BCG Test Research Articles

Study the Occurrence of Mycobacterium Bovis in Tuberculosis of Peripheral Lymph Nodes and its Effect on the Course of the Disease.

The incidence of tuberculosis caused by Mycobacterium bovis, not only the pulmonary form, but also the form developing in the extrapulmonary organs, is also increasing from year to year. Despite the large number of EPTB, TBPLN occupies a leading place among diseases of this type and the study of its pathogenic strains is an urgent task in ensuring the effectiveness of treatment. In this regard, the main purpose of the presented manuscript is to determine the frequency of M. bovis in TBPLN, its effect on the development and course of the disease, as well as the effectiveness of treatment. For this purpose, for the first time, the features of education that occur in patients in peripheral lymph nodes using instrumental methods of ultrasound, computed tomography, and magnetic resonance imaging have been identified. In subsequent studies, 110 patients with peripheral lymph node pathology were diagnosed with TBPLN by detecting mycobacteria in pathological material using general hematological, microbiological and gene-molecular (Gene Xpert) methods. In order to ensure the high effectiveness of drugs used for medicinal purposes, strains of the pathogen were detected using histological, cytological studies, BCG test and specific analyzes such as Diaskintest, Quantiferon test, immunological tests. The study showed that about 80% of patients had M bovis in the overall assessment, 76.4% of patients were sensitive to rifampicin, 9.1% of patients had rifampicin-resistant bacteria, and 14.5% of patients did not have mycobacteria. Therapeutic measures were carried out in 2 different modes, such as standard and individual or with replacement, when all patients were divided into 2 groups. During the period from the 56-day intensive phase of standard treatment to the 84-day intensive phase, a total of 40 patients had a sharp decrease in lymph nodes, elimination of purulent inflammation, and after a while 22 patients in this group had a relapse. In the individual treatment regimen, Levofloxacin and linezolid were used instead of pyrazinamide. While the effectiveness of treatment was achieved in 48 patients of group II after 56 and 84 days of the intensive phase, relapses after a certain time were observed in only 6 patients. When choosing an individual treatment regimen in patients diagnosed with M. bovis, a decrease in relapses to 11.5% is achieved. When M. bovis is detected, an individual scheme of antibacterial treatment of tuberculosis is selected, in which, instead of pyrazinamide, it is recommended to choose one of the reserve lines, depending on the sensitivity of the pathogen to drugs.

Mantoux’s Test and Diagnostic BCG for Diagnosis of Tuberculosis in Children

Objective: To determine the diagnostic accuracy of Mantoux’s test and diagnostic BCG test in the diagnosis of tuberculosis in children by taking AFB (acid fast bacilli) sputum test as gold standard. Study Design: Cross Sectional study. Setting: Imran Idrees Teaching Hospital Sialkot. Duration of Study: This study was conducted from 1st August 2021 to 31st August 2022. Subjects and methods: A total of 260 patients of both gender presented with history of cough, fever and weight loss with history of close contact with tuberculosis were included. Mantoux’s test and diagnostic bacilli calmette Guerin was applied simultaneously to all the subjects. Data regarding Mantoux’s test, diagnostic bacilli calmette Guerin and AFB (acid fast bacilli) sputum test was recorded. Results: Mantoux’s test diagnosed 10.4% patients, Diagnostic BCG test 13.8% and AFB diagnosed 16.9% patients with Tuberculosis. Mantoux’s test has shown sensitivity of 29.54%, specificity 93.5%, diagnostic accuracy by 83%, PPV 48.1%, NPV 86.7% in diagnosis of Tuberculosis. Diagnostic BCG test has shown sensitivity of 59.09%, specificity 95.4%, diagnostic accuracy by 89%, PPV 72.2%, NPV 91.9% in diagnosis of Tuberculosis. Conclusion: BCG test is more sensitive than the Mantoux’s test but the specificity of Mantoux’s test was equal to the BCG test. Keywords: Tuberculosis, Mantoux’s test, Diagnostic BCG, Diagnostic accuracy

