Further observations on tuberculin reactions in active tuberculosis

Rooney, John J.; Crocco, John A.; Kramer, Sybil; Lyons, Harold A.

doi:10.1016/0002-9343(76)90718-x

Cited by 100 publications

(40 citation statements)

References 9 publications

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“…Furthermore, these long-incubation-time IGRA also provide optimal sensitivities for the diagnosis of EPTB, as all cases were detected by the PPD IGRA compared to only 78% with the in vivo TST. This poor sensitivity of the TST for the diagnosis of EPTB was previously reported (27)(28)(29). The results obtained with the combined CFP-10 and PPD IGRA were thus better than those obtained with the TST, which missed 4/63 children with aTB in this cohort.…”

Section: Discussionsupporting

confidence: 52%

Long-Incubation-Time Gamma Interferon Release Assays in Response to Purified Protein Derivative, ESAT-6, and/or CFP-10 for the Diagnosis of Mycobacterium tuberculosis Infection in Children

Schepers

Mouchet

Dirix

et al. 2013

Clin. Vaccine Immunol.

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The diagnosis of childhood active tuberculosis (aTB) and latent Mycobacterium tuberculosis (M. tuberculosis) infection (LTBI) remains a challenge, and the replacement of tuberculin skin tests (TST) with commercialized gamma interferon (IFN-␥) release assays (IGRA) is not currently recommended. Two hundred sixty-six children between 1 month and 15 years of age, 214 of whom were at risk of recent M. tuberculosis infection and 51 who were included as controls, were prospectively enrolled in our study. According to the results of a clinical evaluation, TST, chest X ray, and microbiological assessment, each children was classified as noninfected, having LTBI, or having aTB. Long-incubation-time purified protein derivative (PPD), ESAT-6, and CFP-10 IGRA were performed and evaluated for their accuracy in correctly classifying the children. Whereas both TST and PPD IGRA were suboptimal for detecting aTB, combining the CFP-10 IGRA with a TST or with a PPD IGRA allowed us to detect all the children with aTB with a specificity of 96% for children who were positive for the CFP-10 IGRA. Moreover, the combination of the CFP-10 IGRA and PPD IGRA detected 96% of children who were eventually classified as having LTBI, but a strong IFN-␥ response to CFP-10 (defined as >500 pg/ml) was highly suggestive of aTB, at least among the children who were <3 years old. The use of long-incubation-time CFP-10 IGRA and PPD IGRA should help clinicians to quickly identify aTB or LTBI in young children.

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Section: Discussionsupporting

confidence: 52%

Long-Incubation-Time Gamma Interferon Release Assays in Response to Purified Protein Derivative, ESAT-6, and/or CFP-10 for the Diagnosis of Mycobacterium tuberculosis Infection in Children

Schepers

Mouchet

Dirix

et al. 2013

Clin. Vaccine Immunol.

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“…Systemic high-dose corticosteroid therapy (.15 mg prednisolone equivalent) or treatment with immunosuppressants Advanced pulmonary tuberculosis [133,144], central nervous system tuberculosis and disseminated tuberculosis [145] Sarcoidosis [146] Malnutrition [147] Window period for manifest immune response to infection with Mycobacterium tuberculosis Application errors (incomplete or subcutaneous tuberculin injection, incorrect quantity of tuberculin, inadequate storage of tuberculin)…”

Section: Test Specificitymentioning

confidence: 99%

Tuberculosis contact investigation in low prevalence countries: a European consensus

Erkens

Kamphorst²,

Abubakar

et al. 2010

European Respiratory Journal

239

201

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Contact investigation to identify individuals with tuberculosis and latent infection with Mycobacterium tuberculosis is an important component of tuberculosis control in low tuberculosis incidence countries. This document provides evidence-based and best-practice policy recommendations for contact tracing among high-and medium-priority contacts in a variety of settings. It provides a basis for national guidelines on contact investigation and tuberculosis outbreak management, and should support countries and tuberculosis control managers in evaluating and revising national policies. A review of existing guidelines, a literature search, several meetings and consultation with experts were used to formulate and grade recommendations for action during contact investigation.Available tests to identify individuals with latent infection with M. tuberculosis are designed to identify immune response against mycobacterial antigens and have variable predictive value for the likelihood to develop active tuberculosis in different populations. Contact investigation should therefore be limited to situations with a clear likelihood of transmission or to those with a higher probability of developing active tuberculosis, for instance, young children and immunocompromised persons. A risk assessment-based approach is recommended, where the need to screen contacts is prioritised on the basis of the infectiousness of the index case, intensity of exposure and susceptibility of contacts.

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“…In contrast, STEAD (1969) reports a 20% tuberculin negativity in patients with newly diagnosed, sputum smear positive tuberculosis. Even when cut-offs of 4-5 mm were chosen, 17%-21 % of patients with active pulmonary tuberculosis were skin test nonrespon~ive (HOLDEN et al 1971;ROONEY et al 1976). Most nonresponders became tuberculin positive after 2 weeks of specific antituberculous therapy (ROONEY et al 1976).…”

Section: Purified Protein Derivative Skin Test Reactionmentioning

confidence: 99%