Positive Tuberculin Test Results Research Articles

Diagnosis of goat tuberculosis using tuberculinization and molecular techniques

Tuberculosis is an infectious, chronic, and worldwide disease. It has been known since the beginning of humanity and still negatively influences public health and livestock, especially, in Brazil, in the northeast. Etiologic agents are the mycobacteria of the Mycobacterium tuberculosis complex, which is the most important in mammals’ involvement. The state of Bahia has 68.7% of its territory located in the semiarid region and holds the largest goat herd in the country. Goat breeding is a social and economic activity that adds value to this region. Up to the present, data on goat tuberculosis is unknown in this state. Thus, this study seeks data on tuberculosis prevalence in goats in a semiarid region of Bahia by using the comparative tuberculin test and multiplex polymerase chain reaction (PCR). A total of 600 adult animals of both sexes were evaluated. A prevalence of 0.33% (2/600) and 33.33% (1/3) properties were found for positive animals. Each assessed property had a questionnaire to analyze the epidemiological data management and relevant aspects for the disease occurrence. To confirm the positive tuberculin test results, PCR was used to detect and identify the pathogenic mycobacteria involved in the infection. It is concluded that most of the properties performing goat breeding in the region show low technification levels and promote farming between different species. Low prevalence of the disease alerts preventive measures to avoid major proportion situations that could influence the goat breeding in the state.

History Of Tuberculosis Contact And Tuberculin Test Result

Introduction: Tuberculosis (TB) is a chronic disease caused by Mycobacterium tuberculosis. History of tuberculosis contact has consequences for TB infection. Density of occupancy may also accelerate TB transmission. Tuberculin test is a screening method that can detect TB infection. However, BCG immunization can reduce the specificity of tuberculin test results because it causes false positive results. Aim: The aim of this study is to see the relationship between history of TB contact and tuberculin test results. Other variables related to tuberculin test results were also examined i.e. occupancy density and incidence of BCG immunization. Methods: This research was conducted with cross-sectional analytic design using contingency coefficient test with a value of ɑ = 0.1. TB contacts subjects were taken from Surabaya Pulmonary Hospital and non-TB contacts subjects were volunteers from Medical Faculty of Widya Mandala Catholic University volunteers and Medical Faculty of Wijaya Kusuma. Each group consisted of 25 people taken using consecutive sampling technique. There is a significant correlation between history of tuberculosis contact and tuberculin test (p = 0,000); There is no significant correlation between BCG immunization history and tuberculin test results (p = 0.221) Result: There is a significant correlation between occupancy density and tuberculin test results (p = 0.066). Conclusion: It can be concluded that history of tuberculosis contact and occupancy density are associated with positive tuberculin test results.

The Case for Retiring the Tuberculin Skin Test.

* 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

The role of genexpert in diagnosis of sputum-negative pulmonary tuberculosis

Background The GeneXpert MTB/RIF assay is a new diagnostic test that depends on a real-time PCR analysis of the sample for diagnosis of tuberculosis (TB) and detection of rifampicin resistance. Aim The aim was to evaluate the role of role of GeneXpert in the diagnosis of sputum-negative pulmonary TB. Patients and methods This study included 30 patients suspected to have TB, with mean age being 45.5±17.7 years. All patients had clinical and radiological signs consistent with TB, positive tuberculin test results, and three negative Ziehl–Neelsen sputum smears. Patients having no or incomplete data were excluded from the study. Results This study included 30 patients suspected to be have TB, comprising 24 (80%) males and six (20%) females. Their age ranged from 18 to 70 years, with a mean age of 45.5±17.7 years. They were selected from the Chest Departments of Bab El-Sha’eria, Al-Hussein University, and El-Abbasia Chest Hospitals in the period from February 2017 to December 2017. All patients have clinical and radiological signs consistent with TB, positive tuberculin test results, and three negative Ziehl–Neelsen sputum smears. Our study showed that GeneXpert was positive in 11 (36.7%) patients and negative in 19 (63.3%) patients. Conclusion The GeneXpert assay can be used as a gold standard to diagnose TB. As it is sensitive and specific for diagnosing smear-negative pulmonary TB, the assay is faster than culture.