BCG as Diagnostic Test for Primary Tuberculosis in Children

BCG and PPD Mantoux Intradermal Test were done simultaneously on 35 children suffering from primary tuberculosis hospitalized in the Department of Child Health, School of Medicine, Gajah Mada University, Yogyakarta, Indonesia, during the period of June 1980 to November 1980.
 This study revealed that: The BCG test was almost three times (74.3%) more sensitive than the PPD Mantoux Intradermal test in children suffering from primary tuberculosis. In under-nourished children with tuberculosis, the BCG test was even more sensitive (85.0% : 25.0%) and this difference was statistically significant (P < 0.01).
 There was a high frequency of false negative tuberculine reaction (74.3%) and accelerated BCG reaction (74.3%) in primary tuberculosis. It is suggested that BCG test be used as a diagnostic test as well as prophylactic in tuberculosis children who have had a BCG vaccination.

A comparative study of Mantoux test and BCG test in diagnosis of childhood tuberculosis

Background: India has one of the highest tuberculosis (TB) burdens globally. However, few studies have focused on TB in young children, a vulnerable population, where lack of early diagnosis results in poor outcomes.Methods: The present study was undertaken to assess the sensitivity and specificity of tuberculin test (Mantoux) and BCG test in diagnosis of childhood tuberculosis and to compare above tests as a diagnostic tool and to assess the impact of factors affecting the test. Mantoux test was done with 1 TU contained in 0.1 ml of PPD R23 with tween 80 solution. BCG test was done using a heat stable freeze-dried vaccine, after fresh reconstitution and injected intradermally in left deltoid region with a tuberculin syringe and 27 G hypodermic needle.Results: Tuberculous cases were more common in malnourished subjects more so with severe malnutrition. While maximum positivity 89% was obtained with BCG test, it was only 63% with Mantoux test, done with 5TU of PPD-RT-23. BCG was always positive whenever PPD was positive in any group of children. Sensitivity of Mantoux test was around 63% whereas that of BCG test was 89%. BCG test was more significantly associated with disease than tuberculin test (p <0.001).Conclusions: BCG test is a very sensitive and specific test for diagnosis of childhood tuberculosis. Mantoux test is affected by malnutrition and severity of disease whereas BCG test is affected only minimally. BCG test is more sensitive than Mantoux test (with 5TU PPD RT 23 Tween 80). A BCG induration of ≥10 mm or Mantoux induration ≥15 mm or an accelerated BCG test is indicative of active disease, irrespective of vaccination status of the patient.

Comparison of diagnostic BCG Test with Mantoux Test in Children with suspicion of Tuberculosis

The incidence of TB is increasing at an alarming rate in Pakistan as indicated by WHO 1997. The BCG test has been proved as a rapid, reliable and cost-effective test in children in many international studies. The BCG test has superiority over Mantoux test in children with severe malnutrition and TBM. The BCG test was positive in (80%) patients while Mantoux test was positive in 50% patients. The BCG test was positive in all patients where Mantoux test was positive. Thirty one patients had BCG test positive where Mantoux test was negative. Majority of the patients with positive BCG test (85%) were severely malnourished while Mantoux test was positive in only 15.6% of such cases. Most of BCG test positive children were below 5 years of age. In Tuberculous meningitis(TBM),BCG test was more (86%) conclusive than Mantoux test (14%). All patients with positive Mantoux test also had positive BCG test. In pulmonary TB, 40(91%) patients were BCG test positive as compared to positive Mantoux test (45%). All patients with positive Mantoux test also had positive BCG test.

