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PubMed1987

Comparison of a multiple puncture tuberculin test, 'Imotest', and the Mantoux test in an Australian population.

The new multiple puncture tuberculin testing device, 'Imotest', was compared to the Mantoux test (10 I.U.) in an Australian population. The tests were applied simultaneously to opposite forearms of 105 volunteers. Sixty-eight per cent of the Mantoux tests were positive compared to 39% of the 'Imotests', resulting in a false negative rate of 44% and the difference was highly significant. A further 30 volunteers were tested with a different batch of 'Imotest' and similar results were obtained. When multiple 'Imotests' were applied simultaneously to each of two subjects in a separate study, there was a wide variation of response within each subject, and positive and negative reactions occurred side by side. These results indicate that the 'Imotest' is significantly less sensitive than the Mantoux test and is unsuitable for use as a diagnostic or screening test.

Australia↗
PubMed1986

Tuberculin testing in the young.

The child with a positive tuberculin reaction or uncomplicated primary tuberculosis rarely has symptoms. Since INH prophylaxis for one year will practically always prevent the severe forms of tuberculosis, early diagnosis is essential. An annual or biennial tuberculin test is recommended, and is always indicated when there has been known contact with a tuberculous adult. The Mono-Vacc test is a satisfactory screening device.

Adrenal Cortex Hormones↗
PubMed2001

[Two-step tuberculin testing and BCG vaccination in the personnel of a medical and pharmaceutical university].

In an attempt to cope with recent nosocomial spread of tuberculosis, the tuberculin test with a 0.05 microgram of 0.1 ml intradermal dose of purified protein derivative was performed by a two-step procedure on the personnel of a medical and pharmaceutical university, followed by BCG vaccination for non-reactors in the second test. The second test was repeated after two weeks in all but those with erythema of 10 mm or more in diameter associated with double erythema, vesicle formation, and/or necrosis on the initial testing. The first test was done in a total of 935 participants (73% of all personnel) with a median age of 37 (range, 21-67) years. The rate of participation, by occupation, in the hospital personnel ranged from 63% (183/289) for doctors to 98% (351/358) for nurses. The size of erythema showed a unimodal distribution with a peak in the range of 10-19 mm, with a median of 20 mm (range, 0-102). Reactions below 9 mm, which are interpreted as negative, were found in 16% of all participants, and those above 30 mm in 35%. Among participants aged 20-49 years, especially among nurses, reactions tended to be larger with increasing age. Among 539 participants undergoing repeated testing, reactions between the first and second tests correlated well, showing a median increase in size of 10 mm (range, -43-(+)70) on retesting. Reactions above 30 mm associated with an increase in size larger than 20 mm, among those initially below 29 mm in diameter, were observed in 28% of those retested. Adverse reactions such as vesicle formation with or without hemorrhage, or lymphangitis occurred in 2.5% of all participants on the initial testing and in 1.5% on the retesting, with the highest frequency seen in those aged 30-39 years. BCG was administered to 26 of the 49 participants with a negative reaction on the second test. All vaccinees with a median age of 30 (range, 21-46) years showed tuberculin conversion after two months without developing Koch's phenomenon soon after the vaccination. Incidentally, it is desirable that two-step tuberculin testing such as that in the present study should also be performed using the diameter of induration, particularly that measured transversely, since erythema is not used in any other country than Japan.

Adult↗
PubMedDate not supplied

[The importance of the tuberculin test in adults with bacteriologically confirmed pulmonary tuberculosis].

The tuberculin skin test is used worldwide to assess the tuberculosis infection in humans and animals. It is conventionally admitted that a reaction larger than 10 mm expresses a consumptive infection. It is possible to find a reaction smaller than 10 mm in patients with active disease, like bacteriological confirmed pulmonary tuberculosis, that is a negative reaction. 1719 patients with recently discovered bacteriological confirmed pulmonary tuberculosis were tested with PPD-IC65 solution 2 U/0.1 ml; 497 of them (28.9%) reacted less than 10 mm; 151 of these were retested with PPD solution 10 U/0.1 ml, in 11.5% of them the test was negative.

Adult↗
PubMed1991

Stability of positive tuberculin tests: are boosted reactions valid?

