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PubMed1991

Field comparison of the interferon-gamma assay and the intradermal tuberculin test for the diagnosis of bovine tuberculosis.

An extensive field comparison of the gamma interferon (IFN-gamma) assay and the single intradermal tuberculin test for the diagnosis of bovine tuberculosis was conducted in Australia. The specificity of the IFN-gamma assay was determined by testing more than 6000 cattle from tuberculosis-free herds and varied from 96.2% to 98.1%, depending on the cut-off point chosen to define a positive reactor. For the sensitivity trial, cattle from herds being de-populated because of bovine tuberculosis were examined with both assays. The sensitivity of the IFN-gamma assay was shown to be significantly higher than the single intradermal tuberculin test and varied from 76.8% to 93.6% depending on the method of interpretation. A maximum overall sensitivity of 95.2% was obtained by testing with the IFN-gamma and the tuberculin test in parallel. The superior sensitivity of the IFN-gamma assay and the ability to adjust the sensitivity of the system depending on the task involved, will provide the Australian Tuberculosis Eradication Campaign with a valuable additional test to enable it to accomplish its goals.

Animals↗
PubMed2003

Influence of smoking on cutaneous delayed-type hyper sensitivity reaction by tuberculin skin test.

Tuberculin test (purified protein derivative) is currently accepted as a standard investigation used in the diagnosis of tuberculosis (TB). Although the sensitivity of the test is reliable, a substantial number of those subjected to screening for TB by such test are cigarette smokers. This study is designed to investigate the effect of smoking on cell-mediated delayed-type cellular hypersensitivity (DTH) reaction by PPD. Prospective, case-control study was conducted at the Chest and TB unit of Chest Hospital Kuwait. The study population consisted of 357 healthy volunteers serving as controls and 200 in-patients under direct medical supervision and treatment for tuberculosis as cases. The mean age was 33.69 +/- 8.6 SD; 286 were current smokers and 271 were lifetime non-smokers. PPD test was done using 2TU RT23 SSI-Denmark on all subjects. Median PPD was significant among the cases (P=0.03) between smokers and non-smokers and was highly significant among the healthy controls (P<0.001). No significant difference was seen between median pack years of smoking and PPD levels among the patient group (P=0.264) but the difference was significant among the control group (P<0.001). Univariate analysis of variance (ANOVA) on PPD, taking into account age, pack years of smoking, ethnic groups and BCG scar showed sufficient response but was not statistically significant to all these factors. Smoking habit does not appear to influence the cutaneous delayed type hypersensitivity reaction by tuberculin skin test.

Adult↗
PubMed1999

Tuberculin test variability: using the Norwegian Adrenaline-Pirquet method.

SETTING: Chest Unit, Bergen, Norway. OBJECTIVES: To study the agreement between two Adrenaline-Pirquet tuberculin tests and compare reactivity in groups read after 2, 3 and 4 days. DESIGN: Responders from a random sample of 1200 men and women 20-44 years of age in 1991 were tested with dual Adrenaline-Pirquet skin scratch tests with Norwegian-produced synthetic medium tuberculin and read after 2-7 days. RESULTS: Of 588 subjects dually tuberculin tested, complete agreement existed in 220 (37.4%). A difference of 1 mm one way or the other was observed in 239 (40.6%), whereas a difference of less than 3 mm was found in 567 (96.5%). Using the larger of the two reactions increased the rate of tuberculin positivity (> or =4 mm) by up to 8.4% compared with reading only one of the tests. No statistically significant differences were observed between subjects whose reactions were read after 2, 3 and 4 days. CONCLUSION: Under the non-blinded conditions of this study the dual Adrenaline-Pirquet tuberculin tests demonstrated reproducibility equivalent to the internationally recommended Mantoux test, and appeared to be independent of time of reading within four days.

Adult↗
PubMed2005

The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis.

BACKGROUND: Cutaneous sensitivity to the tuberculin antigen is thought to indicate latent tuberculosis infection (LTBI). Some guidelines suggest treating end-stage renal disease (ESRD) patients for LTBI on the basis of tuberculin positivity. The prevalence of tuberculin sensitivity and cutaneous anergy in Indian patients with ESRD and the utility of the tuberculin test for predicting post-transplant tuberculosis are not known. METHODS: We prospectively studied cutaneous tuberculin reactivity and anergy in 108 ESRD patients and 100 age- and sex-matched healthy controls. Mumps antigen and tetanus toxoid were used as control antigens. Patients who failed to react to all antigens were classified as anergic. Seventy-nine patients underwent living donor kidney transplants and were followed-up for approximately 2 years. RESULTS: About 44% of ESRD patients and 66% of controls showed tuberculin reactivity (P = 0.0018). The prevalence of anergy was significantly higher in the ESRD population (44% vs 16%, P<0.001). The haemoglobin, serum albumin and creatinine values were significantly higher amongst the tuberculin-reactor ESRD patients. Tuberculin positivity and anergy rates in a subgroup of well-nourished ESRD patients were similar to the control population. Four patients developed tuberculosis after transplantation. Tuberculin test had a sensitivity of 50% and a specificity of 52% for post-transplant tuberculosis. CONCLUSIONS: In comparison to healthy controls, tuberculin reactivity rates are lower and anergy rates higher in Indian ESRD patients. There is a significant relationship between markers of nutritional status (haemoglobin, albumin and creatinine) and cutaneous reactivity. Pre-transplant Mantoux positivity has low sensitivity and specificity for predicting post-transplant tuberculosis.