Evaluation of BCG test in diagnosis of tuberculosis in BCG vaccinated children and its comparison with Mantoux test

Evaluation of BCG test in diagnosis of tuberculosis in BCG vaccinated children and its comparison with Mantoux test

Correlation between clinical and radiological presentation of pulmonary tuberculosis in children

Pulmonary tuberculosis may be easily confused with other chest diseases during its initial presentation. This study was carried out to identify presenting clinical and laboratory features that differentiate pulmonary tuberculosis from other diseases and to correlate clinical features and radiological findings. This study was conducted in department of pediatrics and Radiology in Bangabandhu Sheikh Mujib Medical University and Dhaka Shihsu Hospital from July 2005 to June 2006. A total fifty Children below 18 were included in the study after being clinically diagnosed as pulmonary tuberculosis. These patients were subjected to detailed history and, clinical examination. Each patient was evaluated by blood CBC, ESR, Mantoux test, Chest X-ray posterior anterior/lateral view, BCG test and gastric lavage. Statistical analysis was performed by SPSS 8 computer program. Fever, cough, weight loss, night sweats and raised ESR were the most common findings in PTB children. No correlation was found between clinical and laboratory parameters in establishing a confident diagnosis of the disease. The study highlights the importance of further research to pinpoint stronger and more reliable criteria for diagnosis. DOI: http://dx.doi.org/10.3329/bmj.v42i1.18974 Bangladesh Med J. 2013 Jan; 42 (1): 21-24

How to Optimize Current (Available) Diagnostic Tests

Isolation of mycobacterium tuberculosis is the gold standard in the diagnosis of childhood tuberculosis. However, it has inherent limitations due to paucibacillary nature of the disease in children and technical difficulties encountered in collection of appropriate sample. Thus, diagnosis is dependent on circumstantial evidence at best supported by conventional tests such as tuberculin test and chest radiograph. Several new tests are being developed but they lack ideal sensitivity and specificity. Hence, it is important to optimise use of current diagnostic tests. Clinical suspicion based on protocol developed by IAP is a pre-requisite of ordering tests and it is only then that proper interpretation is possible. Tuberculin skin test is still a useful screening test. It does help in establishing presence of infection though not necessarily disease. Attention must be paid to ideal test solution, proper technique and cautious interpretation. BCG test is not recommended. Miliary shadows and fibrocaseious cavitary lesions in chest radiograph are highly suggestive of tuberculosis in our epidemiology. CT scan is rarely necessary and is not cost and radiation-effective. It is ideal to attempt bacteriological examination in every suspected case of childhood tuberculosis. Most practical method is collection of gastric aspirate for smear and culture. It is possible to carry out this procedure in out-patient clinic. Better yield is likely with increasing expertise especially in extensive disease. Bronchoalveolar lavage is an invasive test and bacterial yield is comparable to that of gastric aspirate. Tissue collected for histopathological examination must be submitted for bacteriological tests. PCR is not easily available. It has high sensitivity but lower specificity and thus, is not routinely recommended. Serology has no place in diagnosis of tuberculosis. Interferon gamma release assays are also now available. Sensitivity and specificity of Quantiferon Gold and T-spot tests have not been studied in children and hence are not recommended in routine practice. Instead of trying newer tests, it may be best to avail an expert advice in difficult cases.

Clinico-epidemiological profile and diagnostic procedures of pediatric tuberculosis in a tertiary care hospital of western Nepal-a case-series analysis

BackgroundChanging epidemiology and diagnostic difficulties of paediatric tuberculosis (TB) are being increasingly reported. Our aim was to describe clinico-epidemiological profile and diagnostic procedures used for paediatric TB.MethodsA retrospective case-series analysis was carried out in a tertiary care teaching hospital of western Nepal. All pediatric TB (age 0-14 years) patients registered in DOTS clinic during the time period from March, 2003 to July, 2008 were included. Medical case files were reviewed for information on demography, clinical findings, investigations and final diagnosis. Analysis was done on SPSS package. Results were expressed as rates and proportions. Chi square test was used to test for statistical significance.ResultsAbout 17.2% (162/941) of TB patients were children. Common symptoms were cough, fever and lymph node swelling. The types of TB were pulmonary TB (46.3%, 75/162), followed by extra-pulmonary TB (41.4%, 67/162). Twelve patients (7.4%) had disseminated TB. Distribution of types of TB according to gender was similar. PTB was common in younger age than EPTB which was statistically significant. EPTB was mainly localized to lymph node (38, 50.7%), and abdomen (9, 12%). Five main investigations namely Mantoux test, BCG test, chest radiograph, erythrocyte sedimentation rate (ESR) and fine needle aspiration cytology (FNAC) or biopsy were carried out to diagnose TB.ConclusionsPaediatric TB in both pulmonary and extrapulmonary forms is a common occurrence in our setting. Age incidence according to type of TB was significant. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations.

