Two‐Stage Tuberculin Testing With Control Antigens in Patients Residing in Two Chronic Disease Hospitals

Abstract

We studied the prevalence of tuberculin reactivity and anergy in 360 elderly patients residing in two municipal chronic disease hospitals. Eighty-five (26%) of the 323 patients tested had a positive reaction to a stage 1 tuberculin test and 12 (6%) of the 207 stage 1 tuberculin-negative patients exhibited a booster response to a stage 2 tuberculin test. Thirty percent of the same 207 patients had no response to an anergy panel of skin test antigens that included candida, mumps, and trichophyton. Nonresponders to tuberculin and the anergy panel had significantly higher one-year mortality rates compared to responders (44 v 20%, P = 0.001). Tuberculin-positivity among the 770 employees working in these facilities was 43%; 12 (4%) had a booster response. A survey of 29 randomly selected long-term care facilities in the Boston area indicated that all had a policy for pre-employment screening of employees, but less than 50% had a policy for patients and only one institution used two-stage testing. Routine tuberculin testing is recommended for long-term care facilities and the two-stage method is preferable in institutions with adequate resources.

Cutaneous‐Delayed Hypersensitivity in Nursing Home and Geriatric Clinic Patients

“…Nineteen percent of nursing home residents and 6% of geriatric clinic patients lacked even minimal (3 mm induration) responses. This is in keeping with previous reports involving “healthy” older persons, 27 elderly residents of chronic disease hospitals, 28 and intermediate care nursing home residents, 29 where about one‐third of study subjects were found to be anergic.…”

Tuberculin Skin Test Reaction and Body Mass Index in Old Age Home Residents in Hong Kong

“…4,[11][12][13][14] One study 15 suggested that many elderly persons who were infected in their younger years have outlived their tubercle bacilli and lose the tuberculin reactivity; these individuals are not at risk for developing TB unless reexposed, although waning cell-mediated reactivity with age, as a result of immunosuppressive states, the use of immunosuppressive drugs and oral corticosteroids, and malnutrition have been offered as explanations for negative TST reactivity. 6,7 A second testing has been recommended to detect failing immune response to tuberculin antigen that can be restored by the booster phenomenon to avoid the high apparent conversion rates found in these homes. 6,7 A second testing has been recommended to detect failing immune response to tuberculin antigen that can be restored by the booster phenomenon to avoid the high apparent conversion rates found in these homes.…”

“…5 Another reason for doing a tuberculin test is to establish a baseline so that conversion from new infection can be assessed. 7 A study was conducted to determine the prevalence of active TB and positive tuberculin reaction in old age home residents in Hong Kong. 6 A repeat tuberculin has been recommended when the initial testing is negative to ensure that subjects are not falsely identified as being newly infected because of the restoration of preexisting mycobacterial sensitivity by the antigenic challenge of the initial test or the ''booster phenomenon'' at a later date.…”

Medicine in the elderly

“…3 The reaction of the tuberculin test is also reduced. 4 Reduced immunosurveillance may account for a recently recognized increased susceptibility to cutaneous neoplasia. This is probably a result of abnormal antigen processing by the Langerhans' cells, affecting development of a suppressor T cell population, retarding tumour rejection.5 In addition, reduced numbers of melanocytes produce less melanin, thus compromising the ultraviolet barrier.…”