[On tuberculin tests, tuberculin testing and the treatment of asymptomatic childhood primary tuberculosis].
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Cell-mediated immunity was studied in patients with atopic dermatitis. 113 patients were patch tested with ten contact allergens. The frequency of positive reactions to patch testing with "common contact allergens" was found to be lower in patients with "high IgE values" than in those with IgE less than or equal to 1000 U/ml. A larger number of patients with severe dermatitis reacted negatively to PPD and were more difficult to sensitize with DNCB and NDMA as compared with the patients with mild dermatitis. The results of this investigation support the findings of earlier workers that patients with atopic dermatitis show disturbances in the cell-mediated immune system and these disturbances appear to be correlated to the degree of severity of the dermatitis.
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Tuberculin tests in general use today rely on the response to intradermal injections of tuberculin with assessment of the injection site for swelling at 72 hours post injection. Estimates of the sensitivity of tuberculin tests range from 68-95% while specificity is estimated to be 96-99%. The sensitivity of the test is affected by the potency and dose of tuberculin administered, the interval post-infection, desensitisation, deliberate interference, post-partum immunosuppression and observer variation. Specificity is influenced by sensitisation as a result of exposure to M. avium, M. paratuberculosis and environmental mycobacteria and by skin tuberculosis.
Tuberculin skin test is still the only proven method for identifying infection wtih M. tuberculosis in persons who do not have active disease. Targeted tuberculin testing for latent tuberculosis infection is a strategic component of tuberculosis control in low prevalence countries. This report describes indication, technical method, interpretation of this test and guidelines when the tuberculin test is positive.
This study confirms that repeated tuberculin testing may prevent waning of, or restore, tuberculin sensitivity in BCG-vaccinated schoolchildren, and demonstrates that tuberculin testing has this effect even if it is done relatively shortly after vaccination. Therefore the results of repeated tuberculin tests cannot reveal a possible waning of BCG-induced tuberculin sensitivity. This finding shows that a revaccination policy based on the waning of tuberculin sensitivity is not rational.
Tuberculinic switch is defined as an increase of the intradermal reaction diameter in two tests carried out within three months of each other. The tuberculinic skin reaction proves the presence of a delayed hypersensitivity induced by mycobacterial antigens (Mycobacterium tuberculosis, BCG, some atypical mycobacteria). However, this reaction does not always prove an effective protection against the BK. The intradermal injection of a purified Purified Protein Derivative (PPD) resulting from a culture of M. tuberculosis is the only method validated for the diagnosis of tuberculosis infection (latent infection) and screening for hypersensitivity and post-vaccine BCG (Official French decree No 96-775 of September 5, 1996 and its decree relating to vaccination by BCG and tuberculin tests). The guidelines concerning tuberculin testing are: investigating on a case of tuberculosis; tracking or surveillance of people frequently exposed to tuberculosis (examination on recruitment and follow-up of exposed professionals); prevaccine testing in children over four weeks of age.
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2 batches of baboon infected with tuberculosis were subjected to serial tests with human and bovine tuberculin, while erythrocyte sedimentation rates were estimated concurrently. In the very early stages most but not all reacted to human tuberculin while fewer responded to bovine material. After further development of the disease, tuberculin tests remained positive while sedimentation rates were raised by 10-30 mm per hour. By the time early spread had occurred response to tuberculin was absent but sedimentation rates tended to increase. Advanced cases always tuberculin negative but sedimentation rates were in excess of 50 mm per hour. Such animals were always in good physical condition and represented an insidious danger to other animals and staff in contact with them. Clinical examination failed to reveal cases of tuberculosis except in the terminal stages and no cases were diagnosed by radiography. 2 animals died from apparent anaphylaxis following inoculation of both types of tuberculin. Results showed that use of one or other of these tests alone would not have made possible the elimination of infection.
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A solid-phase radioimmunoassay (SPRIA) was used to investigate several factors influencing false positive and negative results in serodiagnostic test for tuberculosis, Unheated cytoplasmic fractions of mycobacteria, and other microorganisms were bound to polystyrol and antibody binding of sera from tuberculous, non tuberculous hospitalized patients and healthy adults was tested by the SPRIA-method. The level of antibody concentration in the SPRIA reflects roughly cross-reactivity between the antigens. Similar antibody binding occurred with M. tuberculosis, M. bovis, M. ulcerans and several "atyical" mycobacteria as test antigens, while other mycobacterial species and one of two tested tuberculin preparation (PPD) showed less antibody binding capacity. Significant cross-reactivity of fourty to sixty per cent was found between M. tuberculosis and N. asteroides but no cross-reaction was observed with C. parvum, S. typhi, S. paratyphi, C. Albicans or Aspergillus niger. Heating of mycobacterial cytoplasmic antigen resulted in a decrease of the test specifity. Tuberculin testing and intracutaneous BCG-vaccination in healthy adults had no distinct influence on the antibody response against several mycobacterial test antigens. However, a rapid increase of antibody levels was documented in melanoma patients after BCG-immunotherapy by sacrification with a more concentrated vaccine.
Although tuberculin test is widely used for detection of tuberculous infection among children, there is no clear understanding about its performance and interpretation. This article has been written with the purpose of elucidating the performance and interpretation of standard tuberculin test, based on the experiences gained at the National Tuberculosis Institute, Bangalore and other centres. The standard tuberculin test involves intradermal injection of '1TU PPD RT23 with Tween 80' on the mid-volar aspect of forearm and measurement of the maximum transverse diameter of induration after 3 days. Larger the size of induration, higher is the probability of it being due to tuberculous infection. The majority of reactions with induration size of 15 mm and above are attributable to infection with tubercle bacilli, irrespective of BCG-vaccination status. While indurations of less than 5 mm indicate absence of any kind of tuberculin sensitivity, the majority of indurations in 5-9 mm range are usually of non-tuberculous nature. An induration of 10-14 mm requires more careful interpretation. It is more likely to be attributable to infection with tubercle bacilli in case of history of contact with smear positive case or among children with clinical findings of tuberculosis. However, the size of induration in an infected child may be diminished in the presence of immuno-suppressive conditions. One should also consider the purpose of the test while interpreting the test results.
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