Adolescent↗
PubMed2002

[Comparison of effectiveness of BCG vaccination and preventive therapy in Japanese settings, with special emphasis on the sensitivity and specificity of tuberculin testing].

BACKGROUND: BCG vaccination in low prevalence countries is controversial. Most discussions have been done by the comparison of benefit, side effect and cost of BCG vaccination. No discussion has been done on the disadvantage of BCG vaccination from the point of view of loss of sensitivity and specificity of tuberculin test on the diagnosis of LTBI. METHOD: Three groups, i.e. the BCG vaccination group with preventive therapy under worsened sensitivity and specificity of tuberculin test due to previous BCG, no intervention group and non BCG vaccination group with preventive therapy under standard sensitivity and specificity of tuberculin test were set up. The target population was a cohort of Japanese who are born at the year with 0.1% annual risk of tuberculous infection. The TB incidence, TB related mortality (including death by BCG and preventive therapy), TB related loss of DALY (disability adjusted life years), and direct medical cost of the above three groups, for the cohort only and the cohort including secondary TB cases from the clinical cases in the cohort. RESULTS: Under the current program conditions, the merit of BCG vaccination is greater than the merit obtained from the preventive therapy without BCG. Although the medical direct cost is lowest among the preventive therapy group without BCG, next without BCG or preventive therapy and highest among BCG group. Under BCG group, too extensive screening for LTBI does not reduce the loss of TB related DALY, whereas in the non BCG group, extensive screening will help to reduce the loss of TB related DALY and if more extensive screening can be done, the loss of TB related DALY in the non BCG group can be less than that in the BCG group. CONCLUSION: At present extensiveness of screening for LTBI and BCG vaccination contribute to the reduction of TB and loss of TB related DALY. Possible extensive screening without BCG may be able to reduce loss of TB related DALY in comparison to the BCG vaccination group.

BCG Vaccine↗
PubMed2001

Repeat tuberculin testing in BCG-vaccinated subjects in the United Kingdom. The booster effect varies with the time of reading.

The booster effect varies between populations, but has not been studied in the UK. The aim of this study was to investigate the effect of repeat tuberculin tests at 1 wk in BCG-vaccinated healthy subjects (all hospital employees) in the UK; we have assessed whether a booster effect is present 48 and 72 h after injection. Twenty-six subjects received two tuberculin tests (both 10 units) administered by the Mantoux technique-Tests 1 and 2. At Test 2 there was a significant increase in induration at 48 h (mean, 7.8 mm; p < 0.001), no difference at 72 h (mean, 0.2 mm; p = 0.93), and a reduction at 96 h (mean, -4.2 mm; p = 0.02). There were more positive results (> 15 mm induration) at Test 2 compared with Test 1 at 48 h (19 vs. 9, respectively; p = 0.002), but similar numbers at 72 h (11 vs. 10, respectively). These results show that repeat tuberculin testing in this BCG-vaccinated population caused a booster effect that varied with the time of measurement and was maximal at 48 h.

Adolescent↗
PubMed1966

Enhancing of tuberculin allergy by previous tuberculin testing.

A controlled study on the enhancing of tuberculin allergy by one or more earlier tuberculin tests was carried out in a previously untested and unvaccinated population, in an area where the prevalence of non-specific allergy was known to be high. The results have shown that a test with 1 TU of PPD RT 23 in Tween 80 diluent causes subsequent tests to elicit significantly larger reactions. This enhancing effect is more marked among those with initial reactions of 8-13 mm to 1 TU or 10 mm and more to 20 TU. There is practically no enhancement among those whose reactions to 20 TU measure 0-4 mm or even 0-9 mm. Even in the group with reactions of 10 mm and more to 20 TU only some individuals show evidence of enhancement. The enhancing of allergy increases with age.The addition of a 20 TU test increases the enhancement of allergy but mostly among those with reactions of 8-13 mm to 1 TU.The findings suggest that enhancement may be more marked in communities with a high prevalence of non-specific allergy.

Female↗
PubMed1978

Evaluation of the tuberculin test in Malawi.

