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[Practical application of tuberculin tests].

A study was conducted to compare the Tuberculin-Tine test with the Tuberculin Monotest; a total of 1861 pupils (age 15) were tested with either of the two tests, non-reactors were retested with a Mantoux-Test of 10 UI. False negative rates were 16% for the Tuberculin Tine-test and 25% for the Monotest. However the positive reactions of the Monotest were more unequivocal.

Adolescent↗

[Interpretation of the tuberculin test in children].

Tuberculosis is a resurgent disease in Spain. One of the most important reasons is immigration from countries in which this disease is highly endemic. The pediatric population is especially susceptible to adults with tuberculosis and an infected child represents a sentry event of recent transmission in the community. The tuberculin test is an essential instrument in the evaluation of this disease and therefore a determining factor in the therapeutic approach adopted. This document aims to clarify and unify criteria related to the techniques and interpretation of the tuberculin test in children in our environment.

Child↗

Two-step tuberculin testing of passengers and crew on a commercial airplane.

OBJECTIVES: We investigated the risk of tuberculosis transmission from a person with highly infectious pulmonary tuberculosis to fellow passengers and crew members on a 14-hour commercial flight. The 2-step tuberculin testing was used to minimize the effects of the booster phenomenon. METHODS: Passengers and flight crew members identified from airline records were contacted by letter, telephone, or both to notify them of their potential exposure to Mycobacterium tuberculosis. The subjects were advised to undergo Mantoux tuberculin skin testing within the required time period to assess a conversion. In addition, information regarding tuberculosis history and other sources of potential exposure was solicited by means of a questionnaire. RESULTS: Of the 277 passengers and crew members on the aircraft, 225 (81.2%) responded. Of these, 173 (76.9%) had positive tuberculin results on the first test (induration > 10 mm). Thirteen subjects with negative results refused further testing; 11 (28%) of the remaining 39 exhibited the booster phenomenon on the second test. Subjects who exhibited the booster phenomenon were significantly more likely to have received previous BCG vaccination. Nine contacts with negative results on the initial test had positive results on a third test administered at 12 weeks after the flight exposure Of these, 6 contacts had previous BCG vaccination, old tuberculosis, or a family member with tuberculosis; the remaining 3 reported on other risk factors for positive reactions. None of these 3 contacts had sat in the same section of the plan as the index patient. CONCLUSIONS: The 2-step tuberculin testing procedure is an effective tool for minimization of the booster effect, thus allowing accurate monitoring of subsequent tuberculin conversion rates. Moreover, the clustering of tuberculin skin test conversions among passengers in this study demonstrates the possible risk of M tuberculosis transmission during air travel.

Adult↗

National tuberculin test survey in Ethiopia.

To plan and implement an effective National Tuberculosis Control Programme, it is essential to know the incidence of tuberculosis. Thus a tuberculin survey was conducted in Ethiopia between December 1987 and April 1990. A sample of 55 children, aged 6 to 10 years was selected from each of 480 representative clusters from 16 weredas (districts), which were chosen randomly. A total of 26,529 children were given intradermal tuberculin test and the results read in 26,269. There were 23,595 children who had no BCG vaccination of whom 2,503 (10.6%) were positive; this gives a "risk of infection" of 1.4% which is lower than the 3.0% reported for the same age group during the tuberculin survey in 1953-1955, suggesting that there has been a reduction in the tuberculin test positivity rate.

BCG Vaccine↗

Papillomavirus-induced dermatofibroma in cattle following tuberculin testing.

Papillomavirus was identified in two fibromatous dermal nodules which were representative of those present in the caudal fold skin of the tail in 25 of 145 beef cattle tuberculin tested 3 months earlier. Bovine warts were endemic on the property and it is hypothesised that the papilloma virus was introduced intradermally by a virus-contaminated tuberculin syringe. At palpation, the well-circumscribed hard nodular lesions were atypical of the diffuse caudal fold swelling usually present in reactions to tuberculin. Provided tuberculin testing officers are aware of the risk of fibroma and papilloma induction by transmission of papillomavirus, and they are careful to prevent equipment coming into contact with warts at time of inoculation, this source of inaccuracy may be avoided.

Journal Article↗

Comparison of multiple puncture liquid tuberculin test with Mantoux test.

Two studies were performed to compare the disposable liquid tuberculin PPD 'Imotest' with the Mantoux test. While there was a tester effect in the first study indicating the need for accurate application of the imotest, the results of the second study showed that the two tests were comparable in selecting truly positive and negative tuberculin reactors. Results were compared both by conventional methods and by a method new to tuberculin testing, the maximum likelihood technique. This method gives a more accurate estimate of false reaction rates. A significant difference was found between reading at 48 and 72 h for both tests. The acceptability and ease of reading of the imotest, with a tuberculin selectivity comparable to the Mantoux method, make it a suitable alternative tuberculin test, especially for screening large populations.

False Negative Reactions↗

Effect of intradermal tuberculin tests on BCG-induced allergy.

Trials are going forward to determine whether intradermal tuberculin testing with 10 TU at yearly intervals after BCG vaccination may prevent waning of BCG-induced allergy in schoolchildren. Meanwhile, two experiments to the same purpose, carried out in guinea-pigs, are described. They show that waning allergy in guinea-pigs can be sustantially enhanced by intradermal injection of either purified tuberculin or Old Tuberculin, the effect lasting for at least 8 weeks, even with so small a dose as 5 TU. It is pointed out that this enhancing effect has been demonstrated only in BCG-vaccinated guinea-pigs and that it is not known whether the same phenomenon would occur in guinea-pigs infected with living human tubercle bacilli.

BCG Vaccine↗

The current value of tuberculin testing and BCG vaccination in school children.

We have examined the value of routine tuberculin testing and BCG vaccination in Edinburgh school children from 1970 to 1983. Over 89,000 children were observed for a mean period of 7 years, during which 77 new cases of tuberculosis were notified in Caucasians. The average annual incidence of tuberculosis in the 65,692 children receiving BCG vaccination at school was 7/10(5), significantly less than the 19/10(5) estimated in 12,987 Heaf negative children who missed BCG vaccination, and the 41/10(5) in 5,308 tuberculin positive children (P less than 0.001). The efficacy of BCG vaccination in this study exceeded 60%. The 5,308 tuberculin positive children were offered chest radiographs with an initial yield (new cases of tuberculosis detected/radiographs taken) of 1/555 for Heaf grade II children, 1/75 for grade III, and 1/25 for grade IV (P less than 0.001). During the period of this study approximately 700 BCG vaccinations were necessary to prevent one new case of tuberculosis and this represents considerably greater benefit than in England and Wales during the same period. There may be a case for continuing the schools' BCG programme in Scotland for a number of years longer than in England and Wales. A national BCG survey for Scotland would be valuable.

Adolescent↗