Tuberculin skin testing: Determinants and reaction

Lao, Lily Y; Guia, Teresita S. De

doi:10.1046/j.1440-1843.1999.00198.x

Cited by 10 publications

(8 citation statements)

References 22 publications

(20 reference statements)

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“…A recent meta‐analysis stated that the overall sensitivity of the TST for active tuberculosis is 77%; 191 however, the sensitivity of the test can be dramatically impaired, for example, in infants and toddlers 192 as well as in elderly persons, 193 in individuals with congenital or acquired immunodeficiencies (e.g. those with HIV infection 194–196 ), patients being treated with corticosteroids 197 or other immunosuppressive drugs, 198 patients with chronic renal failure, 199,200 malnutrition, 201,202 cancer 203 or overt forms of tuberculosis 204,205 . The specificity of the TST is dependent on the BCG vaccination status 206 and the immune status of the individual who is tested 191 .…”

Section: Immunological Diagnosismentioning

confidence: 99%

Advances in the diagnosis of tuberculosis

2010

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Tuberculosis ranges among the leading causes of morbidity and mortality worldwide. A diagnostic approach to a patient with possible tuberculosis includes a detailed medical history and clinical examination as well as radiological, microbiological, immunological, molecular-biological and histological investigations, where available. Recently, important advances have been achieved in these fields that have led to substantial improvements in the accuracy and the timing of the diagnosis of tuberculosis. Novel methods allow for a better identification of latently infected individuals who are at risk of developing active tuberculosis, they also offer the possibility for a rapid diagnosis of active tuberculosis in patients with negative sputum smears for acid-fast bacilli and enable prompt identification of drug-resistant strains of Mycobacterium tuberculosis directly from respiratory specimen with a high accuracy. In addition, promising methods that will further optimize the diagnosis of tuberculosis are under development. In the future, therapeutic interventions based on the results of novel diagnostic procedures can be made earlier leading to improvements in patient care.

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Section: Immunological Diagnosismentioning

confidence: 99%

Advances in the diagnosis of tuberculosis

2010

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“…A hematological investigation was performed including red blood cell examination, white blood cell count and differential, platelet count, erythrocyte sedimentation rate, levels of serum electrolytes, serum folate, vitamin B 12 , iron, transferrin, albumin, IgA, IgG, IgM, IgE, serum angiotensin converting enzyme (Orlando & Atkins 1990) and levels of C 1 INH. Furthermore a chest radiography was taken followed by a Mantoux test (Lao & De Guia 1999), radioallergosorbent test (RAST) and patch tests.…”

Section: Case Reportmentioning

confidence: 99%

Orofacial granulomatosis with gingival onset

Mignogna

Fedele

Russo

et al. 2001

J Clinic Periodontology

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“…11 In countries with such a high TB incidence, diagnostic algorithms include the tuberculin skin test (TST) as a screening tool, particularly in children. 13,14 It has been shown that the BCG may affect the TST by factors such as strain and dose, 15 number of vaccines administered, 16,17 time since vaccination, 18 age and nutritional status, 19 and method of vaccine administration. 20 However, the scope of these effects is unclear.…”

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confidence: 99%

A Prospective Study of Bacillus Calmette-Guérin Scar Formation and Tuberculin Skin Test Reactivity in Infants in Lima, Peru

Santiago¹,

Lawson²,

Gillenwater³

et al. 2003

Pediatrics

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ABSTRACT. Objectives. To determine the sensitivity of the bacillus Calmette-Guérin (BCG) scar as an indicator of previous vaccination and to ascertain the tuberculin skin test (TST) response in infancy after vaccination in a community from an area hyperendemic for tuberculosis (TB).Methods. In a birth cohort of healthy term infants from Lima, Peru, a single dose of BCG vaccine was administered within the first month of life. Scar formation was assessed biweekly during the first 6 months and again at 3 years after vaccination. TST response was evaluated 6 months after vaccination.Results. Six months after vaccination, 99% (68) of the newborns exhibited a BCG scar (>2 mm). Scar size did not differ by sex, birth weight, age at vaccination, or nutritional status in the first 2 months. Eighty percent of the participants were found 3 years after vaccination, and all of them had a BCG scar. Mean TST reaction size 6 months after vaccination was 2.9 ؎ 0.3 mm. No association was found between sex or age at BCG vaccination and TST size. Only 3 children had a TST >10 mm, and the 3 had a TB contact at home.Conclusions. The BCG scar was a sensitive indicator of vaccination status up to 3 years after the administration of the vaccine in the first month of life. Although nearly a quarter of the children had a TST response >5 mm 6 months after vaccination, TST reactions >10 mm did not occur in the absence of exposure to a person with tuberculosis. A cutoff of 10 mm should be used for disease control purposes in people who are born in countries where TB is endemic. The presence or absence of a BCG scar is often used as an indicator of previous vaccination in clinical settings as well as surveys performed by health institutions such as the Expanded Program on Immunization to assess vaccine uptake. 7 However, the sensitivity of the BCG scar as an index of vaccination status is still the subject of controversy. 6 Failure to form a scar may be related to factors such as lack of maturation of the immune system, 8 faulty technique, or use of a nonpotent vaccine. 9 In Peru, intradermal administration of BCG is given at birth at any health facility, such as a hospital or health post. This is part of the regular immunization program following WHO guidelines. 10 Since 1991, the same strain of BCG has been used across the country. In 2000, the estimated incidence of active pulmonary TB in Peru was 111 cases per 100 000, 11 but in one area, it has been reported to be 364 per 100 000 12 despite 95% coverage of BCG vaccination at birth and a human immunodeficiency virus prevalence of Ͻ0.5%. 11 In countries with such a high TB incidence, diagnostic algorithms include the tuberculin skin test (TST) as a screening tool, particularly in children. 13,14 It has been shown that the BCG may affect the TST by factors such as strain and dose, 15 number of vaccines administered, 16,17 time since vaccination, 18 age and nutritional status, 19 and method of vaccine administration. 20 However, the scope of these effects is unclear. Therefore, for the TST to...

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Tuberculin skin testing: Determinants and reaction

Cited by 10 publications

References 22 publications

Advances in the diagnosis of tuberculosis

Advances in the diagnosis of tuberculosis

Orofacial granulomatosis with gingival onset

A Prospective Study of Bacillus Calmette-Guérin Scar Formation and Tuberculin Skin Test Reactivity in Infants in Lima, Peru

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