To determine the stability and presumed significance of tuberculin skin tests, we followed a cohort of 380 tuberculin-positive patients living in chronic care facilities. Each patient had a positive reaction (greater than or equal to 10 mm induration to 5 tuberculin units of purified protein derivative) to one of three sequential baseline tuberculin tests. One year after the initial series, each patient had a single repeat skin test. Reversion to a negative test occurred in 98 (26%) of the 380 patients. Decreases in induration of 6 mm or more occurred in 88 (90%) of the reverters. Initially positive tests were more likely (p less than 0.001) to remain stable than tests that were "boosted" to positive reactions on the second or third initial administration. Stable responses were found in 96% of those whose tests had greater than or equal to 15 mm induration compared with 61% of those with reactions of 10 to 14 mm induration. Increasing age also was associated with a high rate of reversion. The instability of boosted tuberculin reactions brings into question the clinical significance of these tests. We propose limiting tuberculin testing to two sequential tests.

Aged↗
PubMed1988

Booster effect of tuberculin testing in healthy 6-year-old school children vaccinated with Bacillus Calmette-Guérin at birth in Santiago, Chile.

In order to determine whether tuberculin testing caused a booster effect in children vaccinated with Bacillus Calmette-Guérin (BCG) at birth, we studied forty 6-year-olds by repeat tuberculin testing 2 weeks later on the contralateral forearm. All children were healthy and had no known exposure to tuberculosis. None of the children had a history of mycobacteriosis other than tuberculosis. The mean induration was 2.3 +/- 1.8 mm for the first tuberculin reaction and 7.6 +/- 3.3 mm for the second tuberculin reaction (P less than 0.005). Four children had positive reactions (greater than or equal to 10 mm) to the first purified protein derivative test; 18 children were positive upon retesting. Eleven of these latter children had increases of at least 6 mm from reactions less than 10 mm to greater than or equal to 10 mm. The size of the BCG scar was significantly correlated to the size of both the first and second purified protein derivative reactions (P less than 0.01), suggesting that the increased reactivity upon retesting was a consequence of sensitization induced by BCG vaccination 6 years earlier. All children remained healthy after this study was completed. Retesting of tuberculin reactivity within 2 weeks in BCG-vaccinated children with reactions less than 10 mm will produce reactions greater than 10 mm in some healthy children who may not require antituberculosis treatment.

Antibodies, Bacterial↗
PubMed1982

Reproducibility of the Tine tuberculin test. Research Committee of the British Thoracic Association.

The reproducibility of the tine tuberculin test was assessed by paired tests on 180 subjects. Using the recommended method of measurement, there was lack of agreement in 23%. The discrepancies were reduced to 18% using a different method. There were no examples of a subject with a negative response on one arm and a positive response on the other. The discrepant results always involved reactions classified as doubtful or intermediate on one are with a stronger or weaker reaction on the other. Thus there remains doubt about the ability of the Tine test to produce consistent reactions in tuberculin-positive subjects.

Adolescent↗
PubMed2002

Tuberculin test measurement: variability due to the time of reading.

STUDY OBJECTIVES: It is recommended that the PPD Mantoux tuberculin test be read at 48 or 72 h. We have compared the measurements at these time points. DESIGN: A 10-tuberculin unit (TU) PPD Mantoux test was administered to 116 healthy subjects (76.7% with bacillus Calmette-Guérin scars). PARTICIPANTS: One hundred sixteen healthy adult volunteers were recruited (health service employees, 29 volunteers; general public, 87 volunteers). RESULTS: The measurements made at 72 h were significantly higher than those made at 48 h (median, 9.4 vs 4.95 mm, respectively; p = 0.017). In those subjects with induration at either or both time points (n = 69), the readings taken at 72 h were on average 1.7 mm (95% confidence interval, 0.4 to 3.0 mm) larger than those at 48 h. Using an induration of > 15 mm diameter to define a positive result, there were more positive test results at 72 h (36) compared to 48 h (28), with the results from 10 subjects (8.5%) changing because of the time of measurement. CONCLUSIONS: This study demonstrates that, in adults, the size of the 10-TU Mantoux reaction is significantly larger at 72 h compared to the reaction at 48 h. In clinical practice, tuberculin tests should be read at 72 h as negative tests at 48 h may be false results.

Adult↗
PubMed1983

[Comparison of various tuberculin tests].

In 188 children results of the Mendel-Mantoux (10 or 100 IU) tuberculin test given intracutaneously were compared with ointment and patch tests as well as with three multipuncture tests using dried or fluid old or purified tuberculin. The new and easily performed multipuncture test with liquid old-tuberculin was significantly superior at 89.4% positive reactions to the other tests (Mendel-Mantoux test as standard at 100%). There were no false-positive results.

BCG Vaccine↗
PubMed1989

Cutaneous-delayed hypersensitivity in nursing home and geriatric clinic patients. Implications for the tuberculin test.

