The aim of this study was to determine the reliability of skin tests with common antigens as a measure of delayed-type hypersensitivity response in children undergoing tuberculin skin test (TST). Children from developing countries underwent TST as well as skin tests with diphtheria-tetanus vaccine (DT) and candida antigens prior to heart surgery. We included 52 children (mean age: 7.16 years). Forty-two (81%) and 20 of the 52 patients (38%) reacted to the DT and candida skin tests, respectively (P < 0.001 for the difference in response to these antigens). There was no difference in response to candida and DT antigens between patients with positive or negative TST. There was no difference between patients aged 6 years or older compared to younger patients in the response to DT or candida antigen. Skin tests with common antigens are associated with a high false-negative rate and may not predict reliably a state of anergy.
To examine whether treatment with cardiopulmonary bypass (CPB), which causes transient cellular immunity depression, influences tuberculin skin testing (TST) interpretation. The study was also aimed to assess the degree of cellular immunity depression following open heart surgery. Fifteen children from developing countries with latent tuberculosis (TST >or=10 mm), undergoing open heart surgery had their TST repeated within 48-72 h following surgery. We compared the size of skin test induration before and after surgery and the relation of postsurgery skin induration to time on CPB (pump time). There was no significant difference in the size of induration before and after surgery (mean: 14.7 mm versus 13 mm, respectively). Pump time ranged from 38 to 204 min (mean: 110 min). Two of the children had pump time over 3 h. The TST of both of them turned negative after surgery, as opposed to all other children (P = 0.01). Most patients retained skin test reactivity. Only patients with pump time longer than 3 h had a negative TST.
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