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[Mendel-Mantoux tuberculin test with GT 1 in the public health office].

Within the German Public Health Service, the recommendation of the German Central Committee für Combatting Tuberculosis to use the intracutaneous tuberculin test according to Mendel-Mantoux as a standard test has led to demands for additional investigations on sensitivity and specificity of different tuberculin doses. In routine everyday work of the Public Health Office of the German provincial capital Stuttgart the Mendel-mantoux tuberculin test with tuberculin GT 1 Behring was examined in respect of sensitivity and incidence of excessive reactions and compared to a former study with GT 5. 2,592 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 May and October 1998, using the Mendel-Mantoux test with GT 1 Behring. Of these, 202 persons did not return for checking the result. The 2390 checked persons were 28.4 years old on the average, the majority being female (59.0% against 41.0% males) and of German nationality (59.6% against 40.1% other nationals). A positive reaction was seen in 16.2% (induration > or = 6 mm), in 7.2% Germans against 29.6% other nationals. In 51% of the positive results the indurations had a diameter of more than 10 mm, in 12.6% more than 15 mm, 9 probands, i.e. 0.4% of all tested persons, had an excessive reaction (formation of blisters with local necrosis). Especially among the other nationals, the share of strongly positive results (> 15 mm) did not decrease to the same extent as did the share of positive results as a whole. 94 persons belonging to the surrounding of a bacillary index case got a second test with GT 10. Of these, 30 (31.9%) had a positive reaction. The use of a low tuberculin concentration (GT 1) for the intracutaneous test according to Mendel-Mantoux cannot be recommended. The sensitivity is significantly lower than with GT 5 which leads to seeming tuberculin conversions (because of the low sensitivity of GT 1) without avoiding excessive reactions. For tuberculin surveys in areas adjacent to bacillary index cases, the intracutaneous test according to Mendel-Mantoux should be performed with the usual dose (GT 10) as a standard test. For other purposes, the multipuncture-stamp test may be sufficient.

Adolescent↗
PubMed1955

THE 5 TU versus the 10 TU intradermal tuberculin test.

With the growing demand in practical tuberculin-testing work for an effective single-dose intradermal test to replace the serial-dose procedures, the 5 TU and 10 TU doses have both been used for single-dose tests in recent years. The present study was undertaken for the purpose of determining the difference in the effects of these two doses.The material was collected by testing large general population groups participating in the Danish mass campaign in two areas in Jutland; 5 TU and 10 TU were given to alternate persons. Results are presented for 3,764 adults, none of whom gave a history of previous BCG vaccination.With either dose, the population groups were clearly separated into two groups, reactors and non-reactors. The average diameter of reactions for 10 TU was larger by about 2-3 mm than for 5 TU, and the frequency of bullous reactions was only slightly greater with the stronger dose.The two known sources of tuberculin sensitivity in Denmark, apart from BCG, are infection with human and with bovine tubercle bacilli. As both appear to result in a degree of sensitivity demonstrated about equally well with either 5 TU or 10 TU, either dose would seem to be suitable as a single-dose test for tuberculin-testing surveys in similar general populations.

Adult↗
PubMed1987

Observations on the incidence of herds with non-visible lesioned tuberculin test reactors in south-west England.

The herd incidence of confirmed Mycobacterium bovis infection in cattle in the south-west of England has been approximately ten times that of the remainder of England and Wales; this greater incidence has been attributed to infection from badgers. The incidence of herds with only non-visible lesioned tuberculin test reactors, from which M. bovis was not isolated, has also remained higher in the south-west region. The incidences of these latter unconfirmed incidents were compared in parishes in the south-west region in which M. bovis in cattle had been confirmed, and those where M. bovis had not been confirmed, for the period 1979-83. This analysis was carried out both for those parishes in which herds had been subjected to annual tuberculin testing and for those subjected to biennial tuberculin testing. The incidence of unconfirmed incidents was significantly higher in parishes in which confirmed incidents had occurred, and this difference was found in both the annual and biennially tested parishes. The relative risks for the incidence of unconfirmed incidents in annually and biennially tested parishes were 1.89 and 2.56, respectively. The incidence of unconfirmed incidents in biennially tested parishes was lower than in annually tested parishes. The incidence of non-specific tuberculin test reactor herds was estimated from tuberculin test results in the eastern region of England during a period when tuberculosis was not confirmed in cattle. A comparison of this incidence and that of unconfirmed incidents in the south-west region suggests that approximately 70% of the unconfirmed incidents in the south-west were related to exposure to M. bovis. The results of the analyses indicate that unconfirmed incidents cannot be completely ignored in epidemiological analyses and studies of bovine tuberculosis in the problem areas of the south-west region of England.

Animals↗
PubMed2001

Evolution and current use of the tuberculin test.

Since it was first introduced in the late 1800s, the tuberculin test has undergone continual refinement in its formulation, standardization, and dosage, as well as its interpretation and indications for use. New guidelines have replaced universal screening with targeted testing and rigid definitions of positivity with individualized criteria formulated from a Bayesian approach. This review summarizes the evolution of the test and provides information to help gauge its predictive value.

Animals↗
PubMed1997

[Prevalence of positive tuberculin test in a population of patients requiring long-term care in a hospital setting].

