Positive Tuberculin Reaction Research Articles

The immune response to vaccination in undernourished and well-nourished Nigerian children.

The immune response of young Nigerian children to a full course of infant immunizations was studied in relation to their nutritional state at the time of vaccination. No significant correlations were found between anthropometric measurements made at the time of vaccination and the antibody response to triple, polio, measles, meningococcal and typhoid vaccines. Significant correlations were found between serum pre-albumin levels and the response to group A meningococcal polysaccharide vaccine and between serum albumin levels and the response to group C meningococcal polysaccharide vaccine. These correlations may reflect the depressive effect of malaria both on serum albumin and pre-albumin levels and on immune responsiveness to meningococcal polysaccharides. No significant correlations were found between nutritional state at the time of BCG vaccination and the development of a positive tuberculin reaction five weeks later. We conclude that under-nutrition has little or no effect on the immune response to vaccines used in routine infant immunization programmes.

BCG vaccination of the newborn infant with the 131 Copenhagen strain

From October 1, 1979 to September 30, 1981 a prospective study on the side-effects of BCG inoculation was conducted in the cities of Duisburg, Essen, and Mülheim, in very close cooperation with practising pediatricians, public health authorities, and obstetric departments. Particular consideration was given to suppurating regional lymphadenitis. In the period covered by the study 21.294 infants from 23.390 live births (i.e., 89%) were BCG-vaccinated using the Copenhagen 1331 strain manufactured by Behringwerke. A suppurating regional lymphadenitis occurred in 66 cases, i.e., a complication rate of 0.3%. The conversion ratio was high. Out of 8.144 documentation forms that could be assessed 6.840 (84%) attested to a positive tuberculin reaction caused by prophylactic test U 4. If the result of this test was negative a second test, after Mendel-Mantoux, strength 10, was used. According to this a total of 7.311, i.e., altogether 98.4% of the inoculation results evaluated, were positive. Both the conversion ratio as well as the incidence of ulcers at the vaccination site depend to a slight degree on the concentration of units in the vaccine which are capable of reproduction, to the extent that at higher concentrations the conversion ratio increases, as does the number of ulcers at the vaccination site.

The low yield of routine radiographic screening of tuberculin-positive hospital employees

On the basis of limited benefit in relation to cost, mass radiographic screening for tuberculosis was challenged and abandoned in the 1970s. In the 1980s the value of such periodic screening of hospital employees with known positive tuberculin reactions was queried on the same grounds but without comparable data. We report here the results of 11 years of radiographic screening of tuberculin-positive employees of a university hospital. Although 3900 chest films were obtained at considerable cost, only one proved and six suspect cases of tuberculosis were detected, all of which were symptomatic. Even in the absence of symptoms all could have been identified by other screening criteria, five on the basis of recent tuberculin conversion and two as tuberculin-positive new employees. These data support the recent statement that periodic chest roentgenograms of hospital employees with known positive reactions to tuberculin skin testing are not justified.

Ten year evaluation of a trial of cremoprophylaxis against tuberculosis in Frobisher Bay, Canada

A trial of chemoprophylaxis to prevent tuberculosis in Canadian Inuit (Eskimos) was carried out in Frobisher Bay, Canada during 1971–1974. A completely supervised regimen of isoniazid and ethambutol thrice weekly for 18 months was administered. A 10-year evaluation of 370 treated persons and 217 control subjects demonstrates the sustained value of adequate chemoprophylaxis in reducing the risk of developing active tuberculosis in the 3 groups under study-1, those with a previous episode of active tuberculosis, 2, positive tuberculin reactors with normal chest X-ray and 3, BCG vaccinated individuals with large tuberculin reactions. There were 3 cases of active disease in the treated group, a risk of 0.1% per annum, and 13 cases among the controls, a risk of 1.0% per annum.

Management of tuberculin reactors in children and adolescents previously vaccinated with BCG.

