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[Tuberculin test in the diagnosis of childhood tuberculosis: Analysis of quantitative and qualitative features]

OBJECTIVE: To evaluate the role of the tuberculin test in the diagnosis of tuberculosis in children. METHODS: Test diagnosis study; Tuberculin test with PPD Rt 23 (2 UT) was performed in 158 children, distributed in 2 groups: 101 no tuberculous, BCG vaccinated children and 57 tuberculous ones (diagnosis by clinical-radiological and epidemiological features). The interpretation of the tuberculin test was made by quantitative analysis (Mantoux test) and qualitative analysis (Koch and Listeria phenomena). RESULTS: Using cutoff = 10mm in Mantoux test, we found sensitivity of 85.9% and specificity of 86.1%. The qualitative analysis (Koch phenomenon), showed sensitivity of 77.2% and specificity of 98%. CONCLUSION: The qualitative analysis of the tuberculin test was useful in the diagnosis of tuberculosis in children, associated to the Mantoux test interpretation.

Journal Article↗
PubMed1960

Simultaneous multiple tuberculin testing.

In experimental work with tuberculin testing-for example, for comparing different testing procedures, for standardizing tuberculin, etc.-two tests are often given to each person. Because of variations in allergy from person to person, such duplicate testing gives a much more precise comparison of two test procedures for a given number of persons than does the alternate use from person to person of two test procedures to be compared. In adopting this method of testing it is tacitly assumed that the two tests in the same person do not interact in any way. The present paper shows, however, that this assumption is not justifiable.The authors describe an experiment in which 611 infants who had been BCG-vaccinated at 2-5 days of age were tuberculin-tested 3-5 months later, 306 of them with a single 10 TU test and 305 with a 10 TU test in one arm and a 100 TU test in the other arm. The results showed that there was a highly significant difference between the two groups, both in the average size of the reactions and in the degree of induration, the single-test group giving the larger and stronger 10 TU reactions.

Biomedical Research↗
PubMed1979

Tuberculin test conversion during repeated skin testing, associated with sensitivity to nontuberculous mycobacteria.

To determine whether repeating the tuberculin test after a brief interval might result in tuberculin conversion, we tested 213 healthy volunteers twice, 1 month apart, with 5 TU of tuberculin purified protein derivative (PPD). Three nontuberculous mycobacterial antigens (PPD-G, PPD-Y, and PPD-B) were also applied with the first tuberculin test. By widely used criteria, 14 volunteers (6.6 per cent) converted their tuberculin tests from negative to positive on the second testing. Whereas 13 of 103 subjects (12.6 per cent) with nontuberculous antigen sensitivity converted their tuberculin test to positive, only one of 110 subjects (0.9 per cent) with no known prior mycobacterial sensitivity converted to positive (P less than 0.005; x2 = 10.05). When retested with 5 TU of tuberculin PPD 6.5 months after the second test, nine of 13 converters reverted to negative. We conclude that tuberculin conversion may occur when the skin test is repeated at 1 month, and that boosting of cross-reacting mycobacterial sensitivity might have caused a portion of the conversions in this population of young, healthy midwestern volunteers. Sensitivity to Mycobacterium tuberculosis might also be boosted by tuberculin testing. Because the prevalence of sensitization by tuberculous and nontuberculous mycobacteria can be expected to vary in different populations, the significance of tuberculin conversion will also vary with the population being tested.

Adolescent↗
PubMed2003

[Assessment of nurses' understanding of tuberculin testing at a general hospital].

