Abstract
BackgroundTuberculosis remains a serious disease worldwide. Anti-tuberculosis campaigners many times face negative tuberculin skin tests after Bacille Calmette Guérin vaccination. Increasing tuberculin units might be a solution. However, is skin reaction a linear function of tuberculin dose? Are there any side-effects when higher tuberculin doses are administered?Case presentationSix simultaneous Mantoux tuberculin skin tests, using 1, 2, 5, 10, 20, and 50 tuberculin units (88 altogether) of purified protein derivative RT23 per 0.1 mL were applied in a healthy male Greek 35-years-old, with known natural Mycobacterium tuberculosis primary infection since five years. Skin indurations 72 hours later were 15, 22, 23, 19, 23, and 27 mm respectively.ConclusionNo linear relation between tuberculin dose and skin reaction observed; skin reaction increased as tuberculin dose increased but with a decreasing rate, especially after 2 TUs, which seem correctly defined for detection of natural infection. No side-effects occurred.
Highlights
No linear relation between tuberculin dose and skin reaction observed; skin reaction increased as tuberculin dose increased but with a decreasing rate, especially after 2 tuberculin units (TU), which seem correctly defined for detection of natural infection
Skin reaction was not a linear function of tuberculin dose; induration was increased with a decreasing rate as tuberculin dose increases (Figure 2), while an unexpected decrease occurred in the dose of 10 TUs
Chance is highly improbable because the phenomenon was observed again a few days later (November 1985), when 431 children, previously vaccinated with lyophilized Bacille Calmette-Guérin (BCG) (April 1985), were Mantoux tested using the same vials and found the same pattern, in particular a mean diameter in mm 5.8 in 74 children tested with 1 TU, 9.3 (4.4) in 15 with 2 TUs, 10.9 (5.7) in 88 with 5 TUs, 10.0 (5.4) in 94 with 10 TUs, 11.4 (5.8) in 78 with 20 TUs, and 14.5 (4.9) in 82 with 50 TUs [11]
Summary
Anti-tuberculosis campaigners many times face negative tuberculin skin tests after Bacille Calmette Guérin vaccination. Case presentation: Six simultaneous Mantoux tuberculin skin tests, using 1, 2, 5, 10, 20, and 50 tuberculin units (88 altogether) of purified protein derivative RT23 per 0.1 mL were applied in a healthy male Greek 35-years-old, with known natural Mycobacterium tuberculosis primary infection since five years. During eighties the first author (ID), responsible for the antituberculosis campaign in Ioannina prefecture, Greece, faced negative post Bacille Calmette-Guérin (BCG) vaccination tuberculin skin tests (TST) many times, and he had to answer why. BCG contains weak bacilli; post-BCG TSTs may need increased tuberculin doses. He increased tuberculin units (TU) [1], supposing that the more the units are the more the reaction is. None of the three relevant papers [2,3,4], retrieved (22 May 2008) from Medline using the algorithm (Mantoux OR Imotest OR Tine OR "tuberculin skin test*" OR "tuberculin test*") AND (simultaneous* OR multiple OR "same person" OR "same individual" OR "same patient") AND (dose OR dosage OR unit* OR "TU"), had used more than 15 TUs altogether simultaneously on the same person, compared to 88 TUs in our case
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