Between 1960 and 1981, 142 Bacillus Calmette-Guérin (BCG)-vaccinated children and adolescents were evaluated in the Children's Chest Clinic, Bellevue Hospital. These patients came from 28 countries and had positive tuberculin reactions and/or exposure to active tuberculosis. Antituberculous therapy was given to 8 with active tuberculosis, to 8 with calcified pulmonary primary lesions and to 105 positive tuberculin reactors without disease. In a 1 1/2- to 16-year follow-up no tuberculous disease occurred, and two patients with previously negative roentgenograms developed calcified pulmonary lesions. Guidelines are given for the management of patients previously vaccinated with BCG with special reference to the value of prophylactic isoniazid therapy for those considered infected by Mycobacterium tuberculosis but without evidence of disease.

Chemoprophylaxis of pulmonary tuberculosis. Current recommendations and controversies.

The recommendation for chemoprophylaxis for all persons under 21 years of age with a positive tuberculin reaction is accepted by nearly all authorities. Doubt exists concerning the treatment of those over 21 unless special risk factors are present. The key to safe isoniazid prophylaxis lies in emphasizing the side effects of hepatitis and in urging patients to report any untoward symptom. The alternative to prophylaxis must be close surveillance by means of periodic chest roentgenograms.

Cellular infiltrate in situ and response kinetics of human intradermal and epicutaneous tuberculin reactions

Monoclonal antibodies used in the avidin-biotin-peroxidase complex (ABC) method and a histochemical azo-dye method for acid α-naphthyl acetate esterase (ANAE) were used to identify T lymphocytes and their functional subpopulations, B cells, and mononuclear phagocytes in tuberculin-test reactions. At 6 and 24 hr up to 52% of all dermal inflammatory cells in situ were T6+, whereas at 72 hr no T6+ cells were observed in the dermis. This suggests that in the initial phases of tuberculin reactions the epidermal Langerhans cells are mobilized to the perivascular spaces in the dermis. At 6, 24, and 48 hr T3+ T lymphocytes usually formed the main inflammatory cell type in situ. The high proportion of Ia+ T lymphocytes and the variations in the local proportion and numbers of T4+ and T8+ cells suggest that T cells play an active role in the generation of a positive tuberculin reaction. At 72 hr T-pattern ANAE+ lymphocytes accounted for 64 ± 9 and 35 ± 10% of all cells in situ in epicutaneous and intradermal tuberculin reactions, respectively ( P < 0.05). The corresponding values for M-pattern ANAE+ macrophages were 27 ± 9 and 53 ± 10% ( P < 0.10). This indicates that the recruitment of mononuclear phagocytes is delayed if tuberculin is applied epicutaneously rather than injected intradermally.

Positive Tuberculin Reactions Among American Elementary School Children in Europe

Positive Tuberculin Reactions Among American Elementary School Children in Europe

The pattern of age-specific tuberculin hypersensitivity in two groups of south african schoolchildren

In epidemiological studies on tuberculosis we have observed a decrease in the prevalence of positive tuberculin reactions around the age of 13. This decrease was apparent in a variety of populations studied. Statistical analysis of the tuberculin testing data demonstrates the significance of the decrease in the proportion of positive reactors at age 13 and also of a reduction in size of reactions. The possibility of suppression of the delayed hypersensitivity reaction at about puberty is considered.

COMPARISON OF MULTIPLE PUNCTURE LIQUID TUBERCULIN TEST WITH MANTOUX TEST

Two studies were performed to compare the disposable liquid tuberculin PPD 'Imotest' with the Mantoux test. While there was a tester effect in the first study indicating the need for accurate application of the imotest, the results of the second study showed that the two tests were comparable in selecting truly positive and negative tuberculin reactors. Results were compared both by conventional methods and by a method new to tuberculin testing, the maximum likelihood technique. This method gives a more accurate estimate of false reaction rates. A significant difference was found between reading at 48 and 72 h for both tests. The acceptability and ease of reading of the imotest, with a tuberculin selectivity comparable to the Mantoux method, make it a suitable alternative tuberculin test, especially for screening large populations.