НЕДОСТАТОЧНОСТЬ ИНДЕКСА ПИТАНИЯ КАК ОДИН ИЗ ПРЕДИКТОРОВ РАЗВИТИЯ ТУБЕРКУЛЁЗА В СТРАНЕ С ВЫСОКИМ БРЕМЕНЕМ ЗАБОЛЕВАНИЯ

Objective: The comparative study of nutrition index in healthy persons and TB patients, residents of different regions of Tajikistan and determination of the relationship between the degree of protein-energy insufficiency of the body and the transition of latent tuberculosis into an active form of the disease. Methods: Under surveillance were 390 healthy persons and 200 patients with active tuberculosis, residents of different regions of Tajikistan. Comparable groups by sex, age characteristics and geography of places of residence were quite representative. All observed healthy subjects were put a tuberculin sample intradermally with 2 TE of the drug "TUBERCULIN PPD" according to a standard procedure. The diagnosis of tuberculosis made based on clinical and radiological data, as well as the results of sputum microscopy and its study on the GeneXpertRIF apparatus. All observed persons (healthy and sick with tuberculosis) were subjected to biochemical blood tests and trophological status calculations using standard formulas. Results: A tuberculin sample showed that of the 390 observed persons, 260 (66.7%) had a negative response, while the remaining 130 (33.3%) had a different reaction to a different degree. The nutrition status only 17.7% of healthy individuals corresponded to the graduation of light undernourishment whereas among sick patients with tuberculosis the insufficiency of food revealed 77.0% of cases, including 43.5% – light, 27.0% – medium and in 6.5% – a serious degree. Examining of the presence of infection with MTB and malnutrition status among the survey revealed that of 69 people with mild malnutrition in 41 (10.5%), the results of the tuberculin sample were positive. Conclusion: Infection of MTB according to the tuberculin sample is detected in one third of adults used by the studied persons. Individuals with a combination of malnutrition and positive tuberculin test results are at risk for developing tuberculosis, and they should conduct a course of chemoprophylaxis and improve the quality of nutrition. The majority of tuberculosis patients showed malnutrition, which testifies the importance of this starting mechanism of transition from a latent to an active form of the disease. Keywords: Nutrition index, tuberculosis, predictors, biochemical blood test, tuberculin sample.

Prevalence and Factors Associated with Tuberculosis Treatment Success among TB/HIV Co-Infection in North-East Malaysia.

One of the six strategies developed by WHO, in order to stop Tuberculosis (TB) is addressing TB/HIV high-risk groups. This study aimed to determine the prevalence of successful TB treatment and factors associated with TB treatment success among TB/HIV co-infection patients in North-East Malaysia. A cross-sectional study was carried out in the a-year period from 2003 to 2012 by reviewing TB/HIV records in all hospitals and health clinics. The outcome of interest was treatment success as defined by Ministry of Health (MOH) when the patients was cured or completed TB treatment. Out of 1510 total TB/HIV co-infection cases, 27.9% (95% CI: 25.2, 30.6) of the patients were having treatment success. A majority of TB/HIV co-infection cases were male (91.1%). Fifty-eight percent the patients were drug addicts and 6% were having positive tuberculin tests. The multiple logistic regression revealed that male (OR: 0.39, 95% CI: 0.22, 0.71) and positive tuberculin test result (OR: 2.61, 95% CI: 1.63, 4.19) were significantly associated with the treatment success of TB/HIV co-infection patients. Other factors such as age, comorbid, sputum smear and x-ray findings were not significantly factors in this study. Female patients and those with negative tuberculin test should be emphasised for successful tuberculosis treatment.