BACKGROUND: The last ten years have seen a resurgence of tuberculosis, yet little information is available about the implementation of tuberculin testing and consistency in its use and interpretation. OBJECTIVE: To evaluate knowledge of tuberculin testing among hospital nurses. MATERIAL AND METHOD: A questionnaire on various aspects of the tuberculin test was administered to registered nurses assigned to various services of our university hospital. The questions were grouped by sections (techniques for administering the test, reading the results and interpreting them). RESULTS: One hundred thirty-five nurses were surveyed; 127 (94%) answered all the questions. Overall, only 42% responded to 10 or more of the 14 items on the questionnaire. By sections, questions related to technique of administration, reading the tuberculin test result and interpreting it were answered correctly by 46%, 11% and 7% of the subjects, respectively. Only two variables were independently related to the number of correct responses: 1) working on a medical ward at the time of the survey or 2) administering the test more than once a week. CONCLUSIONS: This study confirms that hospital nurses' understanding of tuberculin testing is unacceptable. A team of professionals skilled in tuberculin testing should be designated at every level of the health care system to assure the reliability of tests performed for clinical or research purposes.

Adult↗
PubMed1979

The booster phenomenon in serial tuberculin testing.

To determine the frequency, magnitude, and causes of the booster phenomenon in tuberculin testing, a total of 1,478 employees from 10 hospitals throughout the United States received sequential intradermal tests using PPD-T. In addition, approximately 70 per cent were initially tested with PPD-G. Boosting was found in all age groups tested, but increased with age. It occurred as soon as one week after an initial tuberculin test, but rarely before that time. The boosted reactions were apparently caused either by remote tuberculous infection or recent or remote sensitization by one or more of the nontuberculous mycobacteria. In areas endemic for nontuberculous mycobacteria, they are the most likely cause of the sensitivity that may be boosted. On the basis of these findings, it is recommended that when repeated tuberculin testing is required as part of a hospital control program, a second identical tuberculin test be given one week after the first. When subsequent tests are given, this should permit separation of boosted reactions from reactions caused by new infections. Persons who do not boost when giben repeat tests at one week, but whose tuberuclin reactions change to positive after one year, should be considered to have newly acquired tuberculous infection and managed accordingly.

Adult↗
PubMed1995

[Tuberculin tests in school leavers in canton Berne , Neuenburg and Wallis 1992/1993].

To determine the prevalence of tuberculosis infection in Switzerland, standardized tuberculin tests using 2 units of tuberculin Berna PPD RT 23, administered by specially trained personnel, were performed on school leavers in 3 Swiss cantons in 1992/1993. Of the 7036 school leavers, averaging 15 years of age, only 294 (4.18%) were not BCG-vaccinated. Non-vaccinated persons had tuberculin test indurations > 15 mm in 2.04% (6663 BCG vaccinated persons in 1.14%). Calculations of potentially influential factors using stepwise ordinal polychotomous regression showed that tuberculin test indurations are significantly larger after BCG vaccination, as well as with increasing age at immigration from high prevalence tuberculosis countries. Indurations were smaller with increasing time passed since BCG vaccination, as well as in females. Pets at home did not significantly influence the size of tuberculin reactions. Theoretically the positive predictive value of tuberculin tests in Switzerland is small because of the low tuberculosis prevalence. From our data the maximal prevalence of infection in 15-year-olds is estimated at 0.91% (2.48% in the non-vaccinated) in Swiss and 2.54% (9.77% in the non-vaccinated) in foreign born school children. These rates, higher than extrapolated from previous studies, are comparable to data from other industrialized countries. They do not warrant a change in BCG vaccination policy in Switzerland, which since 1987 requires BCG vaccination in children immigrating from countries with high tuberculosis prevalence only.

Adolescent↗
PubMed1989

Significance of the tuberculin test in Singapore.

The standard tuberculin test used by all Singapore government hospitals and institutions is the intradermal Mantoux test using 1 TU of PPD RT23 with Tween 80, and read 72 hours later. There is almost 100% BCG coverage in Singapore children for many years, and therefore the tuberculin skin reaction must be interpreted with special consideration. Taking 8 mm and above as positive, six month old infants vaccinated at birth gave a positive rate of 42% and a mean reaction size of 5.89 mm. The reaction appeared to wane rapidly and among 6 year old school children the positive rate dropped to 12% and the mean size to 2.38 mm. By the age of 11 years, the children showed a positive rate of 36% and a mean size of 6.27 mm. A further increase is observed in 15 year old children, the positive rate being 88% and mean size 13.28 mm. Among tuberculosis contacts, the positive rate and mean size of the tuberculin reaction are generally higher, especially in the younger age groups. Tuberculosis patients above 15 years old were observed to be practically all positive reactors with a mean size of at least 16 mm.

