Associations Between Kveim Test Results, Previous B.C.G. Vaccination, and Tuberculin Sensitivity in Healthy Young Adults

Hart, P. D’Arcy; Mitchell, D. N.; Sutherland, Ian

doi:10.1136/bmj.1.5386.795

Cited by 23 publications

(6 citation statements)

References 15 publications

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“…In the BCG group the two equivocal granulomatous responses to the Kveim suspension were no more typical in appearance than those in the other groups, and it is likely that in lepromatous leprosy, as in sarcoidosis (Israel & Sones, 1966), BCG fails to augment Kveim reactivity. Certainly the BCG group did not show the high prevalence of Kveim positivity found in apparently healthy persons who had been BCG vaccinated but failed to be converted to tuberculin sensitivity (Hart et al, 1964). It remains uncertain why some patients with leprosy, particularly the tuberculoid group, develop granulomata which are not typical of a positive Kveim test result.…”

Section: Discussionmentioning

confidence: 98%

“…Particular attention was therefore paid to Kveim reactivity in relation to tuberculin sensitivity in the lepromatous group. A high prevalence of Kveim positivity was reported in a small group of apparently healthy young adults in Britain who had failed to be 'converted' to tuberculin sensitivity after two BCG vaccinations (Hart, Mitchell & Sutherland, 1964). With these findings in mind, we decided to carry out Kveim tests in leprosy patients who were 'nonconverters' to tuberculin sensitivity after BCG vaccination.…”

Section: Objectivesmentioning

confidence: 99%

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The Kveim test in leprosy

Rees¹

1970

Postgraduate Medical Journal

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Summary From the older literature it has been claimed that a significant proportion of patients with the tuberculoid, but not the lepromatous, form of the disease, gave positive Kveim reactions. It is concluded, however, from a review of this older literature that none of the claims are based on studies using a validated Kveim antigen and that the majority of the readings were based on macroscopic, rather than microscopic assessment. The International Study by Siltzbach on Kveim tests in leprosy patients using a validated antigen and assessed microscopically reveal no positive reactions among fifty-seven patients with all types of leprosy from Finland, Israel, Italy and Turkey. However, this same study on Japanese patients gave two positive and five equivocal Kveim reactions among ten lepromatous patients and one equivocal reaction among three tuberculoid patients. Our own studies in Malaysia with the same validated Kveim antigen used by Siltzbach and assessed microscopically gave one weak positive Kveim reaction among twenty-one lepromatous patients and four equivocal Kveim reactions among nine tuberculoid patients. It is concluded from these results that, with the possible exception of Chinese and Japanese patients, false positive Kveim reactions are extremely rare in patients with all types of leprosy. Therefore in parts of the world where leprosy is endemic the Kveim reaction can still be accepted as an important confirmatory diagnostic test for sarcoidosis. It is suggested that further surveys of Kveim reactivity be undertaken on Chinese and Japanese leprosy patients, since both have a similar ethnic origin, in order to determine whether such patients are more liable to elicit a granulomatous reaction to Kveim antigen.

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Section: Discussionmentioning

confidence: 98%

Section: Objectivesmentioning

confidence: 99%

The Kveim test in leprosy

Rees¹

1970

Postgraduate Medical Journal

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“…Neither these observations, nor those of Mitchell et al (1967 ) and Me yer et al. (1967), conflict with the interpretation, suggested above , of the results of the study of D'Arcy Hart et al (1964 ). Although there has been much discussion about sarcoidosis in BCG vaccinated individuals, considered in Chapter 23 (p. 498) , BCG vaccination probably does not affect the incidence of sarcoidosis.…”

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confidence: 84%

Sarcoidosis

Scadding

Mitchell

1985

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“…It is of interest that positive Kveim tests have been reported among patients with tuberculoid leprosy (Kooij & Gerritsen, 1958;Kooij, 1963;Pearson et al, 1969) and also in apparently healthy subjects who showed no evidence of sarcoidosis or other disease, and who failed to show conversion to tuberculin sensitivity following two technically satisfactory BCG vaccina-tions (Hart, Mitchell & Sutherland, 1964;Mitchell et al, 1967Mitchell et al, , 1968b.…”

Section: Discussionmentioning

confidence: 99%