Active Pulmonary Tuberculosis Despite Isoniazid Chemoprophylaxis in Children Who Were Exposed to Smear Positive Pulmonary Tuberculosis: Case Series

Introduction: Children, especially those younger than six years old are very susceptible to tuberculosis (TB); therefore, there is need for preventive intervention to face active pulmonary tuberculosis (PTB). Using chemoprophylaxis as an effective intermediation against latent TB was proven during the last decades. Case Presentation: Here, we presented three children of a mother, referred to our clinic due to smear positive PTB. Their mother was being treated with a four-drug regimen since one month before. All the close contacts were evaluated for TB and isoniazid was started for her daughters aged four and six, who had positive tuberculin test results and did not show any signs and symptoms of active TB. Later, these two children and her 19-year-old son were involved with active PTB. Discussion: Isoniazid chemoprophylaxis dose not completely prevent from TB development. Therefore, we should observe and evaluate all the cases that have a history of close contact with smear positive PTB using isoniazid prophylaxis.

Analysis Factor Associated Tuberculin Test in Children Contact Tuberculosis History

ABSTRACTTuberculosis in children can not be separated from the history of contact with smear-positive tuberculosis patients as a source of infection. The aims of this study was to identify and analyze the risks tuberculin test results among children who had contact with patients with smear-positive tuberculosis in health center Bangil and health center Raci Pasuruan. The design of this study was cross sectional using systematik random sampling technique. Sample were drown from children with history of contacts with smear positive tuberculosis patients during 2012. This studies was from January until Juni 2013. The independent variables included age, sex, BCG immunization status, nutritional status, the average duration of exposure per day and residential density, the dependent variable was the tuberculin test results. It was found that from the study the results that a positive tuberculin test result was 28.57%. There was a significant relationship between age, nutritional status, the average duration of exposure per day, residential density of the tuberculin test, and there was no significant relationship between sex and status of BCG immunization results and tuberculin test results. Male and a dense residential density increases the risk of a positive tuberculin test results. While a good nutritional status is a protective factor for tuberculin test result positive.Keywords: tuberculin test, children, history of contacts of smear positive

Analysis Factor Associated Tuberculin Test in Children Contact Tuberculosis History

ABSTRACTTuberculosis in children can not be separated from the history of contact with smear-positive tuberculosis patients as a source of infection. The aims of this study was to identify and analyze the risks tuberculin test results among children who had contact with patients with smear-positive tuberculosis in health center Bangil and health center Raci Pasuruan. The design of this study was cross sectional using systematik random sampling technique. Sample were drown from children with history of contacts with smear positive tuberculosis patients during 2012. This studies was from January until Juni 2013. The independent variables included age, sex, BCG immunization status, nutritional status, the average duration of exposure per day and residential density, the dependent variable was the tuberculin test results. It was found that from the study the results that a positive tuberculin test result was 28.57%. There was a significant relationship between age, nutritional status, the average duration of exposure per day, residential density of the tuberculin test, and there was no significant relationship between sex and status of BCG immunization results and tuberculin test results. Male and a dense residential density increases the risk of a positive tuberculin test results. While a good nutritional status is a protective factor for tuberculin test result positive.Keywords: tuberculin test, children, history of contacts of smear positive

Factores predictores de la aparición de nuevos casos de infección tuberculosa y de viraje tuberculínico en un estudio de contactos

To study new cases of latent tuberculosis (TB) infection, active TB and tuberculin conversions detected by means of a system for tracing the contacts of TB patients and to analyze the factors that predict the appearance of new cases.We performed a longitudinal, prospective study of all contacts of patients with active TB in the health district of Vigo, Pontevedra, in 2005 and 2006. The total rate of positive tuberculin test results and the percentage of tuberculin conversions at the end of the study were analyzed. The predictive factors for positive results were identified by a multivariate analysis.A total of 742 contacts of patients with TB were studied. The mean age of contacts was 35 years (SD=19.1) and 406 (54.7%) were women. Most (91.8%) were contacts of pulmonary TB patients, 70.4% were contacts of bacilliferous patients and 40.2% were highly exposed. The study was completed with 540 (72.8%) cases, 280 (51.9%) of which were infected or diseased. Of the 297 contacts who completed the study 12 weeks later, 37 (12.5%) showed tuberculin conversion. The factors independently associated with a positive tuberculin test result were male sex, age >or= 30 years old, and degree of contact (high exposure in contacts and positive sputum smear in the index case); the two latter factors were predictive for tuberculin conversion.Contact tracing of TB patients was an effective strategy in our area. The factors most closely related to positive tuberculin test results, particularly to conversion, were positive direct microscopy of sputum for the index case and high exposure. Strategies to improve adherence to this kind of study should be sought.