Adolescent↗
PubMed1992

[IgG against A60 antigen and the tuberculin test in healthy individuals and tubercular patients].

BACKGROUND: Study of the relation between the antibodies against the A60 antigen and the tuberculin test. METHODS: An indirect ELISA for detecting serum antibodies (IgG) against the antigen A60 and tuberculin test, has been applied to 20 patients with pulmonary tuberculosis, and 52 healthy persons without tuberculous history. RESULTS: For the all people (healthy and patients) both techniques have had almost identical results in 76.4%. In the healthy people the ELISA A60 and tuberculin test positive results were: 20.7% and 26.9%, respectively. For the patients group this results were: 85% and 80%. These results were statistically significant (p = 0.0001). CONCLUSIONS: In the healthy people the antibodies response against A60 antigen has a direct relationship with the results of the tuberculin test. The combined use of ELISA A60 and the tuberculin test improve their separate results.

Adult↗
PubMed1984

Mantoux and Tine tuberculin tests compared in Kuwait.

Mantoux and Tine tests were performed on 260 patients with an overall agreement between the 2 tests of 96%. On clinical evaluation, 17% of those expected to be positive reactors were found to be negative to both tests, and 8% were positive in those expected to be negative. The Tine test produced comparable results with the Mantoux test, and is suitable for clinical tuberculin testing purposes. Although both tests were sensitive but not highly specific, tuberculin testing is still wanted in our area, perhaps not in diagnosing pulmonary tuberculosis, but in the investigation of lymphadenopathy where positive reactions make non-tuberculous origin unlikely.

Adult↗
PubMed1996

[Tuberculin test in HIV infection].

BACKGROUND: Intravenous infected-HIV drug abusers (IDAP/HIV+) are known to have a higher risk of tuberculosis (TB) than others. The effectiveness of tuberculin testing (Mantoux) in the detection of the TB infection in HIV(+) patients is probably lower than HIV(-) individuals. The aim of this paper is to assess tuberculin testing in the active search of cases of TB infection in IDAP individuals and their differences between HIV(+) and HIV(-) ones. METHODS: We studied 332 patients with intravenous drug use belonging to a therapeutic community and to in-patients. Tuberculin testing was performed on all of them. They were examinated if had been previously vaccinated with BCG and we carried out the counting of linfocites CD4 in HIV(+) ones. In the cases of negative tuberculin skin test a second test was administered after 7 days. The patients were grouped in HIV(+) and HIV(-) and the variables were statistically assessed by the chi 2 and a logistic regression model. RESULTS: Tuberculin testing resulted positive in 16.9% IDAP/HIV(+) in comparison with 39.9% of IDAP/HIV(-). The induration size was significantly smaller in HIV(+) than HIV(-) individuals. In both cases, we found that in BCG vaccinated patients positive tuberculin testing was significantly lower than negative tuberculin. The booster effect was detected in 8.9% of HIV(+), whereas in HIV(-) not BCG vaccinated it was of 21.4% and in HIV(-) BCG vaccinated it increased to 30.9%. When the level of the linfocites CD4 exceeds 500/mm3 in HIV(+) the percentage of Mantoux test (+) equals HIV(-) individuals. CONCLUSIONS: A decrease in sensitivity of tuberculin testing in the diagnosis of TB infection in IDAP/HIV(+) was detected. A high percentage of booster effect in IDAP was also demonstrated. We recommend the performance of tuberculin testing at the beginning of HIV infection.

Adolescent↗
PubMed1965

THE TUBERCULIN TEST.

