Mean Tuberculin Research Articles

Retrospective analysis of seven breast tuberculosis cases.

The present study aimed to evaluate the demographic data, diagnostic methods, therapeutic regimens and duration of therapy in 7 breast tuberculosis (BTB) cases. The data of BTB cases treated between January 2006 and December 2013 were retrospectively evaluated, with a total of 648 tuberculosis (TB) cases recorded during the 8-year period. Among these cases, 296 patients (50%) suffered from pulmonary TB, 278 (43%) from non-pulmonary TB and 45 (7%) from PTB plus NPTB. In total, 7 BTB were diagnosed, which constituted 1.08% (7/648) of all TB cases and 2.51% (7/278) of all NPTB cases. The mean age of patients was 34±9.46 years, with no pregnant or lactating women. Bilateral breast involvement was detected in only 1 case, while all cases had a BCG scar, and obtained a mean tuberculin skin test (TST) result of 14.28±6.79 mm (range, 7-26 mm). The symptoms included presence of a mass, tenderness, pain, swelling and fluctuation in the breast, with or without discharging sinuses. In 1 case, history of contact with TB was found. All patients were newly-diagnosed BTB cases, with no other organ involvement. Upon histopathological examination of breast tissue, granulomatous inflammation with typical caseous necrosis was observed in 1 case, non-caseous necrosis inflammation was detected in 2 cases, granulomatous inflammation was observed in 3 cases, and mastitis and fat necrosis inflammation was observed in 1 case. Acid-fast bacilli (AFB) staining was positive in only 2 cases, and all patient were treated with anti-TB drugs with a successful outcome and no recurrence. In conclusion, BTB is a rare form of TB and the present retrospective study reported 7 cases of BTB along with the results of histopathological examination, microbiological examination and treatment. TB must be considered when there is presence of breast masses presenting with tenderness, pain, swelling and fluctuation, with or without discharging sinuses.

Comparative study between tuberculin skin test and serum albumin level in patients with active pulmonary tuberculosis

Tuberculosis is difficult to diagnose and is an important cause of death among adults in developing countries. There is an urgent need for low-cost diagnostic markers in resource-limited settings. The aim of the study was to investigate the relationship between the intensity of the tuberculin test and serum albumin level in patients with active pulmonary tuberculosis. Forty patients with active pulmonary tuberculosis before treatment were classified into two groups: group A and group B. Group A included 20 patients (17 men and three women; age 23–70 years) with serum albumin level below 3.5 g/dl. Group B included 20 patients (16 male and four female patients; age 15–68 years) with serum albumin level of 3.5 g/dl or more. Patients were subjected to full clinical evaluation. Comorbidities that may affect tuberculin reaction, such as HIV infection, alcoholism, chronic renal failure, and neoplasms, were excluded. Laboratory tests included complete blood count, evaluation of erythrocyte sedimentation rate, liver and kidney function tests, plain chest radiography, tuberculin skin test using the Mantoux technique, sputum test for acid fast bacilli by means of Ziehl–Neelsen staining for three consecutive days, and serum albumin level at the same time as the tuberculin test. There was a statistically significant difference between the two groups as regards serum albumin level. The mean tuberculin skin test diameter in group A was 7.5 ± 3.94 mm and in group B was 20.9 ± 5.51 mm, which revealed statistically significant difference between the two groups. There was a statistically significant positive correlation between the intensity of tuberculin skin reaction at 72 h and serum albumin levels in both groups. Patients with active pulmonary tuberculosis and lower serum albumin levels have weaker skin responses to tuberculin test.