Consensus statement on childhood tuberculosis

Revised National Tuberculosis Control Program (RNTCP) has focused on adults with smear positivity a tool not so well used in children with tuberculosis. There is a need to redefine standardization of diagnosis and management protocols for childhood tuberculosis. Indian Academy of Pediatrics constituted a Working Group to develop consensus statement on childhood tuberculosis (TB). Members of the Group were given individual responsibilities to review the existing literature on different aspects of the childhood TB. The group deliberated and developed a consensus which was circulated to all the members for review. Efforts were made to ensure that the recommendations are standardized. To produce recommendations and standard protocols for reasonably accurate diagnosis and rational treatment of tuberculosis in children. Fever and or cough > 2 weeks with loss of weight and recent contact with infectious case should arouse suspicion of TB. Chest Xray and trial with broad-spectrum antibiotic for 7-10 days is justified. In case of clinical and radiological non-response, Mantoux test and sputum or gastric aspirate for AFB is recommended. If AFB is positive, diagnosis is confirmed. If AFB is negative but chest Xray is suggestive and Mantoux test is positive, it is a probable case and if these tests are negative, alternate diagnosis must be sought and referral made to an expert. Ideally it is recommended to use 1TU of PPD for Mantoux test but 2 or 5 TU may be acceptable (but less preferred). Cut-off point of 10 mms for natural infection may be used for test done with 1, 2 or 5 TU. There is no linear relation of reaction to tuberculin strength and so no more than 5 TU should be used. BCG test is not recommended. Diagnosis must not be made without an attempt to look for AFB in gastric aspirate or sputum, as it is possible to get AFB even in primary complex. Elisa and PCR tests for TB are not recommended. There is no place for trial of anti tubercular therapy. Lymphnode enlargement > 2 cm with or without typical findings suggestive of TB and failure of antibiotic response demands FNAC for histopathology and bacteriology. Clinical suspicion of tubercular meningitis (TBM) should be confirmed by CSF examination and CT scan though none of these investigations are confirmatory and hence should not be considered in isolation. CSF tests for TB antibody and PCR are not recommended for routine use. Diagnosis of abdominal TB is made on circumstantial evidence and there are no standard guidelines. For treatment, disease is divided into three categories. The Category I and III are recommended for different types of new cases i.e. those who have received treatment for not more than 4 weeks. Category III includes primary pulmonary complex, one site peripheral lymphadenitis and pleural effusion, while all other forms of TB are included in Category I, that corresponds to smear positive TB in adults. This is because AFB is often found in many Category I disease in children. Category II includes defaulters, relapses and failure cases irrespective of the site of disease. Standard protocol is followed for each of these categories. Intermittent thrice weekly therapy with higher dose has been found to be equally effective as daily therapy and so is recommended in DOTS Direct Observed Therapy Short term. Compliance of treatment must be ensured. Repeat chest X-ray is ideal at the end of therapy. Liver function tests are not routinely recommended. Recommendations are also made for special situations such as MDRTB, TB and HIV and neonate born to mother suffering from TB.