In a trial involving 371 head of cattle, the results of using avian plus bovine tuberculin and avian plus mammaliam tuberculin were compared. One group of 185 cattle from areas of low tuberculosis incidence and another group of 186 cattle from areas of high incidence were tuberculin tested and examined for pathological lesions. Using the interpretation "non-specific infection not established" with avian plus mammaliam tuberculin on the readings from cattle from high incidence areas, the test detected 83% of the cattle with visible lesions, whereas the avian plus bovine tuberculin test only detected 63%. The avian plus mammaliam tuberculin test is therefore more accurate; however, it appears to be too sensitive as it produces a higher rate of inconclusive results from non-infected cattle, and is thus more difficult to interpret. Many cattle giving positive reactions were found to be free of tubercular lesions when examined post mortem; the possibility is discussed of their allergy to the test being caused by mycobacteria other than tuberculosis, as mycobacteria belonging to Runyons Group IV have been isolated from some of these cases.

Animals↗
PubMed2000

[Study of the two-step tuberculin tests and gamma-interferon assays in elderly persons].

Recently, an outbreak of lung tuberculosis among elderly residents happened in the home for aged, and it has become a social problem. To analyze the problem of tuberculosis in the elderly persons, we performed two-step tuberculin tests at two weeks interval and gamma-interferon assays for diagnosis of human tuberculosis to residents in the home for aged. 45 males (age; 77.3 +/- 8.9 SD) and 118 females (age; 81.9 +/- 8.6 SD) elderly persons (> or = 60) were examined. Standard dose of PPD was injected intracutaneously, and read at 48 hours. Erythema of 10 mm diameter or more was considered positive. The results were as follows. (1) The percentages of positive reactors in the 1st (T1) and the 2nd (T2) tuberculin tests were 50.3% and 68.1%, respectively. (2) The diameters of erythema and percentage of positive reactors (T1) did not very with age, but the size of erythema increased from 13.5 mm (T1) to 21.2 mm (T2) among those below 80 years, and from 13.0 mm (T1) to 16.4 mm (T2) among those 80 years or higher (p < 0.01). (3) The percentage of positive reactors (T1) varied by sex, namely males react stronger than females. (4) A dose of interferon-gamma released specifically in response to PPD stimulation of whole blood cultures showed no close relation with the diameters of erythema. In conclusion, tuberculin reactivity waned among elderly persons, and the fact suggests that they would have lower resistance against new infections, and as a result, they might have higher risk of developing tuberculosis. Elderly residents should be performed two-step tuberculin tests at the time of their entrance to the home for aged, and negative reactors should carefully be followed up.

Aged↗
PubMed1995

The relationship between the tuberculin test and the Kveim test in sarcoidosis in Ireland.

The aim of this study was to correlate tuberculin reactivity with the Kveim test in sarcoidosis. Case records 1983-91 inclusive, of those patients with positive Kveim tests and recorded tuberculin tests in an acute regional general hospital serving south-west Ireland (counties Cork and Kerry) were reviewed. Of 39 patients with positive Kveim tests 28 (72%) were tuberculin negative to a test dose of 10 tuberculin units or more. The group was slightly though significantly younger (p < 0.05) in age than the corresponding group (n = 11; 28%) with positive tuberculin tests. The incidence of tuberculin reactivity in the presence of Kveim reaction is higher than that expected for sarcoidosis. Corresponding studies in Britain and Scandinavia show a considerably lower tuberculin positive rate, which may be due to a lower prevalence of tuberculosis in these countries. However the younger age of the tuberculin negative group in our study may reflect a continuing decline in tuberculosis prevalence in south-west Ireland.

Adult↗
PubMed1989

Tuberculin testing: comparison of imotest with Heaf and Mantoux.

Immunisation against tuberculosis is still recommended for secondary school children in the UK. Only children who do not react to tuberculin tests are offered vaccination. We report the results of two studies, carried out to evaluate a new applicator of the disposable Imotest multiple puncture tuberculin test. The results demonstrate that Imotest is well tolerated and compares favourably with the Heaf and Mantoux tests. Imotest detected significantly more tuberculin responders than Heaf.

Child↗
PubMed1992

[Predictive value of the standardized tuberculin test in children vaccinated with BCG].

The applicability of tuberculin test in children under five years of age, BCG-vaccinated during their first year of life, is a controversial matter. With a view to clarifying the subject the predictive positive value of the test in a region of high BCG coverage and low prevalence of tuberculous infection was analysed. From the proportion of strong reactors among infants and school-age children, vaccinated and not unvaccinated, the declining rate of BCG induced allergy and the increment rate of naturally acquired tuberculin sensitivity between the first and the seventh years of life were calculated. Those calculations allowed for the estimation of the respective values for the intermediate ages. The numbers of false positives to be expected were calculated by difference. Knowing the sensibility and the specificity (1 - FP) of the test, the BCG coverage and the prevalence of infection, the predictive values for tuberculous infection were: 1.52%, 4.22%, 8.26%, 14.86% and 23.00%, respectively from the first to the fifth years of life. Under these conditions, the probability of a strong reaction being provoked by BCG is very high, decreasing the applicability of the test both in clinics and epidemiology.

BCG Vaccine↗