Relationship of nutritional status with tuberculin sensitivity

To estimate the prevalence of under-nutrition among school children and to find out the relationship between nutritional status and tuberculin sensitivity. A cross sectional study was carried out among 3335 children between 5-8 years of age attending 60 schools in Bangalore city selected by stratified random sampling. The nutritional anthropometric indices were calculated using reference median as recommended by World Health Organization, classified according to standard deviation units termed as Z-scores. The nutritional status of the children was assessed by Weight for age, Height for age and Bio-mass-index (BMI). Depending upon the method for classifying nutritional status, the prevalence of under-nutrition (including mild and severe under-nutrition) varied between 14.9-29.8%. The prevalence of severe under-nutrition varied from 2.9-6.7%. The frequency distributions of reaction sizes were found to be similar among children classified by nutritional status. The differences in proportions of significant reactions (=10 mm) and mean tuberculin reaction sizes between children classified by nutritional status were not found to be statistically significant. Tuberculin sensitivity was not influenced by nutritional status among apparently healthy school children.

Increased risk of tuberculosis in patients treated with antitumor necrosis factor alpha

Drugs which antagonize tumor necrosis factor alpha (TNF-alpha) are known to increase the risk of tuberculosis. We aimed to evaluate the risk of tuberculosis in patients treated with anti-TNF-alpha, in Turkey. Two hundred and forty patients receiving anti-TNF-alpha, from December 2005 to December 2007, were included in the study. All participants provided a history and underwent a physical examination, a chest X-ray, and a tuberculin skin test. Isoniazid treatment was initiated in those patients with a latent infection, and they were followed up at 2-month intervals. A Bacillus Calmette-Guerin (BCG) scar was present in 184 patients (77.6%). The mean tuberculin skin test induration of patients on admission was 10.7+/-7.0 mm. Male gender and the presence of a BCG scar were predictors of a higher tuberculin skin test result (P<0.05), while there was no significant effect of age on the tuberculin skin test (P>0.05). Of the 240 subjects, 229 (95.4%) received methotrexate or corticosteroid treatment prior to anti-TNF-alpha therapy. Isoniazid treatment preceded anti-TNF-alpha administration in 185 (77.1%) of the 240 patients. Two patients developed tuberculosis (incidence 833/100,000). There was no correlation between initial and 12-month tuberculin skin test results (P>0.05). Tuberculin skin test conversion was detected in five subjects during the 12-month follow-up; however, none developed active tuberculosis. One patient developed a drug reaction secondary to etanercept, and another demonstrated hepatotoxicity due to isoniazid. This study shows that anti-TNF-alpha therapy increases the risk of tuberculosis, despite treatment of latent infection.

Tuberculin reactivity: prevalence and predictors in BCG-vaccinated young Norwegian adults

We studied tuberculin reactivity in young Norwegian adults and its possible dependency on age, gender, previous BCG vaccination, smoking habits, occupational exposure, diet as well as years of education as a measure of socio-economic status. Responders of a random sample of men and women aged 20–44 years living in Bergen, Norway were interviewed and tested with the adrenaline-Pirquet test with Norwegian-produced synthetic medium tuberculin at the out-patient chest clinic in the city of Bergen in 1992–1993. Nine hundred and three subjects out of 1200 met for the clinical examination (75%). Five hundred and eighty-eight subjects were tuberculin-tested and read, whereof 95% were BCG vaccinated by age 14. Mean tuberculin reactivity was 4.8 mm (SD: 3.0 mm). A positive reaction (⩾4 mm) was found in 64%, whereof 7% had a strongly positive reaction (⩾10 mm). A negative reaction (<4 mm) occurred in 36%, whereof 10% had no reaction (0 mm). Only 30% of the females and 36% of the males aged 21–25 years were tuberculin positive 7–12 years after BCG vaccination. Linear regression analysis demonstrated tuberculin reactivity to increase with increasing age, male gender with an increasing sex effect by age, and current smoking. Occupational dust or gas exposure, a diet rich in vitamin C or years of education did not influence tuberculin reactivity significantly.