The Detection of Airborne Transmission of Tuberculosis from HIV-Infected Patients, Using an In Vivo Air Sampling Model

Nosocomial transmission of tuberculosis remains an important public health problem. We created an in vivo air sampling model to study airborne transmission of tuberculosis from patients coinfected with human immunodeficiency virus (HIV) and to evaluate environmental control measures. An animal facility was built above a mechanically ventilated HIV-tuberculosis ward in Lima, Peru. A mean of 92 guinea pigs were continuously exposed to all ward exhaust air for 16 months. Animals had tuberculin skin tests performed at monthly intervals, and those with positive reactions were removed for autopsy and culture for tuberculosis. Over 505 consecutive days, there were 118 ward admissions by 97 patients with pulmonary tuberculosis, with a median duration of hospitalization of 11 days. All patients were infected with HIV and constituted a heterogeneous group with both new and existing diagnoses of tuberculosis. There was a wide variation in monthly rates of guinea pigs developing positive tuberculin test results (0%-53%). Of 292 animals exposed to ward air, 159 developed positive tuberculin skin test results, of which 129 had laboratory confirmation of tuberculosis. The HIV-positive patients with pulmonary tuberculosis produced a mean of 8.2 infectious quanta per hour, compared with 1.25 for HIV-negative patients with tuberculosis in similar studies from the 1950s. The mean monthly patient infectiousness varied greatly, from production of 0-44 infectious quanta per hour, as did the theoretical risk for a health care worker to acquire tuberculosis by breathing ward air. HIV-positive patients with tuberculosis varied greatly in their infectiousness, and some were highly infectious. Use of environmental control strategies for nosocomial tuberculosis is therefore a priority, especially in areas with a high prevalence of both tuberculosis and HIV infection.

高齢者呼吸器疾患の基礎と臨床の最前線 ４．高齢者呼吸器感染症予防の新戦略―ワクチン療法を中心として

Pneumonia is a major cause of morbidity and mortality in elderly people, especially in those with chronic medical conditions such as chronic heart and lung diseases. We prospectively examined the effect of influenza and pneumococcal vaccinations on the rate of hospitalization for and complications of pneumonia, all respiratory tract conditions and mortality in elderly bedridden patients and found that both febrile days and pneumonia cases decreased. Thus, these results show that it is valuable to vaccinate for influenza elderly people even if they are confined to bed. Furthermore, the tuberculin skin test is an easy method to check the cell-mediated immunity in the elderly people. In the tuberculin skin test, all Japanese over 65 years old should have positive status. A negative result indicates depressed cell-mediated immunity. We undertook a trial to vaccinate tuberculin negative elderly people with BCG vaccine and found that the risk of pneumonia is decreased to a similar degree to that in subjects with positive tuberculin test results. We conclude that vaccination might be an effective strategy for the prevention of pneumonia in elderly people with limited activities of daily living.

Rifampin and pyrazinamide for 2 months prevented TB in patients with HIV infection who had a positive tuberculin test result

Source Citation Gordin F, Chaisson RE, Matts JP, et al. Rifampin and pyrazinamide vs isoniazid for prevention of tuberculosis in HIV-infected persons. An international randomized trial. JAMA. 2000;...

