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PubMed1996

[Non-specific tuberculin reactivity due to sensitization to non-tuberculous mycobacteria (NTM) in children not vaccinated with BCG. Diagnostic value of a comparison of intradermal tests with tuberculin and NTM antigens].

Sensitisation to non tuberculous mycobacteria (NTM) may provoke a non specific tuberculin reaction and can cause problems in the interpretation of tuberculin tests in subjects who have not been vaccinated with BCG. The practice of testing for antigens to NTM (sensitins) should be useful for pointing to the right diagnosis. Our study was carried out on 24 asymptomatic children aged between 11 months and 8 years 9 months; these children were considered to be sensitive to NTM based on comparative cutaneous tests (reactions to sensitins > or = 5 mm and > or = 3 mm vs tuberculin) and were selected from a group of 53 children who had either initially achieved a positive tuberculin reaction or who had undergone conversion on subsequent prevaccination testing. The tests were carried out with tuberculin RT 23, tuberculin Merieux and sensitins from M. avium and M. intracellulare. They had been repeated two to four months later in cases of a response to one of the different reactants. At the first examination the tuberculin reactions were most often weak, the Merieux tuberculin induced a stronger response than the RT23 tuberculin. A dominant response for one or both sensitins was present in 18 cases. The tuberculin reactions became weaker whilst the sensitins remained relatively stable. The difference became significant in the six remaining cases. Although tests for tuberculin and sensitins have some diagnostic value which is necessarily imprecise, comparative analysis of the cutaneous reactions to the different antigens may contribute to avoid an erroneous interpretation for tuberculin allergy in asymptomatic young children without any risk factors for tuberculous infection. It is important to identify those subjects having non specific tuberculin reactivity induced by sensitisation to NTM in order to avoid non justified chemoprophylaxis and also to be able to vaccinate these children with BCG.

Antigens↗
PubMed2006

A university hospital's 10-year experience with tuberculin testing: value of the 2-step tuberculin skin test.

BACKGROUND: The usefulness of the 2-step tuberculin skin test as a tool for monitoring tuberculosis exposure among health care workers is controversial. OBJECTIVES: We aimed to determine the cost-effectiveness and influence of initiation of a preemployment, 2-step tuberculin skin-testing program on the annual tuberculin skin conversion rate among a university hospital's health care workers. METHODS: The tuberculin skin test conversion rates among the recipients of 31,729 tuberculin skin tests over 10 years were retrospectively analyzed. Data from the first 6 years of this study were generated when a single preemployment tuberculin skin test was utilized. Data from the last 4 years were gathered after the advent of a preemployment 2-step program. A cost analysis of the 2-step tuberculin skin test process was performed to determine the annual cost of this program. RESULTS: Relative risk of a conversion was 8.43 times less during the 2-step period when compared with the years when a single tuberculin skin test was given at the start of employment (P < .001). A cost analysis showed that the annual added cost of the 2-step program was approximately 9,565 US dollars. CONCLUSION: A greater than 8-fold reduction in the number of annual tuberculin skin test conversion coincided with, but could not be attributed solely to, the initiation of a 2-step program in our hospital. The Infection Control Committee concluded that the 2-step testing program is essential to achieve the hospital's goal of a 0% annual tuberculin skin test conversion rate and that the annual cost is justified.

Chi-Square Distribution↗
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↗
PubMed1958

Inhibition of tuberculin skin hypersensitivity in guinea pigs by injection of tuberculin and intact tubercle bacilli during fetal life.

FEMALE GUINEA PIGS WERE SUBJECTED TO LAPAROTOMY AT DIFFERENT STAGES OF PREGNANCY, AND THEIR FETUSES INJECTED THROUGH THE UTERINE WALLS WITH ONE OF THE FOLLOWING PREPARATIONS: Old Tuberculin, tubercle bacilli of the BCG strain killed by heat or exposure to phenol, and living BCG. A large number of the animals injected in utero with Old Tuberculin failed to develop skin hypersensitivity to P.P.D. following vaccination with 200 or 800 gamma phenol-killed tubercle bacilli (BCG) in early adulthood. Normal control animals were sensitized by vaccination with such quantities of phenolized BCG. The failure of animals which had been injected with Old Tuberculin in fetal life to respond hypersensitively to P.P.D. after adult vaccination with tubercle bacilli is ascribed to their acquisition of a state of immunological tolerance to tuberculoprotein (tuberculin tolerance). Fetal injection with killed BCG conferred a state of tolerance on a few of the animals, and rendered others tuberculin-sensitive. Fetal injection with living BCG sensitized most of the animals to tuberculin, even when fetal exposure was as early as 46 days before birth, and induced tolerance in none. Fetuses of the same litter, injected simultaneously with identical inocula, often responded differently, some becoming tolerant to tuberculin, others developing hypersensitivity, and still others remaining immunologically unaffected, becoming neither sensitive nor tolerant. The state of tuberculin tolerance induced in these experiments was limited. When tolerant animals were revaccinated with living BCG several weeks after vaccination with phenol-killed bacilli, they developed as high a degree of tuberculin skin sensitivity as the originally non-tolerant animals.

Animals↗