Natural Killer Cell Activity in Multidrug-Resistant Pulmonary Tuberculosis

Background: Multidrug-resistant pulmonary tuberculosis (MDRTB), a major problem in developing countries, may result from either insufficiency of host cellular immune response or mycobacterial mechanisms which has been more intensively investigated so far. Objectives: The aim of the study was to investigate natural killer cell activity (NKA) and T lymphocyte subsets in HIV– patients with secondary MDRTB. Methods: 20 male patients with MDRTB (mean age 38 ± 8 years), 15 nonresistant tuberculosis male patients (NRTB) (mean age 36 ± 11 years) and 12 healthy male controls (mean age 35 ± 8 years) were included. The percentages of CD3+, CD4+, CD8+, CD25+, CD11b+ and CD16+56+ cells were measured by flow-cytometric analysis of peripheral blood lymphocytes (PBL). NKA was evaluated using the anticandidal index method. Results: The mean tuberculin response was higher in MDRTB and NRTB patients compared to controls (15.4 ± 3.8, 15.1 ± 3.3 and 10.9 ± 2.8 mm, respectively; p < 0.001). There was no significant correlation between PPD response and PBL subsets or NKA. The percentages of both CD3+ and CD3+CD4+ T lymphocytes were significantly lower in MDRTB (62.4 ± 12.1 and 33.9 ± 9.0%) compared to NRTB (70.8 ± 7.5 and 42.9 ± 8.6%; p < 0.05). Patients with MDRTB had significantly lower NKA compared to NRTB and controls (30.9 ± 11.3, 49.7 ± 15.5 and 40.0 ± 8.5%, respectively; p < 0.01). Conclusion: This reduction in NKA may suggest a role for impaired NK function in the pathogenesis of MDRTB in HIV– patients.

Tuberculin reactivity in healthy school children in Pondicherry.

Five hundred healthy school children in the age group 5-9 years underwent tuberculin testing. Seventy nine per cent of the study population had a BCG scar. 9.2% children were found to be suffering from malnutrition, using the Quetlet's Index and 7.8% were found to be malnourished by weight for age method. 18.6% of the children were tuberculin positive (induration > or = 10 mm) and the prevalence of tuberculin positivity increased with age. The numbers of tuberculin reactors or the mean tuberculin reaction were not affected by malnutrition. BCG scar status neither affected the mean tuberculin size nor the number of tuberculin reactors.

BCG revaccination and tuberculin reactivity.

Interpretation of tuberculin reactions in revaccinated children is somewhat controversial among paediatricians. In this study, the effect of the number of BCG vaccines on tuberculin reactivity is evaluated. In 2810 healthy children aged 7 to 14 years with purified protein derivative (PPD) testing. Children were grouped according to the concordance of the number of the reported/documented vaccinations to the number of scars. Group 1 and 2 comprised of children 7 to 10 years of age and 11 to 14 years of age respectively, who had non-concordant scar numbers, and Group 3 and 4 included 7 to 10 and 11 to 14 years old children with concordant scar numbers. Mean tuberculin induration sizes were 8.0 +/- 5.7 mm for Group 1, 10.6 +/- 4.9 mm for Group 2, 9.8 +/- 4.9 mm for Group 3 and 10.9 +/- 4 mm for Group 4. As the time interval after the last dose of vaccination increased, mean induration sizes decreased in Group 1 and Group 3. In contrast, the mean reaction sizes of Group 2 and Group 4 showed a positive correlation with the period after the last dose of vaccine. It seems advisable that an induration size > or = 15 mm should not be attributed to BCG vaccination in countries with a high tuberculosis infection prevalence and routine BCG revaccination policies. A detailed investigation for tuberculosis infection and disease should be performed in those cases.

Absence of relationship between tuberculin reactivity and atopy in BCG vaccinated young adults

BACKGROUNDAn inverse association between tuberculin responses and atopy has been observed in Japanese children, indicating that BCG immunisation, subclinical exposure to Mycobacterium tuberculosis without clinical disease, or host characteristics may...

Development of tuberculin reactivity and sensitization to M. scrofulaceum and M. fortuitum in children BCG-vaccinated at birth.