Immunologic derangement in myotonic dystrophy: Abnormal contact sensitization to dinitrochlorobenzene

A broad spectrum of immunologic parameters was investigated in 13 cases of myotonic muscular dystrophy (MyD), including those for cellular immunity which has attracted little attention in the past. One was a 46-year-old woman having both MyD and a thymoma. This association between MyD and thymoma is probably coincidental without biologic significance. There was no evidence of malignancy in the remaining 12 patients. The delayed cutaneous hypersensitivity reaction to dinitrochlorobenzene was anergic in 3 patients and showed impaired positive reactivity in 3 patients, as compared with no failure of response in normal adults or children with Duchenne muscular dystrophy. A high proportion of patients with MyD displayed positive tuberculin reactions, as did controls. Our case of MyD with a thymoma showed marked lymphocytopenia in peripheral blood, but the number of lymphocytes in peripheral blood in the remaining 12 patients was normal. Uptake of tritiated thymidine by lymphocytes in the presence of phytohemagglutinin was normal. Serum gammaglobulin was reduced in 4 patients with MyD. The mean value of serum immunoglobulin level was decreased only in the class of IgG. A wider derangement of immunologic function may occur in MyD than was previously recognized.

Positive Tuberculin Reactions Among Children of United States Military Personnel in Germany

Positive Tuberculin Reactions Among Children of United States Military Personnel in Germany

The Ottawa County project: a report of a tuberculosis screening project in a small mining community.

Following a retrospective review of tuberculosis cases reported from Ottawa County, Oklahoma, from 1969 through 1973, a selective tuberculosis screening project was implemented. Screening of a "target group" of the population, 519 former miners, greater than or equal to 50 years of age, resulted in the discovery of abnormal chest X-rays in 182; (103 with silicosis, 36 with silicotuberculosis, 12 with inactive tuberculosis, and 31 with other abnormalities). Eighty-five of these persons had positive tuberculin skin tests. Preventive therapy was recommended for 50, and 36 completed the prescribed course of treatment. Eight new bacteriologically confirmed cases of tuberculosis were found and treated. A large number of persons (1,904) residing in the same area who were not part of the target group were also screened for tuberculosis. This group contained a large number of positive tuberculin reactors but very few were candidates for isoniazid preventive therapy. Thirteen persons in this group had abnormal chest X-rays consistent with inactive tuberculosis but 12 had been identified and given preventive therapy before the project began. These data suggest that selective approaches to screening for tuberculosis in a community which are based on an in-depth retrospective review of the tuberculosis case register can be highly successful.

Suppression of tuberculin reactivity during natural rubella. Observations with 54 patients.

Fifty-four patients with previously positive tuberculin reactions were followed for tuberculin sensitivity, between the incubation period of natural rubella and the 40th day after the onset of rash. In many instances, tuberculin sensitivity was partially or completely depressed beginning in the incubation period and extending for up to 4 weeks after rash onset. Two of 3 cases of subclinical rubella infection also showed this phenomenon. The highest incidence of negative reactions was 83% in the first 3 days after rash onset. A few subjects had a larger skin reaction to tuberculin than the baseline reading during the 2 to 5 weeks after rash onset.

特異的抗マクロファージ血清に関する研究

A cultured human monocytic leukemia cell line, J-III, was used to make heterologous antiserum against human peripheral monocyte surface antigens. To eliminate non-specific antibodies, this antiserum was extensively absorbed with human erythrocytes, neutrophils, nonglass adherent mononuclear cells (mainly lymphocytes) and fetal kidney homogenate. The absorbed serum showed high specificity against human peripheral monocytes, suggesting the presence of similar antigenic determinants on J-III cells and human monocytes. Using this purified serum, an immunofluorescent technique was used to demonstrate macrophages in the site of pathology in various immunological diseases. In synovial tissues from patients with rheumatoid arthritis, positively stained cells were observed in the center and surrounding area of the germinal center. Small numbers of positive cells had also infiltrated around small vessels. Mesangial cells of renal biopsy specimens from patients with SLE were not stained. In Sjögren's disease, salivary glands showed granulomatous change, in which small numbers of diffusely scattered positive cells were observed. Similar changes were seen in Hashimoto thyroiditis. Patients with Behcet's disease showed only a few positive cells in the site of erythema nodosum. There were a small number of infiltrated positive cells in biopsied skin at the site of a positive tuberculin reaction.