Effect of tuberculosis on milk production in dairy cows

Objective— To evaluate differences in milk production between cows with positive and negative caudal fold tuberculin test results in a Mycobacterium bovis-infected dairy herd. Design— Cross-sectional epidemiologic survey. Animals— 369 Holstein cows with lactation duration between 200 and 360 days. Procedure— The caudal fold tuberculin test was performed. Information on milk production data, parity, calving season, days of lactation, previous milk production, and whether cows had clinical mastitis was obtained from farm records. Composite milk samples were collected and submitted for bacterial culture. Results— 170 cows had positive tuberculin test results, and 199 had negative results. Cows with positive test results produced less milk (mean, 347 kg [763 lb]) than did cows with negative test results after adjusting for variables biologically related to milk production. Calving season (spring, summer) was significantly associated with reduced milk production. Cows with clinical mastitis produced less milk than did cows without clinical mastitis, but the difference was not statistically significant in the multiple regression analysis. Clinical Implications— In this herd, tuberculosis was associated with a 4% decrease in milk production. Milk production losses per cow attributable to calving season (spring, summer) were 3 times those attributable to tuberculosis. However, because of the high prevalence of tuberculosis in this herd, the impact of tuberculosis on total herd milk production was an additional cause for concern. (J Am Vet Med Assoc 1998;213:851-854)

Benefit of two-step PPD testing of new employees at a New York City hospital

Background: Recent concern about nosocomial transmission of tuberculosis has led hospitals to scrutinize employee tuberculin conversion rates. The Centers for Disease Control and Prevention recommends two-step testing of new employees to limit the booster phenomenon. The cost of such a program and its subsequent yield have not recently been examined. Methods: Employee health records were retrospectively reviewed of persons hired from 1993 and 1994 at St. Clare's Hospital in New York City, all of whom received two-step testing at time of initial employment. Results: Of 262 new employees, 107 (41%) had positive tuberculin results on initial testing. The results of 15 (9.7%) of the remaining 155 patients became positive on two-step testing administered 1 week later. Persons with a positive second test result were significantly more likely to be male or foreign born or to have received previous bacille Calmette-Guérin vaccination. Identification of these 15 persons and exclusion of them from probable subsequent conversion prevented an almost 50% increase in the annual conversion rate at our hospital, from 3.2% to 4.7%. Conclusion: Two-step tuberculin testing is an essential means of identifying persons with a baseline positive tuberculin test result, thus allowing accurate reporting of subsequent employee tuberculin conversions.

High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy

<h3>Objectives.</h3> —To determine the incidence of active tuberculosis in human immunodeficiency virus (HIV)—seropositive and HIV-seronegative drug injectors with cutaneous anergy and to examine the effectiveness of isoniazid chemoprophylaxis in preventing tuberculosis among drug injectors with positive tuberculin test results. <h3>Design and Setting.</h3> —Prospective observational study linked to an ongoing study of HIV infection within a New York City (NY) methadone program; subjects also underwent routine intradermal tuberculin testing and multiple-antigen delayed-type hypersensitivity skin testing. The 31-month study period ended December 31, 1990. <h3>Methods.</h3> —Anergic subjects and tuberculin reactors who were HIV seropositive were compared by HIV disease status and CD4⁺T-lymphocyte levels. Tuberculosis incidence was calculated for anergics (none treated with isoniazid) and for treated and untreated tuberculin reactors, by HIV serological status. <h3>Results.</h3> —Among those seropositive for HIV, anergic subjects had more advanced HIV disease and fewer CD4⁺cells (median 0.33 vs 0.56 ×10⁹/L,<i>P</i>&lt;.01) compared with tuberculin reactors, although neither clinical status nor CD4⁺cell counts consistently predicted anergy. Five (7.6%) of 68 anergic subjects who were HIV seropositive and none of 52 anergic subjects who were HIV seronegative (n=18) or of unknown (n=34) HIV serological status developed active tuberculosis during the study period (<i>P</i>&lt;.05). The tuberculosis incidence rate among anergic subjects who were HIV seropositive was 6.6 cases per 100 person-years (95% confidence interval [CI], 2.1 to 15.3). Of 25 HIV-seropositive tuberculin reactors who did not receive or complete 12 months of isoniazid prophylaxis, tuberculosis incidence was 9.7 cases per 100 person-years (95% CI, 2.6 to 24.7;<i>P</i>=0.56, compared with the rate among anergic HIV seropositives); there were no cases of tuberculosis in 53.4 person-years of follow-up for 27 HIV-seropositive tuberculin reactors who received 12 months of prophylaxis (rate difference between treated and untreated groups, 9.7 cases per 100 person-years, 95% CI, 1.3 to 18.0). <h3>Conclusion.</h3> —Drug injectors with cutaneous anergy who are seropositive for HIV are at high risk of active tuberculosis, similar to that among untreated HIV-seropositive tuberculin reactors. A decreased incidence of active tuberculosis was seen in HIV-seropositive tuberculin reactors receiving 12 months of isoniazid chemoprophylaxis, compared with untreated or partially treated subjects. These results support the routine use of delayed-type hypersensitivity testing to accompany tuberculin testing for drug injectors with known or suspected HIV infection, and consideration of isoniazid prophylaxis for anergic as well as tuberculin-reactive subjects who are HIV seropositive, in populations with a high prevalence of coexisting HIV and<i>Mycobacterium tuberculosis infection</i>. (<i>JAMA</i>. 1992;268:504-509)

