PPD (Purified Protein Derivative) Test Mantoux test/Mantoux screening test Tuberculosis skin test Tuberculin Sensitivity Test

est Pirquet test

The tuberculosis skin test (PPD test) is used to determine if someone has developed an immune response to the bacterium that causes tuberculosis (TB). This response can occur if someone currently has TB, if they were exposed to it in the past, or if they received the BCG vaccine against TB. The tuberculin skin test is based on the fact that infection with M. tuberculosis bacterium produces a delayed-type hypersensitivity skin reaction to certain components of the bacterium. The components of the organism are contained in extracts of culture filtrates and are the core elements of the classic tuberculin PPD. Reaction in the skin to tuberculin PPD begins when specialized immune cells, called T cells, which have been sensitized by prior infection, are recruited by the immune system to the skin site where they release chemical messengers called lymphokines. These lymphokines induce induration (a hard, raised area with clearly defined margins at and around the injection site) through local vasodilation (expansion of the diameter of blood vessels) leading to fluid deposition known as edema, fibrin deposition, and recruitment of other types of inflammatory cells to the area. An incubation period of two to 12 weeks is usually necessary after exposure to the TB bacteria in order for the PPD test to be positive. Anyone can have a TB test, and it can be given to infants, pregnant women, or HIV-infected people with no danger. It is only contraindicated in people who have had a severe reaction to a previous tuberculin skin test.

Test Administration: Give 0.1 ml of 5 Tuberculin Units PPD intradermally. Needle too deep

Needle too shallow

Inserted properly

All tests should be read between 48 and 72 hours. If more than 72 hours has elapsed and there is not an easily palpable positive reaction, repeat the test on the other arm and read at 48 to 72 hours after the second administration.

Measure the induration - not erythema. Measure and report results in millimeters of induration.

All persons with positive reactions should be evaluated for preventive therapy, once TB disease has been ruled out.

POSTIVE REACTIONS An induration of 5 or more millimeters is a positive result for the following: People with HIV infection People who inject illicit drugs and whose HIV status is unknown People who have close contact with people with infectious TB People with chest radiograph findings suggestive of previous TB disease An induration of 10 or more millimeters is a positive result for the following: People with medical conditions that appear to increase the risk for TB (not HIV infection), such as diabetes People born in areas of the world where TB is common Low-income groups with poor access to health care

People who inject illicit drugs but who are known to be HIV negative Children younger than 4 years old People in other groups likely to be exposed to TB, as identified by local public health officials People who live in residential facilities, like correctional facilities or nursing homes

An induration of 15 or more millimeters is considered a positive reaction for people with no risk factors for TB. In most cases, people who have a very small reaction or no reaction probably do not have TB infection. For people who may be exposed to Tuberculosis on the job (correctional facilities, staff of nursing homes and health care workers), the classification of the skin test reaction is based on Risk of exposure to TB Size of the induration Employees individual risk factors for TB Hence, in facilities where the risk of exposure to TB is very low, 15 or more millimeters of induration could be considered a positive reaction for employees with no other risk factors for TB. In facilities where TB patients receive care, 10 or more millimeters of induration may be considered a positive reaction for employees with no other risk factors for TB. Those who test positive for the tuberculin skin test will more than likely have a positive reaction if they are skin-tested later in their lives. This is true whether or not they received treatment.

Negative Reactions Reactions below the cutting point are considered negative.

Positive Reaction: 18mm

Negative Reaction:

Positive Reaction: