Tuberculin Test

Fact & Myth Magdy M Khalil

Prof. Chest Medicine, Ain Shams University

History
Tuberculin is an extract of tubercle bacilli Robert Koch 1890: TB remedy Clemen von Pirquet 1890s: TB immunity Seibert 1930s: PPD

Mantoux test
ID, 0.1ml of PPD, 5TU Reading after 48-72 h Induration Positive: 10 mm

Five years ago 32 ys old lady , pregnant 3rd trimester R. cervical lymphadenopathy TB skin test: positive Anti TB

Q: Do you recommend TB test in this case?

Anti TB for 3 months with good response Delivered and stopped medications Resumed anti TB medications 6 months later

Two weeks ago R. thyroid swelling Ultrasound: Mass with breakdowns TB skin test: positive Referral to chest clinic for anti TB

Q: Do you recommend TB test in this case?

Natural history
Organism: Myc. tuberculosis Entry
Respiratory tract Alimentary tract Skin

Immune response
Cell-mediated immunity Delayedtype hypersensitivity

Latent TB Infection
No symptoms No spread of infection Radiology ? Microbiology: -ve

TB skin test: Positive (usually)

TB Disease
Symptoms: +ve May spread infection Radiology: abnormal Microbiology: positive
TB skin test: Positive (usually)

Old Healed TB
May have radiographic findings No symptoms or symptoms related to fibrosis TB skin test: Positive (Usually)

+ve TB skin test

Active TB Old TB Latent TB Treat Re-assess Local regulations

Facts
Searching for diseases? Positive TB skin test indicates infection; not necessarily disease

Facts
Screening for infection?

TB skin test is not absolutely sensitive or specific for TB

Screening for TB infection?

Contacts Anti TNF-alfa Immigration

Highly +ve TB skin test?

More efficient response

Strong antigenic stimuli

Disease: No prognostic significance Infection: >25 mm ? Risk for active disease

TB skin test and BCG?

Distinguishing between a TB skin test reaction caused by infection with M. tuberculosis and a reaction caused by BCG is difficult However:
Larger induration Contact with TB

interval between vaccination

and testing

the greater is likelihood that the reaction represents infection with M.tuberculosis

TB blood test?
IFN- release assays (IGRAs)
QuantiFeron-TB Gold or T Spot-TB

Infection specificity (latent TB vs prior BCG)

Disease

? sensitivity in detecting active TB

Back to the lady!

Would you have recommended TB test?

dr_mmk2001@yahoo.com