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PubMed1965

A NEW APPROACH IN DISPENSING TUBERCULIN PPD AND IN PERFORMING A MULTI-PUNCTURE TUBERCULIN TEST.

A simple and low-cost kit for single-dose tuberculin testing is described. For those who perform occasional tuberculin tests only, this kit is proposed as a substitute for the Heaf apparatus used in carrying out a multi-puncture test. No difference in the tuberculin skin reactions could be observed when the needle multi-puncture test was compared with the Heaf test in BCG-sensitized guinea pigs and in 12 volunteers. A comparative study on 37 student nurses, using the needle multi-puncture method and the intracutaneous method (Mantoux test), showed that with the needle multi-puncture method more positive reactors were detected than with the Mantoux test using 1:2000 dilution of OT. However, more positive reactors were obtained with the Mantoux test using 1:100 dilution of OT. It is felt that the singledose kit can be a valuable asset when only few skin tests are performed.

Animals↗
PubMed2000

Density of tuberculin skin reaction and its association with tuberculosis infection as defined by dual tuberculin testing.

OBJECTIVE: To determine whether the density of tuberculin skin reactions is associated with tuberculosis infection. METHODS: In a national tuberculin survey in Tanzania, 1983-1987, all eligible children in a random sub-sample of schools underwent dual tuberculin skin testing with PPD-RT23 and PPD-scrofulaceum. The density of reactions to RT23 was classified as proposed by Palmer. A larger reaction to PPD-scrofulaceum than to PPD-RT23 is suggestive of infection with environmental mycobacteria. Tuberculosis infection was defined based on dual skin test results applying a range of possible definitions. RESULTS: A total of 10,782 children aged 5-14 years and without BCG scar were included in the analysis. Large skin reactions to RT23 were generally firmer than small ones. After taking the size of the skin reaction to RT23 into account, its density was not associated with the size of the skin reaction against PPD-scrofulaceum. In particular, the density of reactions in the range 6-11 mm was not associated with tuberculosis infection according to any of the definitions used. CONCLUSION: This study suggests that the density of reaction was not associated with tuberculosis infection in Tanzanian school children after taking the size of the induration into account.

Child↗
PubMed2005

Tuberculin skin test results and the booster phenomenon in two-step tuberculin skin testing in hemodialysis patients.

Patients with chronic renal failure are at increased risk for tuberculosis (TB). Centers for Disease Control and Prevention (CDC) have recommended annual skin testing for TB, with tuberculin-purified protein derivative (PPD), in patients with chronic renal failure. Uremia alters the macrophage function, which can lead to anergy for skin tests. The aim of this prospective study was to determine the prevalence of positive tuberculin skin test (TST) and the booster effect of TST in hemodialysis patients living in a relatively underdeveloped portion of the country. Material and Methods. Patients were recruited from Van (Yuzuncu Yil University Hospital, Yuksek Ihtisas Hospital) and the Mus State Hospital). At the time of this study, a total of 143 patients were under hemodialysis treatment in these hemodialysis centers, and among them, 124 were included in the study. Informed consent was obtained before inclusion in the study. A positive PPD was an induration of >10 mm in response to five tuberculin units of PPD (RT23-Tween 80), at 72 h. TST-negative patients received a booster TST 10 days later, approximately 10 cm away from the previous intracutaneous injection. The test dose could not be increased due to unavailability of this kind of preparation. The test was performed and interpreted in the same way. Skin testing was performed in June and December 2003. Patients with known active TB are not included in the study. Testing was not done in hospitalized patients to rule out effects of other disease states. Results. Mean age of the patients was 45.3 +/- 16 (range 13-82) years. All patients were on HD treatment twice (n: 14) or three times (n: 110) weekly. Duration of dialysis before TST was 30 +/- 17 (12-84) months. With the first test (n: 14), 11.3% of the patients showed a positive reaction; the second test added (n: 15) 12.1% more TST-positive patients, reaching a total of (n: 29) 23.4% of the patients with a positive TST. The

Age Distribution↗
PubMed1997

Comparison of a tuberculin interferon-gamma assay with the tuberculin skin test in high-risk adults: effect of human immunodeficiency virus infection.

