[Variability of skin test on both tuberculosis and co infected patients with HIV under tuberculosis treatment].
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Abstract:
To evaluate the variability of tuberculin skin test (TST), we did a prospective study in the pneumology unit of the teaching hospital at Point G and in the tuberculosis unit of the health district II at Bamako, Mali TST was applied two times to every patient more than 18 years old: at the beginning before the tuberculosis treatment (tst1) and after 2 months (tst2). For all 113 patients followed in both units, 41 were enrolled in this study (36, 2%). The mean age of patients was 37.9 years and 73.2% were male.(sex proportion was 2.72 for male). The different forms of Tuberculosis were: 63.4% of tuberculosis with smear positive(TSP); 7.3% of tuberculosis with smear negative(TSN); and 29,3% of disseminated tuberculosis. 22% of the patients were HIV positive. The tst1 was positive for 58.5% of the patients(11.11% of the HIV positive patients and 78.13% of the HIV negative). The diameter of indurations of the TST increased considerably during the treatment mainly with patients infected by HIV. The TST test can be an indicator of follow op for these patients who had less AFB most of time?Keywords:
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In order to determine the prevalence of latent infection due to Mycobacterium tuberculosis in drug users and to provide centres for drug users with a practical tool for tuberculosis screening, 237 drug users were subjected to the Monotest and, for reference purposes, to the Mantoux test. The overall prevalence of subjects with a tuberculin skin reaction size > or = 5 mm in the Mantoux test was 25.7%; utilizing a cut-off of > or = 10 mm, the prevalence was 11.4%. Irrespective of cut-off, the Monotest showed a sensitivity of > 90% and a specificity of > 80%. At a prevalence of 25.7%, and with cut-offs of > or = 5 or > or = 10 mm, the positive predictive value was 83% or 62.2%, respectively. Irrespective of cut-off, the negative predictive value was > 97%. In conclusion, the Monotest proved satisfactory as a tool for epidemiological screening in a population with a high prevalence for latent tuberculosis, namely drug users.
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Tuberculosis is an important public health issue throughout the world. Medical students as other health care workers are exposed to tuberculosis during their clinical rotations.
The objective of this study was to evaluate latent tuberculosis infection in preclinical medical students and new infections during clinical rotations. A prospective cross sectional study was performed between 2008 and 2011 in Yazd by serial Tuberculin Skin Test in medical students. Medical students who have passed their 3.5 year preclinical stage were invited to participate in a 3-step PPD study before starting their clinical rotations .They were examined initially for BCG scar. In the first skin test, induration ≥10 mm was taken as positive. Students with initial negative test were retested 14 days later to identify boosting effect. Third test was done between 1to 3 years after the second step.
Seventy medical students were invited to study, 54 participated in the study (77.1%). In the first test, 39.6% (95% CI 26-53.2%) had positive skin test≥10mm.In the second step 10 mm increase in induration was observed in one student without scar of BCG and 7 mm increase in induration was seen in another student. In the third step eight students 20.5% (95% CI, 7.83% to 33.17%) converted from negative to positive (TST≥10mm) during the period of study.
Tuberculosis is an occupational infection among medical students. As a result, implementation of an effective tuberculosis infection control program is mandatory for prevention of tuberculosis among medical students.
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As an ancient infectious disease, tuberculosis (TB) is still the leading cause of death from a single infectious agent worldwide. Latent TB infection (LTBI) has been recognized as the largest source of new TB cases and is one of the biggest obstacles to achieving the aim of the End TB Strategy. The latest data indicate that a considerable percentage of the population with LTBI and the lack of differential diagnosis between LTBI and active TB (aTB) may be potential reasons for the high TB morbidity and mortality in countries with high TB burdens. The tuberculin skin test (TST) has been used to diagnose TB for > 100 years, but it fails to distinguish patients with LTBI from those with aTB and people who have received Bacillus Calmette–Guérin vaccination. To overcome the limitations of TST, several new skin tests and interferon-gamma release assays have been developed, such as the Diaskintest, C-Tb skin test, EC-Test, and T-cell spot of the TB assay, QuantiFERON-TB Gold In-Tube, QuantiFERON-TB Gold-Plus, LIAISON QuantiFERON-TB Gold Plus test, and LIOFeron TB/LTBI. However, these methods cannot distinguish LTBI from aTB. To investigate the reasons why all these methods cannot distinguish LTBI from aTB, we have explained the concept and definition of LTBI and expounded on the immunological mechanism of LTBI in this review. In addition, we have outlined the research status, future directions, and challenges of LTBI differential diagnosis, including novel biomarkers derived from Mycobacterium tuberculosis and hosts, new models and algorithms, omics technologies, and microbiota.
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Interferon-γ releasing assays (IGRAs) are currently widely employed in the initial work up of Mycobacterium tuberculosis infection, as well as in suspected tuberculosis (TB). These assays are commonly utilized over the Tuberculin Skin Test (TST) in high resource and low TB burden settings, despite the unclear benefits shown in such contexts. The debate on the use of TST and IGRAs is of current interest also in Italy due to the increasing presence of immigrants from countries with a high incidence of TB and the rising attention of health care institutions to economic costs. The aim of this study was to compare QuantiFERON-TB (QFT) and TST results in active TB. We evaluated QFT results and TST reactions from 245 consecutive patients having both tests, registered among 411 patients admitted for TB at the Infectious Disease Clinic, Department of Medicine of the University of Perugia (Italy). We compared the rates of positive QFT and TST tests and noted no statistically significant differences overall or in relation to age, gender, HIV status and TB localization. Among foreign-born patients with confirmed TB, we observed a lower rate of positive TST results. The results of our study indicated that both QFT and TST can be used in the work up of TB having special attention when evaluating foreign-born patients.
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Skin test
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We describe a healthcare worker with a previously positive tuberculin skin test result who developed active tuberculosis. An investigation revealed 280 potential contacts, 3 of whom had positive tuberculin skin test results. Our experience demonstrates the potential benefits of therapy for latent tuberculosis infection as a component of a tuberculosis-control program.
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Thirty-four patients with tuberculosis were skin tested with 5 tuberculin units (TU) of purified protein derivative of Mycobacterium tuberculosis (PPD). PPD supplied by Park Davis and Co., Detroit, Michigan, U.S.A. (PPD-PD) as well as PPD obtained from The Razi Institute, Hessarak, Teheran (PPD-RI) were both used for skin testing in each patient. The results indicate that 74-79% of patients with active tuberculosis have positive tuberculin reactions, that PPD-RI is a potent source of tuberculin for skin testing and that a substantial proportion of our tuberculous patients (21-26%) have negative tuberculin skin reactions.
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Assays measuring gamma-interferon (INGA) produced by peripheral lymphocytes exposed to antigens specific of Mycobacterium tuberculosis have a very high specificity, thus avoiding false positive results of the tuberculin skin test (TST) such as the BCG or atypical mycobacteria, and allowing a better targeting of treatments for latent tuberculosis infection (LTBI). Their sensitivity is superior to that of the TST in immuno-compromised and elderly subjects, and probably in immuno-competent individuals. They do not allow however to make the distinction between LTBI and active tuberculosis. Furthermore, their sensitivity, although superior to that of the TST, is not sufficient to exclude active TB specially in immuno-compromised subjects. Their main indication remains the detection of LTBI in screening or contact tracing, or in immuno-compromised subjects.
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