OBJECTIVE: To determine the prevalence of positive tuberculin tests in a population of patients requiring long-term care in a hospital setting. DESIGN: Prevalence study: to evaluate reaction to the test among patients who agreed to be included in the study. SETTING: The study took place in two units of the Enfant-Jésus hospital where patients are admitted for chronic care. PARTICIPANTS: A total of 108 patients were eligible for the study; 56 agreed to take part. One patient died before the study was completed. INTERVENTIONS: The tuberculin test consisted of an injection of PPD-T and reading the reaction 48 to 78 hours later. A reaction > 10 mm was considered significant. Patients with insignificant reactions were injected again 2 weeks later in order to evaluate positive response secondary to reactivation of the immune system (booster effect). MAIN OUTCOME MEASURES: Indications of previous tuberculosis, risk factors for tuberculosis, immunosuppressive medication, length of stay in hospital, size of reaction. RESULTS: Seventeen tuberculin tests were positive (30.9%); of these, six were positive after the second injection. CONCLUSION: The prevalence of positive tuberculin tests was high in our elderly population; this finding is comparable to the findings of American studies.

Aged↗
PubMed1975

[Significance of the tuberculin test in the early detection of renal tuberculosis].

Authors used the tuberculin test (modified Koch's test) in 84 urological patients. In 22 of them, renal tuberculosis was revealed by this test and then confirmed by other methods. Subcutaneous injection of tuberculin in patients with renal tuberculosis was followed with the increase of leucocyturia and erythrocyturia. This reaction was especially expressive in the early stages of renal tuberculosis. The tuberculin test must be widely used in first-stage laboratory investigations in urological patients because it is easy and rapid.

Female↗
PubMed1980

Unread tuberculin tests.

Serial audits of tuberculin skin testing at a community teaching hospital indicated an ongoing need for standardization and quality control.

Evaluation Studies as Topic↗
PubMed1999

Comparison between a gamma-IFN assay and intradermal tuberculin test for the diagnosis of bovine tuberculosis in field trials in Brazil.

Bovine tuberculosis is a major problem in Brazil. The intradermal tuberculin test is the standard test for detection of bovine tuberculosis in Brazil but can lack both sensitivity and specificity. The purpose of this study was to compare a bovine gamma-IFN assay with the tuberculin test under field conditions in Brazil. A total of 1632 animals from 13 dairy farms were tested using the single cervical tuberculin test (SCTT). Among those animals, about 15% of each herd, 220 in total, represented a high-risk group and were selected to be tested using the gamma-IFN test. Of the 1632 animals tested, 207 presented significant reactions representing 12.7% of the cattle studied. In the selected group the number of animals positive by the gamma-IFN assay was 126/220 (57.3%) and the total number of reactive cows on SCTT was 106/220 (48.2%). The real number of infected cattle, following standards, was 120/220 (54.5%). From these results the relative sensitivity rate of gamma-IFN test was 100% including the false-positive results and 88.3% for the SCTT--a significant (P < 0.01) difference in favour of the gamma-IFN test of 11.7%. The gamma-IFN assay also identified some positive animals 60-120 days earlier than the SCTT. In conclusion, we believe that the gamma-IFN assay can be used alone or in combination with the SCTT, as a valuable tool for the control of bovine tuberculosis in the Brazilian national herd.

Animals↗
PubMed1955

REPEATED tuberculin tests in the same site.

When the tuberculin-testing technique for the Tuberculosis Research Office field studies became so standardized that successive tests were being placed in about the same site on the forearm, there was a sudden and pronounced increase in the frequency of bullous reactions.Preliminary trials pointed to repeated testing in the same site as the most likely cause of this altered response to tuberculin. To obtain further information, a study was carried out on 356 mental patients, each receiving an initial test with 5 TU in one forearm and 3 months later two follow-up tests with 5 TU-one in the same site as the initial test and one in the corresponding site on the other forearm.This study shows that among tuberculin-sensitive persons the response to tuberculin injected into the site of a previous test differs both in size and in character from the response to tuberculin injected into an unused site. In the previously used sites the tuberculin reactions appear sooner and fade sooner than reactions in new sites; they attain greater maximum size and present a much higher frequency of bullae. Thus, the "used-site" phenomenon may cause practical problems in the interpretation of reactions in programmes involving periodic tuberculin-testing.

Humans↗
PubMed1994

The booster effect in two-step tuberculin testing among young adults in Montreal.

OBJECTIVES: No consensus exists regarding the definition and interpretation of a significant boosting reaction after sequential tuberculin testing. The booster phenomenon is thought to represent remote tuberculous infection where tuberculin reactivity has waned, but it has also been described among persons with previous exposure to other mycobacteria or Bacille Calmette-Guérin (BCG) vaccine. We studied the factors affecting the booster phenomenon among Canadian-born young adults to determine the definition that would maximize sensitivity and specificity of a positive booster reaction in these persons. DESIGN: Point-prevalence survey of initial tuberculin reactions and response to repeated tuberculin testing after 1 to 4 weeks. SETTING: Community-based study of all students entering health professional training programs at six post-secondary institutions. MEASUREMENTS: In 1989, 1990, and 1991, students completed self-administered questionnaires, underwent two-step tuberculin testing with purified protein derivative-tuberculin (PPD-T), and had their childhood BCG vaccination status verified. In 1991, students were also tested with purified protein derivative-Battey (PPD-B) (for Mycobacterium intracellulare). RESULTS: Overall, 74 students (5.2%) had positive booster reactions, which were significantly associated with older age (P < 0.001), larger initial tuberculin reactions (P < 0.001), previous BCG vaccination (P < 0.001), older age when vaccinated (P < 0.02), longer interval from vaccination to testing (P < 0.01), and sensitivity to PPD-B (P < 0.001). Boosting was not associated with the number of BCG vaccinations, sex, or risk factors for tuberculous infection. The pattern, mean, and mode of the frequency distributions of booster reactions among those with BCG vaccination and sensitivity to PPD-B were similar to those with assumed tuberculous infection. CONCLUSIONS: In young adults, booster reactions due to previous tuberculous infection are uncommon and cannot be distinguished from false-positive reactions due to past exposure to other mycobacteria.

Adolescent↗