A novel, whole blood interferon-gamma (IFN-gamma) assay was evaluated to determine its suitability for detecting Mycobacterium tuberculosis exposure in intravenous drug users with or without human immunodeficiency virus (HIV) infection. Whole heparinized blood was incubated overnight in separate wells with tuberculin purified protein derivative (PPD), saline, and mitogen controls. Levels of IFN-gamma in plasma supernatants were determined by rapid ELISA. Participants were then administered the tuberculin skin test (TST) and tested for cutaneous anergy. The whole blood IFN-gamma test agreed (89%-100%) with a positive TST in both HIV-seropositive and -seronegative subjects, but reactivity to PPD was more detectable by the whole blood assay among those with negative TSTs or anergy. TST induration diameter and IFN-gamma responses were correlated (Spearman's p = .45, P = .0001), but both responses were blunted by HIV infection. In summary, tuberculin reactivity appears to be more detectable by the whole blood IFN-gamma assay than by TST, and the assay requires no return visit for test reading.

Adult↗
PubMed2002

[The tuberculin reaction two years after the initial two-step tuberculin skin test in our hospital].

The tuberculin skin test was carried out to employees of our hospital one and two years later after the initial two-step tuberculin skin test in 1999 to examine the possibility of new tuberculosis infection. Nineteen weakly positive reactors aged 39-year-old or less in 1999 were followed up by tuberculin reaction for two years. The significant changes were not recognized in either the size of erythema or the size of induration, examined by one-way ANOVA and Tukey-Kramer multiple comparison procedure. Among weakly positive reactors aged 39-year-old or less, it seemed that there had been no new tuberculosis infection during 2 years follow-up.

Adult↗
PubMed2000

Effect of anti-tuberculosis treatment on the tuberculin interferon-gamma response in tuberculin skin test (TST) positive health care workers and patients with tuberculosis.

SETTING: Public hospital, Victoria, Australia. OBJECTIVE: To evaluate the effect of multidrug treatment and isoniazid (INH) chemoprophylaxis on the tuberculin interferon-y assay (QIFN) in 19 patients with culture-confirmed Mycobacterium tuberculosis and 119 health care workers (HCWs) with tuberculin skin tests (TST) > or =15 mm. DESIGN: Patients with M. tuberculosis were treated with standard medication and tested with QIFN at diagnosis and at regular intervals over a 12-month period. All HCWs, 59 (50%) of whom were prescribed INH chemoprophylaxis, were tested with QIFN at baseline, 2, 4, 6 and 12 months. RESULTS: QIFN results in patients with tuberculosis were consistent and reproducible. At the initial time point QIFN assays were positive for M. tuberculosis in 67%, and once positive, the QIFN assay remained so over the 12-month period. In the HCWS, initial QIFN assays were positive in 73 (61%). During the 12-month study, 91 HCWs had a QIFN assay on at least two occasions. The overall reproducibility between tests was fair (kappa statistic = 0.45), and was little affected by administration of INH. CONCLUSION: These data suggest that although the QIFN assay is generally positive in patients with proven tuberculosis, it does not provide clinically useful information during the first 12 months of treatment with multidrug chemotherapy or INH chemoprophylaxis.

Adult↗
PubMed1975

Suppression of tuberculin skin reactivity by prior tuberculin skin testing.

In two consecutive studies, eighteen and forty-one normal subjects were given a standard tuberculin skin test of 1 tuberculin unit (0.02 mug of PPD). Two days later another skin test was given. Readings of the skin reactions showed that subjects exhibiting strongly positive skin reactions in their primary skin tests showed a significantly smaller indurations in their primary skin tests tended to have equal or larger areas of induration after the secondary skin tests. These observations are discussed in relation to the possible existence of regulatory mechanisms of cell-mediated immune reactions.

