The Tuberculin Skin Test

Huebner, Robin E.; Schein, Maybelle F.; Bass, John B.

doi:10.1093/clinids/17.6.968

Cited by 786 publications

(553 citation statements)

References 23 publications

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“…PPD is an immunological reagent widely used for diagnosis of tuberculosis, but knowledge about the components of this heat-inactivated culture filtrate of mycobacteria is very limited 11,12,[24][25][26][27] . In this study a proteomic analysis of tuberculin purified protein derivative (PPD) samples used for diagnosis of animal tuberculosis in Brazil and UK was carried out in order to identify the proteins present in this immunological reagent.…”

Section: Discussionmentioning

confidence: 99%

Identification of proteins from tuberculin purified protein derivative (PPD) by LC-MS/MS

Borsuk¹,

Newcombe²,

Mendum³

et al. 2009

Tuberculosis

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Section: Discussionmentioning

confidence: 99%

Identification of proteins from tuberculin purified protein derivative (PPD) by LC-MS/MS

Borsuk¹,

Newcombe²,

Mendum³

et al. 2009

Tuberculosis

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“…The only widely used test is the century-old tuberculin skin test (TST), which has many drawbacks. Foremost among these is its poor specificity (21). This results from the broad antigenic cross-reactivity of purified protein derivative (PPD), a crude mixture of more than 200 M. tuberculosis proteins widely shared among M. tuberculosis, M. bovis Bacillus CalmetteGuérin (BCG), and most environmental mycobacteria (22).…”

mentioning

confidence: 99%

Evaluation of T-Cell Responses to Novel RD1- and RD2-EncodedMycobacterium tuberculosisGene Products for Specific Detection of Human Tuberculosis Infection

et al. 2004

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The tuberculin skin test for diagnosing Mycobacterium tuberculosis infection suffers from antigenic crossreactivity of purified protein derivative with BCG, resulting in poor specificity in BCG-vaccinated populations. Comparative genomics has identified several genetic regions in M. tuberculosis and M. bovis that are deleted in M. bovis BCG. Proteins encoded in these regions will form the basis of new specific T-cell-based blood tests that do not cross-react with BCG, but only two, early secretory antigen target 6 and culture filtrate protein 10, have been studied in detail in humans. We investigated four novel gene products, encoded by RD2 (Rv1989c) and RD1 (Rv3873, Rv3878, and Rv3879c), that are absent from most or all of the vaccine strains of BCG, respectively. Sixty-seven overlapping peptides were tested in ex vivo gamma interferon enzyme-linked immunospot assays in 49 patients with culture-confirmed tuberculosis and 38 healthy BCG-vaccinated donors. Forty-five percent (95% confidence interval [CI], 31 to 57%) and 53% (95% CI, 39 to 67%) of the tuberculosis patients responded to Rv3879c and Rv3873, respectively, identifying these proteins as major M. tuberculosis T-cell antigens in humans, while 35 and 25% of the patients responded to Rv3878 and Rv1989c, respectively. Of the 38 BCG-vaccinated donors, 1 (2.6%) responded to peptides from Rv3878 and Rv3879c, 3 (7.9%) responded to Rv3873, and none responded to Rv1989c. Exclusion of cross-reactive peptides encoded in conserved motifs of Rv3873, a PPE family member, increased its specificity to 97.4%. The high specificity of Rv3879c peptides and nonconserved Rv3873 sequences, together with their moderate sensitivity in tuberculosis patients, identifies these peptides as candidates for inclusion in new T-cell-based tests for M. tuberculosis infection.Accurate diagnosis of tuberculosis (TB) infection is essential for the treatment, prevention, and control of this resurgent disease (1). Since Mycobacterium tuberculosis is often difficult to culture from patients with active TB, and impossible to culture from healthy latently infected people, an immunebased diagnostic test indicating the presence or absence of M. tuberculosis infection would be very useful for the diagnosis of active TB and screening for latent M. tuberculosis infection. The only widely used test is the century-old tuberculin skin test (TST), which has many drawbacks. Foremost among these is its poor specificity (21). This results from the broad antigenic cross-reactivity of purified protein derivative (PPD), a crude mixture of more than 200 M. tuberculosis proteins widely shared among M. tuberculosis, M. bovis Bacillus CalmetteGuérin (BCG), and most environmental mycobacteria (22). Hence, false-positive results are common in people with environmental mycobacterial exposure and previous BCG vaccination. Since most of the world's population is BCG vaccinated and since the confounding effect of BCG persists for up to 15 years after vaccination (41), this is a significant problem. Thus, there has been a...

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“…In our patient we could not find the primary site and the only finding was the positive tuberculin test [9]. Although the tuberculin skin test is the only method of detecting M. tuberculosis infection, it is neither 100% sensitive nor 100% specific [7]. Pelvic radiographs, bone scans and CT scan showed a localized lesion at the left sacroiliac joint.…”

Section: Discussionmentioning

confidence: 61%