Couverture vaccinale des enfants de CM2 (10-11 ans) du Finistère, France, en 2004

Within the context of a cross-sectional survey to study the health status of 10 & 11-year-olds in Finistere (western France) in 2004, their vaccination status was also investigated. A random sample of 1003 children was selected, and 992 completed questionnaires were returned in response to the status of tuberculosis vaccination. 67% of children's cases corresponded to the acceptable vaccination status according to the French 1990 guidelines, including the BCG test. Prime injections were correctly carried out (ranging from 95% for measles to 97.7% for trivalent diphtheria, tetanus, and poliomyelitis [DTP] vaccines). Vaccine coverage rates were seen to decrease with the follow-up doses of injections required: 89% for the fourth dose of pertusis (whooping cough) vaccine and 91.9% for the fifth does of DTP. Coverage was remarkably lower for the third dose of hepatitis B vaccine and the second dose of trivalent measles, mumps, and rubella which have both been recommended later in France. The community and living environment (urban & rural) is a common factor found closely associated with vaccination compliance and coverage rates. For the most part, the vaccination rates for these children in Finistère were higher than the national ones.

BCG skin reaction in Mantoux-negative healthy children

BackgroundTuberculosis poses a great challenge, especially in children. The response of BCG Test may be different in previously vaccinated children and needs to be considered before interpreting positivity for TB. This study has been carried out to determine the pattern of BCG reaction comparing previously vaccinated with non-vaccinated children.MethodsThe study was conducted in the healthy school children aged 4–6 years. The BCG skin reaction in Mantoux-negative children was compared between children with and without previous BCG scar. After the Mantoux and BCG Test, the analysis of variance was done as per protocol.ResultsOut of 50 children previously BCG vaccinated, 39(78%) showed exaggerated BCG test responses while out of another 50 children who were not vaccinated for TB, only 9(18%) showed exaggerated BCG Test response (p-value < 0.00001). Average induration obtained in children who were immunized with BCG at birth was much greater than those who were not immunized. 80% and 76% males and females respectively in Group I showed exaggerated BCG response while 16% and 20% males and females respectively of Group II showed exaggerated BCG response.ConclusionThe present study indicates that normal healthy children may have a mild exaggerated BCG Test response i.e. induration up to 8 mm because of prior BCG vaccination. Therefore, BCG Test, though important should not be the only criteria for start of chemotherapy for TB in children as the side effects of drugs may cause much morbidity. An induration up to 8 mm after the BCG Test can be normal in Indian settings due to exposure to Mycobacterium in environment and/or BCG vaccine.

Potential utility of BCG test in excluding tuberculosis in adults

In developing countries, many sputum-negative suspects of pulmonary tuberculosis (PTB) are given antituberculous medication just because tuberculosis (TB) could not be excluded in them. Many studies have shown that BCG test is nearly 100% sensitive, except in those with severe malnutrition, steroid therapy and other causes of immunosuppression. The aim of the present study was to find out the proportion of PTB suspects in whom BCG test may be useful in excluding diagnosis of TB. The study was carried out on adult subjects attending District Tuberculosis Clinic (DTC), Pali, Rajasthan, India. Out of 104 subjects studied, all 18 sputum-positive subjects showed a positive BCG test indicating 100% sensitivity of the test. The result of BCG test was negative in 16.28% of 86 sputum-negative suspects of TB. The BCG test did not show any adverse reactions among these cases except for adenitis of axillary or cervical lymph nodes in 6.7% subjects. The study raises the possibility that BCG test may be useful in excluding diagnosis of tuberculosis in a proportion of adult sputum negative-suspects of PTB in developing countries like India. More studies are needed in this direction.

BCG test reaction in previously BCG Moreaux-Rio de Janeiro-vaccinated healthy children

BCG-test reaction was carried out in 91 non-tuberculous children between 2 and 11 years old, who had received BCG vaccination during the first six months of life to critically evaluate the usefulness of this test in Pediatric practice. The BCG-test profile of the vaccinated group was shown to have a unimodal distribution, varying from 3 to 17 millimeters, with a median of 6 millimeters. It was demonstrated that the degree of reaction decreases with time. Nevertheless, false-positives could be expected in a significant percentage when reactions larger than 10 millimeters are considered as a cutoff. The specificity can be increased using only reactions with diameter equal or greater than 15 millimeters as an indicator of tuberculous disease.