Adult↗
PubMed2002

[Problems about tuberculin skin test raised from consultations and countermeasures--influence to the interpretation of tuberculin skin test in case of the stoppage of BCG revaccination abolition and the introduction of induration measurement].

Since people have very limited access to informations on TB, Chiba Anti-TB Association started "Chiba Kekkaku Dial 110", free TB consultation service through telephone, fax and e-mail, since October 1997. We received 1453 consultations during three years by September 2000. The most frequent consultations was about tuberculin skin test (TST) that amounted to 383, 26.4% of the all consultations. We reviewed the consultations on TST to know why consultations on TST are so frequent and what are problems clients want to know. We categorized the consultations according to the professions of clients and three periods of TST, that is, before testing, during testing and reading, and post reading. There were 178 (46.5%) consultations from health professionals, 134 (35.0%) from general citizens and the rest of them were from those unknown job. The health professionals were 94 physicians, 34 public health nurses, 23 school nurses, 19 nurses, 2 medical technicians, 2 radiographers and 4 others. Consultation after tuberculin reading was the most frequent: 93 out of 178 consultations from health professionals and 97 out of 134 from general citizens. Especially, difficulty in the interpretation of the reading result was common reason of the consultations in both health professionals (69/93) and general citizens (89/97). They feel difficulties in TST result because of widely practiced BCG revaccination and booster phenomenon due to the repetition of TST. Furthermore, TST reading results vary very much between readers especially in double redness (erythema), and it sometimes affects the diagnosis of tuberculosis infection. Therefore, if repeated TST and BCG revaccination practices in children are abolished, most of those consultations might be solved. When induration measurement is used in TST according to the international standard, the complexity of the classifications of the result seems to be dissolved. Considering the current practices in Japan, we recommend that the size of TST induration should be measured and recorded as we measure and record erythema. And induration should be referred in interpretation when they diagnose TB infection with TST.

BCG Vaccine↗
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↗
PubMed1975

Adoptive transfer of cell-mediated immunity to tuberculin using RNA from tuberculin-sensitive subjects.

Adoptive transfer of delayed hypersensitivity skin test response to tuberculin with 'immune' RNA extracted from the sensitized lymphocytes of a healthy subject or a patient with Hodgkin's disease was successfully demonstrated in previously non-sensitive patients with neoplastic diseases including Hodgkin's disease. 'Non-immune' RNA obtained from non-sensitive man, on the other hand, failed to transfer PPD skin reactivity in non-sensitive recipients. 'Immune' RNA-mediated PPD skin test response remained positive for a considerable period of time, indicating that the effect of 'immune' RNA is systemically active. 'Immune' RNA was found to be RNase-sensitive but DNase-resistant. In vitro adoptive transfer of delayed hypersensitivity with 'immune' RNA, as assayed by lymphocyte transformation test, was unsuccessful.

Deoxyribonucleases↗
PubMed2002

[Time course of changes in tuberculin responses in children with monotonous tuberculin sensitivity on anti-tuberculous drugs].

A group of 64 children with monotonous tuberculin sensitivity was analyzed. Intrathoracic lymph nodal tuberculosis (ITLNT) was revealed in 26 (41%) children. The remaining 38 (59% children with tuberculosis infection received a course of preventive treatment by taking into account the presence of risk factors. After tuberculosis treatment in children with ITLNT and tuberculous infection, papules due to Mantoux test significantly reduced in size.

Adolescent↗
PubMed1980

Persistently negative tuberculin reactions: their presence among children with culture positive for Mycobacterium tuberculosis (tuberculin-negative tuberculosis).

Mantoux tests were performed on 200 children with culture-proven Mycobacterium tuberculosis infections. A group of 28 patients initially had negative reactions to 5 TU PPD-S. Of these, 17 had had extensive or overwhelming tuberculous disease at the time of admission, seven of whom reacted to 250 TU PPD; after a course of chemotherapy, all the survivors had positive reactions to 5 TU PPD-S. The 11 with less severe disease had negative reactions to 5 TU PPD-S and 250 TU PPD, as well as to PPD-A/B/G; in only two could a ready explanation be found for the negative reactor state. In general, a small number of children without life-threatening forms of tuberculosis may have persistently negative tuberculin reactions without any apparent cause. In such cases, other criteria for diagnosis must be relied on, such as lymphocyte transformation, culture, and biopsy.