Cephalometric comparisons of the results of the Wardill-Kilner and Von Langenbeck palatoplasties: Samir E. Bishara, Hans Enemark, and Rosemary F. TharpCleft Palate J. 13:319–329, October, 1976

Although little is yet known about tuberculosis in Nepal itself because no records can bestudied there and no survey within the country has yet been carried out, the prevalence of radiographic tuberculous lesions and of positive tuberculin reactions in would-be Gurkha recruits suggests that the disease must be quite common in the districts of Nepal whence the British army draws its Gurkha recruits.In the army, the incidence of tuberculosis in Gurkhas is still high in spite of strict measures enforced to reduce it. Even in men who joined the army scince 1951, amongst whom all negative reactors on enlistment have been vaccinated with BCG, the incidence has been high compared with the rates shown by troops of other nationalities serving in the same area.A particularly high incidence is demonstrated in Gurkha recruits during their firstyear of army service. This has been due mainly to the large number of cases of primary tuberculosis which have occurred. It is suggested that many recruits are primarily infected on the journey they make from their homes to the recruiting depots in Nepal where they enlist. The conditions on this journey are highly conducive to the spread of respiratory infection, and tuberculosis is known to exist among the inmates of the rest houses along the routes and around the depots.Most cases in the Brigade of Gurkhas now occur in men who are already tuberculin positive when they enlist, having already acquired their primary infections in Nepal before joining the army. It is estimated that by the end of 1966, if the present rates continue, about 46 new cases of tuberculosis will occur each year, of which 40 will be in positive reactors and only five or six in vaccinated men. If future incidence is to be reduced it is on the positive reactors that particular attention must be directed.In the positive reactors a relationship is demonstrated between strong tuberculin sensitivityon enlisment and subsequent disease incidence. Not only has the incidence been considerably higher in the strong reactors, but they have provided the bulk of the disease which has occurred in the reactor group. The recruit who reacts strongly to tuberculin on enlistment appears to be at special risk of developing tuberculosis during his army service, and it is recommended that special measures, namely isoniazid prophylaxis, be taken to prevent the emergence of overt manifestations of tuberculous disease.The various factors which might have been responsible for the occurrence of disease in the positive reactors are examined. It is estimated that one in four cases in positive reactors has been due to exogenous infection acquired after contact with another infectious person. The sources of such infection are believed to exist most commonly in the following situations and in the following order: in Nepal itself, where soldiers return on leave once every three years; in the wives and families of soldiers; in the civilians of the countries where Gurkhas serve, and in other (infectious) soldiers.The endogenous exacerbation of already-existing latent foci has been responsible for three in four of the cases occurring in positive reactors. Such exacerbation can occur because individual resistance is low, or because environmental factors such as fatigue, stress and privation have upset the equilibrium existing between resistance and bacterial virulence.Since the various ‘environmental’ factors have been affected for the better rather thanfor the worse by military service, the conditions of life in the army cannot be held mainly responsible for the disease which has occurred in the positive reactors. It may be the case that the primary factor responsible for endogenous breakdown in Gurkhas is that many of them possess low levels of native or natural resistance. This may be because Nepal as a country is comaparatively young in its experience of tuberculosis and stocks still exist amongst the Gurkhas who are immunologically ill equipped to deal with endogenous progression of naturally acquired primary lesions.

Tuberculosis among immigrants in Britain. Memorandum from the Joint Tuberculosis Committee.

