Interpretation of the tuberculin skin test

Rose, David N.; Schechter, Clyde B.; Adler, Jack J.

doi:10.1007/bf02602749

Cited by 80 publications

(38 citation statements)

References 27 publications

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“…25 Published reports of the specificity of TST range from 90% to 99%. [26][27][28][29] However, this range was inconsistent with our base-case parameters. Our base-case parameter for the prevalence of TST positivity in the risk factornegative population was 0.37%, which implies a specificity of not less than 99.6% in that group.…”

Section: Model Input Estimation and Sensitivity Analysesmentioning

confidence: 49%

Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry

Flaherman

Porco

Marseille³

et al. 2007

Pediatrics

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The cost to prevent a case of tuberculosis by using either universal screening or targeted testing of kindergarteners is high. If targeted testing replaced universal tuberculin skin testing in California, then $1.27 million savings per year would be generated for more cost-effective strategies to prevent tuberculosis. Improving the positive predictive value of the risk factor tool or applying it to groups with higher prevalence of latent tuberculosis would make its use more cost-effective. Universal tuberculin skin testing should be discontinued, and targeted testing should be considered only when the prevalence of risk factor positivity and the prevalence of tuberculin skin testing positivity among risk factor-positive individuals are high enough to meet acceptable thresholds for cost-effectiveness.

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Section: Model Input Estimation and Sensitivity Analysesmentioning

confidence: 49%

Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry

Flaherman

Porco

Marseille³

et al. 2007

Pediatrics

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“…Human immunodeficiency virus (HIV) coinfection can further complicate TB diagnosis with an atypical clinical picture of pulmonary TB and a higher likelihood of negative sputum smears for AFB (7,8,12,13,25). The tuberculin skin test (TST) is the standard for diagnosis of latent tuberculosis infection (LTBI), is the only test available for that purpose in resource-limited settings, and is sometimes used to aid in the diagnosis of active TB; however, its specificity is limited by cross-reactivity with nontuberculous mycobacteria and BCG vaccine strains of Mycobacterium bovis, and its sensitivity can be affected by malnutrition and immunosuppression (17,27).Because of the efficacy of current therapeutic options, the need is great for affordable and rapid diagnostic methods with high sensitivity and specificity for TB and latent TB infections, especially in settings of high HIV prevalence. The gamma interferon (IFN-␥) release assay (IGRA) is an in vitro test based on release of IFN-␥ by foreign epitope-stimulated T cells.…”

mentioning

confidence: 99%

Sensitivity Analysis and Potential Uses of a Novel Gamma Interferon Release Assay for Diagnosis of Tuberculosis

et al. 2006

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Sputum smears for acid-fast bacilli (AFB) are the primary methods for diagnosis of tuberculosis (TB) in many countries. The tuberculin skin test (TST) is the primary method for diagnosis of latent TB infection (LTBI) worldwide. The poor sensitivity of the former and the poor specificity of the latter warrant the development of new tests and strategies to enhance diagnostic capabilities. We evaluated the sensitivity of an "in-tube" gamma interferon release assay (IGRA) using TB-specific antigens in comparison to the TST and the sputum smear for AFB in TB cases in South Africa. The sensitivity of the IGRA for TB was considered a surrogate of sensitivity in LTBI. Among 154 patients with a positive culture for Mycobacterium tuberculosis, the sensitivity of the IGRA for the diagnosis of TB varied by clinical subgroup from 64% to 82%, that of the TST varied from 85% to 94%, and that of two sputum smears for AFB varied from 35% to 53%. The sensitivity of the IGRA in human immunodeficiency virus (HIV)-infected TB cases was 81%. HIV-infected TB patients were significantly more likely to have indeterminate IGRA results and produced quantitatively less gamma interferon in response to TB-specific antigens than HIV-negative TB patients. The overall sensitivity of the TST in all TB cases was higher than that of the IGRA (90% versus 76%, respectively). The combined sensitivities of the TST plus IGRA and TST plus a single sputum smear were 96% and 93%, respectively. The TST combined with IGRA or with a single sputum smear may have a role in excluding the diagnosis of TB in some settings.Worldwide, there were 8.8 million new cases of active tuberculosis (TB) and an estimated 1.7 million deaths from TB in 2003 (32). With increased numbers of TB cases, health systems in resource-limited settings face difficulties in coping with the large patient and specimen loads (16). Sputum smear for acidfast bacilli (AFB) (two or three smears) is the primary microbiologic method used for diagnosis of TB in resource-limited settings. Cultures for AFB require more extensive laboratory facilities, and their cost can be prohibitive. However, there is concern regarding this dependence on the sputum smear for AFB due to its limited sensitivity. Human immunodeficiency virus (HIV) coinfection can further complicate TB diagnosis with an atypical clinical picture of pulmonary TB and a higher likelihood of negative sputum smears for AFB (7,8,12,13,25). The tuberculin skin test (TST) is the standard for diagnosis of latent tuberculosis infection (LTBI), is the only test available for that purpose in resource-limited settings, and is sometimes used to aid in the diagnosis of active TB; however, its specificity is limited by cross-reactivity with nontuberculous mycobacteria and BCG vaccine strains of Mycobacterium bovis, and its sensitivity can be affected by malnutrition and immunosuppression (17,27).Because of the efficacy of current therapeutic options, the need is great for affordable and rapid diagnostic methods with high sensitivity and specificity fo...

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“…Tuberculin anergy ranges from 35 to 74% in pediatric and 20-70% in adults. However, positive results of TST do not always indicate active tuberculosis [16].…”

Section: Tuberculin Skin Test (Tst)mentioning

confidence: 99%

The Existence of Mycobacterium tuberculosis in Microenvironment of Bone

Jabir¹,

Rukmana²,

Saleh³

et al. 2018

Mycobacterium - Research and Development

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Mycobacterium tuberculosis is an obligate aerobe bacteria requiring oxygen in its metabolism. In normal condition, bones have pH of 6.9-7.4 and temperature of 37°C. With the composition mentioned, bones fall in the group of tissue with less rich oxygen (<35%) which theoretically means, M. tuberculosis is hard to grow in the bone environment. Bone microliving environment is formed by the cells constructing the bone itself and the active cells which periodically interact with the bone cells. Activation of these cells gives impact to the temperature, pH, gas concentration, and liquid concentration, and at the same time triggers calcium, phosphor, and other minerals to be deposited in the bone. In the process of new bone formation, the osteoblast cells produce matrix and release them to the microenvironment that needs a high concentration of calcium and phosphor. The survival of M. tuberculosis in the microenvironment of bone is reflected in interaction of the bacteria and the non-immune cells, the bacteria and the organic environment, and the bacteria and the inorganic environment. In addition, the immune system also threatens the survival of M. tuberculosis. The results of these interactions will affect the lives of bacteria and has an impact on the bone microenvironment.

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Interpretation of the tuberculin skin test

Cited by 80 publications

References 27 publications

Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry

Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry

Sensitivity Analysis and Potential Uses of a Novel Gamma Interferon Release Assay for Diagnosis of Tuberculosis

The Existence of Mycobacterium tuberculosis in Microenvironment of Bone

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