Adolescent↗
PubMed1982

Diagnosis of active tuberculosis by immunological methods. 2. Qualitative differences in the dermal response to tuberculin in patients with active pulmonary disease and healthy tuberculin-positive individuals.

The tuberculin reactivity of 107 patients with active pulmonary tuberculosis and 143 healthy age-matched control subjects were compared. At 48 hours 96% of patients and 76% of control subjects were positive reactors. The diameters of the reactions were of similar size. At 24 hours 93% of patients and 65% of controls were positive: the reactions tended to be larger in the patient group but the difference was of no diagnostic value. The greatest discrimination was apparent at 6-8 hours when 72% of patients and only 3.5% of control subjects reacted. Although probably an Arthus reaction, this early response did not correlate significantly with antibody levels measured by enzyme-linked immunosorbent assay. Accordingly the two tests, to some extent, complemented each other diagnostically.

Antibodies, Bacterial↗
PubMed1978

Comparison of the tine and Mantoux tuberculin tests. Report of the Tuberculin Subcommittee of the Researched Committee of the British Thoracic Association.

Intracutaneous (Mantoux 5 TU) and tine tuberculin tests were performed on the opposite arms of 307 people. The results of each test were read by two independent observers at either 48 or 72 hours. Positive readings were recorded in 59% of the Mantoux tests; induration was 10 mm or more in 34.7% of cases. Positive readings were recorded for 3.9% of the tine tests, and a further 15.5% were recorded in the doubtful category. The tine test is unsuitable for epidemiological use because of the high proportion of negative and doubtful results in people positive on the Mantoux test. For the same reasons its usefulness in clinical practice is very limited.

False Negative Reactions↗
PubMed2002

[The frequency profiles of size of two-step tuberculin skin tests with histories of BCG vaccinations and tuberculin tests among hospital employees].

In 1998, Prevention Committee of the Japanese Society for Tuberculosis announced guidelines for dealing with nosocomial tuberculosis infections. These guidelines recommended the two-step tuberculin tests (TST) as baseline data for each medical employee when they started to work. If accurate records of previous TSTs are available in addition to baseline data, they are useful to evaluate the presence of tuberculosis infection when they started to work. We therefore studied the frequency profile of size of TST among medical employees in INBA-HITEC Medical Center and discussed methods to improve investigative measures for tuberculosis infection, and prior to skin testing we asked self-reporting questionnaires regarding history of previous BCG vaccinations and TSTs. We expected that their records of previous TSTs were accurately preserved, however, records of previous TSTs reported by medical employees were found to be inaccurate. From two-step TSTs results, the magnitude of booster phenomenon was defined by diameter of erythema and induration. Results demonstrated that the increase of induration size was larger in subjects > or = 41-years-old than in subjects < 41-years-old. Regarding booster phenomenon, no statistically significant differences were detected according to type of duty post. Many subjects with size of TST erythema > or = 30 mm on the first test showed increase erythema > or = 10 mm on the second test. We therefore suggest that the second test be made for those showing reaction size > or = 30 mm on the first test.

Adult↗
PubMed1981

The heterogenization of tumour cells with tuberculin. I. The coupling of tuberculin to cell surfaces using con-A as ligand.

The introduction of an antigenic determinant strongly recognized by T cells on to a cell enhances the immune response to weak cellular antigens. Tuberculin (PPD) is a particularly suitable antigenic determinant for this purpose since it behaves in many ways as a 'T-cell hapten'. It has been found that direct chemical coupling of PPD to cell surfaces damages their antigenicity, but that this can be circumvented by coupling PPD to the lectin Concanavalin A and using this as the ligand for binding PPD to the cell. Techniques for preparing Con-A/PPD using little glutaraldehyde or SPDP as cross-linking agents are described.

Animals↗