The Nonutility of Chest Roentgenographic Examination in Asymptomatic Patients With Positive Tuberculin Test Results

To determine the value of chest roentgenograms in the management of asymptomatic persons with positive tuberculin skin test results, we undertook a retrospective review of all tests administered by our Employee Health Service, North Shore University Hospital, Manhasset, NY, between July 1, 1983 and November 1, 1987. Of 5200 tests, 247 results were positive. Two hundred twenty-one of these charts were reviewed for roentgenographic results and the presence of symptoms. All persons were asymptomatic. Chest roentgenograms revealed the following: normal, 188; unrelated abnormalities, 24; apical pleural thickening, 5; granulomas, 2; calcified hilar node, 1; and calcified node plus granuloma, 1. We noted no active tuberculosis, nor did the chest roentgenographic results influence recommendations for isoniazid prophylaxis. We conclude that chest roentgenograms are of value in 0% to 1.3% of asymptomatic people with positive tuberculin test results. A larger study should be undertaken to further define the usefulness of chest roentgenograms in this population.

The nonutility of chest roentgenographic examination in asymptomatic patients with positive tuberculin test results

The nonutility of chest roentgenographic examination in asymptomatic patients with positive tuberculin test results

Clinical Findings in Southeast Asian Refugees

Since 1979, we have provided comprehensive medical care to a group of 142 Southeast Asian refugees who relocated in Connecticut. In this group, we identified clinically important issues in child development. As plotted on standard growth curves, 47% of refugee children were below the fifth percentile in height for age and 22% were below the fifth percentile in weight for height. Although these children are potentially at increased risk for nutrition-related health problems, our clinical assessment did not confirm malnutrition. We also confirm a high prevalence of intestinal parasitism (59%), positive tuberculin test results (40%), and hepatitis B antigenemia (16%), as observed previously by health authorities. We conclude that anthropometry should not replace a clinical nutritional assessment of refugee children. (<i>JAMA</i>1983;249:3200-3203)

Clinical findings in Southeast Asian refugees

Since 1979, we have provided comprehensive medical care to a group of 142 Southeast Asian refugees who relocated in Connecticut. In this group, we identified clinically important issues in child development. As plotted on standard growth curves, 47% of refugee children were below the fifth percentile in height for age and 22% were below the fifth percentile in weight for height. Although these children are potentially at increased risk for nutrition-related health problems, our clinical assessment did not confirm malnutrition. We also confirm a high prevalence of intestinal parasitism (59%), positive tuberculin test results (40%), and hepatitis B antigenemia (16%), as observed previously by health authorities. We conclude that anthropometry should not replace a clinical nutritional assessment of refugee children.