Tuberculosis is much commoner among immigrants to Britain than among the native-born. In 1971, 5% of the population were immigrants yet they accounted for 32% of tuberculosis cases. The notification rate among immigrants is falling in some areas but rising in others, and many immigrants are still arriving in Britain. Most immigrants arrive at London Airport, and as many as possible are x=rayed there with the resources available; Many cases escape detection, however, and it is therefore important that accurate information about all immigrants is sent to the medical officer for environmental health at their destination. New arrivals should then be sought out, tuberculin-tested, and positive reactors x-rayed. All those who are tuberculin-negative should be vaccinated with BCG whatever their age. Positive reactors should undergo annual radiography and be encouraged to report symptoms early. For both new and established immigrants with strongly positive tuberculin reactions chemoprophylaxis is suggested. All children of immigrants should be given BCG at birth and tuberculin-tested when they start school so that omissions can be rectified. Implementation of these recommendations could contribute considerably to the control of tuberculosis in Britain.

Experimental Infection with Mycobacterium Avium, Serotype 2, in Pigs

In 3 experiments, 13 pigs were inoculated orally with 0.5 mg Mycobacterium avium daily for 5 days (1 mg = 32–68×106 viable units). Five to 8 days after inoculation, 16 non-inoculated pigs were added to the inoculated pigs. Cultures from faeces showed excretion of M. avium from all the inoculated pigs for some time within the period 16 to 65 days after the last inoculation; the greatest numbers of organisms (62000 per 100 g faeces) were found at about the middle of the excretion period (Table 2). Two of the contact pigs were found to excrete M. avium in small numbers, 1 at 15, the other at 37 and 44 days after contact. All the inoculated pigs and 13 of the contact pigs showed positive intradermal tuberculin reactions. Post-mortem examination showed tuberculous lesions in all the inoculated pigs (Table 3). M. avium was transmitted to 15 of 16 pigs by contact. Five of these pigs showed gross lesions, 10 of them microscopic lesions only; in 9 of them the infection was proved by culture.

BCG-immunotherapy of L 2C-guinea pig leukemia

Guinea pigs of inbred strain 2 were treated by an intradermal injection with a lethal dose of 10 5 gelatine purified leukemic blood leukocytes in mixture with 10 7 colony-forming units (CFU) of BCG strain Copenhagen 1331. Of 56 animals inoculated in this manner 66% showed a significantly ( P = 0.05) improved life expectation in comparison to 48 guinea pigs not BCG-treated, all perishing of leukemia within an average of 22.4 days ( ±3.9 S.D.) after tumor cell application. BCG enabled 19% of the animals to survive L 2C-inoculation more than 15 weeks. Eighteen of these survivors were challenged with 10 5 L 2C-leukocytes, 15 of them remained healthy demonstrating an acquired resistance against this leukemia. Positive tuberculin reaction converted to negative in the three susceptible, challenged animals and was transiently missing in two resistant guinea pigs with a spontaneous remission of histologically apparent leukemia. BCG was useless when injected separately from L 2C-leukocytes or brought into contact with tumor cells 15 days after implantation. Antitumor activity of L 2C-cells adjoining BCG was furthermore hindered by BCG-vaccination six to seven weeks before immunotherapy. Increase of bacterial mass from 1 × 10 7 to 2 × 10 8 CFU for immunotherapy did not restore the antileukemic effect. BCG-induced ulceration at the site of injection of L 2C-leukocytes occurred in pre-sensitized animals much earlier than in unvaccinated guinea pigs. These results are discussed with respect to the presumably restricted possibilities of BCG acting against leukemia in animal models.

Chemoprophylaxis trial in Canadian Eskimos

One hundred and two cases of inactive tuberculosis, 165 positive tuberculin reactors and 103 previous BCG vaccinated individuals showing large tuberculin reactions were placed on the completely supervised regimen consisting of isoniazid and ethambutol given three times a week. Over 90% of these individuals completed 18 months' treatment. There were no active cases of tuberculosis among the treated groups during the observation period averaging 34.8 months. The control groups consisting of 217 individuals had 9 cases of active tuberculosis giving an annual risk of developing the disease of 1.8 per 1000.