Cutaneous-delayed hypersensitivity was studied by one and two-step Mantoux-type skin tests to four standard antigens in 33 elderly nursing home residents, 34 geriatric clinic patients, and 20 healthy young adult controls. Demographic and anthropometric data were collected to determine the effects of nutrition and other variables on cutaneous-delayed hypersensitivity. Anergy (a lack of response greater than 5 mm of induration when read at 48 hours) to any of the four antigens occurred in 34% of nursing home residents, 17% of geriatric clinic patients, and none of the healthy young adults. Mean and maximal responses were less in the nursing home residents than the clinic patients or controls, even if anergic individuals were excluded from analysis, suggesting both a qualitative and quantitative decline in cell-mediated immune function in this elderly population. Repeat testing with each antigen for which there was a negative initial response revealed a "booster" affect of 7 to 19% and occurred as commonly in the healthy young adults as in the nursing home residents or geriatric clinic patients. The mumps antigen elicited strong responses in the healthy young adults, but weak reactions in the nursing home residents. An unexpectedly high prevalence of positive tuberculin (PPD) responses occurred in the nursing home residents, suggesting recent exposure. Analysis of anthropometric and demographic characteristics show that neither nutritional status nor age alone can account for differences in cutaneous-delayed hypersensitivity observed between populations. Cutaneous-delayed hypersensitivity may vary widely between elderly populations and have important practical implications for the tuberculin test.

Adult↗
PubMed1999

[The booster phenomenon in two-step tuberculin testing of employees in a community hospital].

A study was made to clarify to what degree the booster phenomenon was present when the employees in a community hospital in Japan received two-step tuberculin testing (PPD). Of the seventy-five employees, most of all BCG-vaccinated subjects, twenty-three showed strongly positive of more than 30 mm of induration at the first test (PPD/T1), and the remaining fifty-two subjects received a second (PPD/T2) after 2 weeks. The second PPD showed a marked increase in reactivity, sixteen subjects newly became strongly positive and six of eight who were initially PPD negative (< 10 mm) were converted positive, and the mean reaction size changed from 14.7 +/- 5.6 mm (PPD/T1) to 31.5 +/- 15.5 mm (PPD/T2). The degree of boosting, measured by the change in millimeters induration size between PPD/T1 and PPD/T2 (PPD/T2-PPD/T1), was correlated with neither the size of PPD/T1 nor the age of the study participants, and was not associated with the difference of the position in the hospital. Thus, we could not explain the factor why such a marked boosting was observed in this study. However, these results indicated that the two-step tuberculin testing is an essential means of distinguishing new tuberculous infection from booster phenomenon. We agree with the current recommendation for routine two-step testing of new employees in the hospital.

Adult↗
PubMed2004

[Improvement of tuberculin test results with BCG vaccination in set-city primary school children from 2000 to 2002].

PURPOSE: The effects of improved BCG vaccination for babies in Seto-city, Aichi were evaluated. METHOD: The tuberculin test was performed counting the number of BCG needle traces on 3409 children in the first class of primary school in Seto-city from 2000 to 2002. The children in 2000 and 2001 received ordinary BCG vaccination as babies, while the children in 2002 received the improved BCG vaccination. Children who had not received any BCG vaccination were excluded. RESULTS: Percentages of children with needle traces were 25.1% in 2000, 38.1% in 2001, and 70.5% in 2002. Values for those with a positive tuberculin test (PTT percentages) were 32.5% in 2000, 36.5% in 2001, and 63.7% in 2002. The differences were highly significant (P < 0.001) between 2000, as well as 2001 and those in 2002 in the two categories. The PTT percentages with needle traces were 41.8% in 2000, 42.0% in 2001, and 66.9% in 2002, as compared with 29.4%, 33.1%, and 56.1%, respectively for no needle traces. The difference was highly significant between children with needle traces in 2000 and those with no needle traces in 2002 (P < 0.001). The PTT percentages with one to nine needle traces were 40.2% in 2000, 34.0% in 2001, and 63.9% in 2002, and for 10 to 18 needle traces were 46.3%, 55.7%, and 70.7%, respectively. Percentages of children with reddening of the skin from 0 to 4.9 mm in diameter were 34.6% in 2000, 33.3% in 2001, and 16.3% in 2002, and for 5 to 9 mm were 32.8% in 2000, 30.2% in 2001, and 20.0% in 2002. Differences were highly significant between 2000 and 2002 in both categories (P < 0.001). CONCLUSION: These results suggest that improved BCG vaccination has significantly increased tuberculin-positive children, with or without needle traces. The number of needle traces seems to be a less important factor than the percentage of children with needle traces.

BCG Vaccine↗