Since the incidence of tuberculosis is steadily declining in Finland and infections by environmental mycobacteria may be increasing, the aim of the present study was to evaluate the development of tuberculin reactivity and sensitization to environmental mycobacteria. Healthy Finnish schoolchildren aged 10.4-12.4 yrs (n=201) were tested with tuberculin purified protein derivative RT23, Mycobacterium scrofulaceum RS95 and M. fortuitum RS20 sensitins. The same children had been previously tested with the same antigens and methods at the age of 4-6 yrs in 1989. Rapid waning of tuberculin reactivity and decrease in sensitization to environmental mycobacteria were observed between 4-6 yrs. Both tuberculin and sensitin skin reaction sizes decreased significantly over the 6-yrs period. The mean tuberculin skin reaction size was 3.2 mm in diameter, which was significantly (p<0.001) smaller than the mean induration size (4.8 mm) at the age of 4-6 yrs. Similarly, the mean skin reaction sizes to M. scrofulaceum and M. fortuitum sensitins were 3.4 and 1.7 mm, respectively, which were significantly (p<0.001) smaller than 6 yrs earlier (mean 4.5 and 3.1 mm). The number of zero reactions to all antigens increased significantly during the follow-up period. Contacts with pets or farm animals were associated with larger reactions. In contrast, children suffering from allergic symptoms had smaller reactions. Contacts with mycobacteria, either with Mycobacterium tuberculosis or environmental mycobacteria, seem to be too rare to maintain tuberculin responsiveness and a high sensitivity to other mycobacteria. Different bacille Calmette-Guérin vaccine products and dosages used, the declining incidence of tuberculosis and geographical factors, which can influence environmental mycobacterial exposure, may explain the disparity between the present and previous Finnish studies.

Rapid decrease in tuberculin skin test reactivity at preschool age after newborn vaccination.

A study of tuberculin sensitivity was performed in 353 children aged 4-6 years, all vaccinated at birth with British BCG vaccine. Significant waning of tuberculin reactions with increasing age was found (p < 0.05). In the age group < 4.5 years, the mean tuberculin reaction was 6.6 mm, in the age group 4.5-5.5 years 5.2 mm and in the age group of > 5.5 years 3.5 mm. The number of children with positive reactions (> or = 5 mm) was 165 (40%) and those with strong reactions (> or = 10 mm) 49 (14%). None of the latter children had active tuberculosis during a follow-up period of 12 months. Eighty-three (24%) of the children had no reaction. The children who had been revaccinated with the MPR vaccine against measles, rubella and parotitis (n = 31) had significantly larger tuberculin reactions than the non-revaccinated children. Atopic dermatitis or infections during the preceding six months did not have any significant influence on reaction sizes. Our results demonstrate that the variation in size of tuberculin reactions after BCG vaccination at birth is large. We conclude that tuberculin sensitivity wanes rapidly by the age of 4.0-6.3 years.

A comparative study of different techniques of giving BCG vaccination to newborn infants in Hong Kong

Following administration of BCG vaccine to newborns by trained inoculators using a simple triangular needle (20 insertions) technique the mean tuberculin reaction was 13·5 mm. at 3 months using 100 TU of PPD tuberculin (Weybridge). When this technique of BCG administration was used by relatively unskilled vaccinators in private maternity homes a mean of 12·2 mm. was recorded. With 5 TU the figures were 6·7 mm. and 6·3 mm. respectively. When the BCG had been administered by the intradermal, percutaneous Heaf multiple puncture and simple triangular needle (40 insertions) techniques there was no significant difference in the mean tuberculin readings (using 100 TU PPD Weybridge), these being 14·7, 14·9 and 14·6 mm. induration respectively. A jet injector (‘Panjet’) gave a significantly lower mean reading of 14·1 mm. With 5 TU the comparative figures were 7·1, 7·4 and 7·2 mm. with 6·8 mm. for the ‘Panjet’. The mean number of effective punctures detected at the vaccination site were 27·0 for the Heaf apparatus, 10·9 for the triangular needle (20 insertions), 18·3 for the triangular needle (40 insertions) and 6·6 (20 insertions — unskilled). For the intradermal with syringe and ‘Panjet’ techniques the mean sizes of vaccination lesion were 4·2 mm. and 3·6 mm. respectively. In circumstances in which the use of the intradermal method seems unjustified, the simple triangular needle technique can give acceptably good results.