A preliminary study of nectar production of the field cress, Rorippa indica, in relation to the age of its flowers

AbstractFloral nectar production quantity and changes in sugar concentration of the nectar of Rorippa indica were investigated. Flowers were sorted by age. The small flower size was a major factor for the use of BCG test paper in nectar sampling. In flowers of the youngest age category, the nectar volume increased toward the night and decreased during the day. The amount of sugar in the nectar decreased with flower age. The sugar concentration was lower at night than daytime. The variability and changes in nectar concentration enabled various species of insects to forage for nectar.

Is the BCG test of diagnostic value in tuberculosis?

Setting: In developing countries including Turkey, tuberculosis is still a major problem. Rapid diagnosis and early medical intervention are the two most important considerations in preventing the spread of the disease. Objective: This study was carried out to determine the diagnostic value of BCG test in childhood tuberculosis and compare it with tuberculin test in this regard. Design: 50 patients and 20 healthy children without any evidence of previous BCG vaccination and aged 80 days-15 years were simultaneously tested with purified protein derivative (PPD) and BCG vaccine. Results: In pulmonary tuberculosis BCG test was positive in 100% of cases and the PPD test in 44.5%. Similarly, BCG test was positive in 100% of miliary tuberculosis and tuberculous meningitis cases but PPD test was negative in all of them. Out of 22 patients with malnutrition 18 (82%) had positive BCG test and 4 had positive PPD test. BCG test showed uniformly high positivity in all grades of malnutrition. Conclusion: BCG is more reliable and sensitive than the tuberculin test in the diagnosis of tuberculosis. It is still valuable in the diagnosis of tuberculosis especially in developing countries where the disease is still a major public health problem and where sophisticated methods such as rapid culture with BACTEC and demonstration of bacilli with DNA probes are not widely available.

BCG test reaction in previously BCG vaccinated children

BCG test reactions were studied in 1095 non-tuberculous children from 6 months to 5 years of age, who had received BCG vaccination in the newborn period, in order to find out the diagnostic value of the BCG test in previously BCG vaccinated children. Previous BCG vaccination has an effect on the BCG test reaction in the form of an accelerated BCG reaction. Although the degree of reaction decreases with time, 51.4% of children still showed a strongly accelerated BCG reaction 4 1/2-5 years after BCG vaccination. It is concluded that the BCG test cannot be used as a diagnostic test for tuberculosis in children under 5 years of age who have had previous BCG vaccination.

Comparative study of heaf tuberculin tests with PPD and freeze-dried BCG vaccine

Summary Freeze-dried BCG vaccine from the Pasteur Institute was compared in different strengths with PPD (2 mg./ml.) using the multiple puncture method in 1,228 unvaccinated persons. There were quantitative and qualitative differences in the reactions in the same individuals. With strengths of 6 to 30 mg./ml. of BCG a higher proportion of positive reactions were obtained than with PPD. All of a small group of patients with tuberculosis had positive reactions to both antigens. A group of 149 leprous patients gave a pattern of reactions similar to that of the normal group. The BCG test by the multiple puncture method is recommended for use in tuberculin surveys preceding BCG vaccination as a more sensitive indicator of tuberculous infection than the standard PPD test.

Diagnostic BCG test in old individuals

100 individuals between 70 and 100 years of age were tested with Adrenalin-Pirquet test, Mantoux 100 T.U. and Diagnostic BCG test. 41 per cent were definite reactors to the AP test. In 38 per cent the AP test was negative or doubtful, the Mantoux test positive and the BCG test showed a typical early reaction. In 9 per cent the AP test was negative, the Mantoux test negative or doubtful, but the BCG test gave a typical early reaction. Thus in all 88 per cent are considered ‘allergic’. In 12 per cent the BCG test gave no early reaction. 10 out of 11 individuals in the last group, tested again after three months, gave positive Mantoux reactions, and they all gave a typical early reaction to BCG this time. Extensive application of the diagnostic BCG test in non-reactors to tuberculin among old individuals may show that a complete loss of allergy is less common than has been assumed.