 2.5% of all tested persons, had an excessive reaction; firmation of blisters with local necrosis. The intracutaneous test according to Mendel-Mantoux can be routinely performed by Public Health offices, is well accepted by the persons concerned, and is also economic if 3 tests are conducted per bottle. The proportion of positive findings is similar to that obtained with the multipuncture-stamp test, whereas the significance of the results is more differentiated. The indication should be in accordance with the objective.

Adolescent↗
PubMed2000

[Intracutaneous tuberculin test using the Mendel-Mantoux technique. Tuberculin reactivity among inpatients in a pneumology department].

Detection of latent tuberculosis infection is an important step in the control of tuberculosis. The tuberculin skin test is the only proven method for identifying tuberculosis infection in patients who do not have tuberculosis disease. The prevalence of tuberculosis infection among hospitalized patients in a pneumological department of an inner-city hospital was evaluated, using the intradermal tuberculin skin test (Mantoux technique). Interpretation of the Mantoux test was based on the size of induration in millimeters and the individual risk profile of the patients, according to the guidelines of the American Thoracic Society and the Centers for Disease Control, revised in 1989. Of 697 tested patients, 252 showed test results consistent with tuberculosis infection (36.2%). 55 of these 697 patients had active tuberculosis disease or a prior history of tuberculosis (7.9%). A positive tuberculin skin test was found in 197 of 642 patients (30.7%) with a diagnosis different from tuberculosis (COPD, pneumonia, cancer and others). In our study, the sensitivity of the tuberculin skin test for active tuberculosis infection was 95%. The present study revealed a high prevalence of tuberculosis infection among hospitalized patients in a pneumological department. Further studies are needed to assess the usefulness of routine tuberculin skin testing in hospitalized populations.

Adult↗
PubMed1986

The tuberculin test. Studies of the dynamics of reactivity to tuberculin and Candida antigen in institutionalized patients.

To determine the importance of the recall phenomenon ("booster effect") in chronically hospitalized patients, we performed three sequential tuberculin and Candida antigen skin tests in patients at two hospitals. Twenty of 162 patients (12.3%) demonstrated a significant reaction on the initial tuberculin test, and 9 additional patients (5.5%) showed a significant reaction (booster response) to a second tuberculin test administered 3 wk later. Five patients (3.1%) demonstrated a significant reaction only when a third tuberculin test was administered 6 wk after the initial test. Only 1 patient (0.6%) with a significant tuberculin reaction on the first 2 tests was nonreactive on the third test. Nineteen patients (11.7%) demonstrated a significant response to Candida antigen on the initial test and a booster effect was noted in 11 (6.2%) and 6 (3.7%) patients, respectively, on subsequent tests. Four patients (2.5%) appeared to lose reactivity to Candida antigen on each of the 2 repeat tests. Only 25% of patients who demonstrated a tuberculin booster response had a significant reaction to the initial Candida skin test. Serial skin tests may be necessary to reliably determine the ability of a chronically hospitalized patient to demonstrate a response to tuberculin.

Aged↗