A brief historical review of the tuberculin test is followed by consideration of the immunological factors concerned in the tuberculin reaction. The problems in the interpretation of the test, the dosage and types of material used, and methods of administration are discussed. The current problem of tuberculin reversion with and without treatment, as exemplified by the current study of Halifax school children, is considered in some detail. The role of the tuberculin test in the present-day program of tuberculosis control is indicated.

Adolescent↗
PubMed1965

A NEW APPROACH IN DISPENSING TUBERCULIN PPD AND IN PERFORMING A MULTI-PUNCTURE TUBERCULIN TEST.

A simple and low-cost kit for single-dose tuberculin testing is described. For those who perform occasional tuberculin tests only, this kit is proposed as a substitute for the Heaf apparatus used in carrying out a multi-puncture test. No difference in the tuberculin skin reactions could be observed when the needle multi-puncture test was compared with the Heaf test in BCG-sensitized guinea pigs and in 12 volunteers. A comparative study on 37 student nurses, using the needle multi-puncture method and the intracutaneous method (Mantoux test), showed that with the needle multi-puncture method more positive reactors were detected than with the Mantoux test using 1:2000 dilution of OT. However, more positive reactors were obtained with the Mantoux test using 1:100 dilution of OT. It is felt that the singledose kit can be a valuable asset when only few skin tests are performed.

Animals↗
PubMed1986

Multiple puncture tuberculin tests: relationship of false negative responses to variations in dried tuberculin coating.

Multiple puncture dried tuberculin tests compare favourably with the standard Mantoux test provided the tips of the metal prongs are thinly and uniformly coated with tuberculin. Unfortunately, surface tension, varying viscosity of the acacia solutions, and deeper dipping depths lead to increased quantities of tuberculin materials adhering to the metal prongs which results in thickening and retraction of the materials on the metal. Solutions of tuberculin in buffered phosphate produce thin and uniform coatings provided adequate cleaning of the metal--especially degreasing--is carried out. In the absence of this the coating layer may fragment. However, provided the distal 0.6-0.8 mm is covered, sufficient tuberculin will be deposited intradermally.

False Negative Reactions↗
PubMed2006

Tuberculin testing of kidney allograft recipients and donors before transplantation.

UNLABELLED: Immunocompromised patients such as those with chronic renal failure requiring hemodialysis (HD) are at increased risk of developing tuberculosis (TB). The gold standard screening tool used to detect tuberculosis is the tuberculin test, which owes its popularity to its ease of administration and high sensitivity. This study was done to identify the incidence of tuberculin test positivity among dialysis patients before transplantation and also in volunteer living kidney donors. PATIENTS AND METHODS: This cross-sectional, comparative study was done on 308 kidney allograft recipient candidates, 80 potential living unrelated and related donors within a few months before transplantation, and 855 control cases before employment. Patients were tuberculin-tested using the Mantoux technique. The PPD (purified protein derivative)-positive dialysis patients were compared with PPD-negative subjects, regarding age, gender, dialysis duration, cause of chronic renal failure, and nutritional state as well as PPD test results in potential donors. Patients were divided into <10 mm versus > or =10 mm induration. Statistical analysis was performed using SPSS 11.0. RESULTS: The mean age of the donors was 26.6 +/- 4.6 years with a male:female ratio of 87.5%:12.5%. The tuberculin test was positive in 11.25% of cases, all of whom were males with with induration >10 mm. There was no significant difference regarding the PPD results and age. The mean age of recipients was 40.1 +/- 14.7 years with a male/female ratio of 1.3:1. The tuberculin test was positive in 33.6% of recipient candidates. Mean duration on dialysis was 2.5 +/- 1.2 years. No significant correlation existed regarding the dialysis duration, cause of renal failure, c-reactive protein, erythrocyte sedimentation rate, and response to tuberculin test. There was a direct relationship between age and PPD test results (Pearson correlation +192). CONCLUSION: Our results showed that more dialysis patients were PPD positive compared with donors.

Adult↗