The Case for Retiring the Tuberculin Skin Test.

Abstract

* Abbreviations: BCG — : Bacillus Calmette-Guerin CDC — : Centers for Disease Control and Prevention IGRA — : interferon γ release assay LTBI — : latent tuberculosis infection TST — : tuberculin skin test The Mantoux tuberculin test (TST) is likely the oldest widely used test in contemporary diagnostics. In the past, when its obvious weaknesses were considered, it always “received a pass” because of the lack of an alternative test. However, with the advent and improvement of interferon γ release assays (IGRAs), we feel it is past time to reconsider the widespread use of TSTs. An adolescent with inflammatory bowel disease refractory to steroids was tested for latent tuberculosis infection (LTBI). The TST result was read as positive by a nurse and negative by a physician who had never seen a positive TST result. The patient was not treated for LTBI, received infliximab, and 2 months later developed cavitary pulmonary tuberculosis. Contact tracing identified 2 relatives and several classmates with LTBI and a younger sibling with intrathoracic tuberculosis. How can we do better? IGRAs, or blood tests for the diagnosis of tuberculosis infection in place of TSTs, have been licensed in the United States since 2001. IGRAs are now recommended for use for children as young as 2 years of age1 and are recommended by the Centers for Disease Control and Prevention (CDC) for adults in all situations in which a TST has … Address correspondence to Andrea T. Cruz, MD, MPH, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin St, Suite A2210, Houston, TX 77030. E-mail: acruz{at}bcm.edu