Tuberculin Skin Testing

Abstract

We read with interest the article by Kendig et al (May 1998)1Kendig EL Kirkpatrick BV Carter WH et al.Underreading of the tuberculin skin test reaction.Chest. 1998; : 1175-1177Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar and the subsequent correspondence by Dr. Scott (October 1998).2Scott GC Misreading of the tuberculin skin test [letter].Chest. 1998; 114: 1225Abstract Full Text Full Text PDF PubMed Google Scholar Interpreting the reaction to tuberculin protein administered by intradermal injection (Mantoux test) has several problems. There is variation in reading between health-care professionals and the general public, difficulty in ensuring correct placement, and uncertainty in the concept of sequentially greater concentrations.1Kendig EL Kirkpatrick BV Carter WH et al.Underreading of the tuberculin skin test reaction.Chest. 1998; : 1175-1177Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar,2Scott GC Misreading of the tuberculin skin test [letter].Chest. 1998; 114: 1225Abstract Full Text Full Text PDF PubMed Google Scholar,3Colp C Goldfarb A Wei I et al.Patient's self-interpretation of tuberculin skin tests.Chest. 1996; 110: 1275-1277Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,4Howard TP Solomon DA Reading the tuberculin skin test: who, when and how?.Arch Intern Med. 1988; 148: 2457-2459Crossref PubMed Scopus (63) Google Scholar In the United Kingdom, the multiple-puncture (Heaf) test is most commonly used. A standardized dose and depth of injection is provided when a fixed head apparatus is used.5British Thoracic Society Guidelines: chemotherapy and management of tuberculosis in the United Kingdom; recommendations 1998.Thorax. 1998; 53: 536-548Crossref PubMed Scopus (525) Google Scholar Selby and colleagues6Selby CD Allen MB Leitch AG How well do the general public read Heaf skin tests?.Respir Med. 1990; 84: 245-248Abstract Full Text PDF PubMed Scopus (4) Google Scholar examined how well the general public read the Heaf test. Using a self-read card, 550 patients undergoing tuberculin skin testing were found to grade the reaction as accurately as a trained respiratory nurse. This contrasts sharply with the Mantoux test, where poor reproducibility has been found with medical and nonmedical health professionals,1Kendig EL Kirkpatrick BV Carter WH et al.Underreading of the tuberculin skin test reaction.Chest. 1998; : 1175-1177Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar as well as with the general public.3Colp C Goldfarb A Wei I et al.Patient's self-interpretation of tuberculin skin tests.Chest. 1996; 110: 1275-1277Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar,4Howard TP Solomon DA Reading the tuberculin skin test: who, when and how?.Arch Intern Med. 1988; 148: 2457-2459Crossref PubMed Scopus (63) Google Scholar Interpretation of the Heaf test appears to be more reproducible than the Mantoux test in tuberculin skin testing. Tuberculin Skin TestingCHESTVol. 115Issue 6PreviewAs noted in the paper (May 1998),1 the American Academy of Pediatrics (AAP) recommends that only the Mantoux test be utilized and that tests be read by a health-care professional 48 to 72 h after application of the test. Recommendation for interpretation of tuberculin skin test reactions by the Centers for Disease Control and Prevention (CDC), the American Thoracic Society (ATS), and the AAP vary only in the approach to patients with no identifiable risk factors. For these individuals, the CDC and ATS recommend ≥ 15-mm induration as the criterion for a positive skin test reaction. Full-Text PDF