Frost Revisited: The Modern Epidemiology of Tuberculosis

Comstock, George W.

doi:10.1093/oxfordjournals.aje.a112105

Cited by 117 publications

(39 citation statements)

References 24 publications

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“…The late Dr. George Comstock remarked in 1975 that "the frequency of cross-reactions to tuberculin in this [Navy recruit] population is sufficiently great that the prevalence of true tuberculous infections among white recruits may already be approaching zero" (9). The prevalence of sensitization to NTM in the United States population increased from 11% in 1972 to 17% in 2000 (10).…”

mentioning

confidence: 99%

Discordance among Commercially Available Diagnostics for Latent Tuberculosis Infection

Mancuso

Mazurek²,

Tribble³

et al. 2012

Am J Respir Crit Care Med

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mentioning

confidence: 99%

Discordance among Commercially Available Diagnostics for Latent Tuberculosis Infection

Mancuso

Mazurek²,

Tribble³

et al. 2012

Am J Respir Crit Care Med

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“…About one-third of the world's population is believed to be latently infected with M. tuberculosis (7). Immunocompetent individuals with M. tuberculosis infection have a 10% risk during their lifetimes of developing active disease, becoming new foci for transmission, with half of this risk being in the first 2 years after exposure (5,25). It is therefore important to identify people at risk for recent infection with M. tuberculosis, i.e., close contacts of patients with infectious pulmonary TB, persons having clinical conditions associated with an increased risk for progression to active TB (for example, human immunodeficiency virus infection, injection drug use, and fibrotic lesions on chest radiograms), children, and those who are in an early active phase of their infection (1,4).…”

mentioning

confidence: 99%

Use of Antibodies in Lymphocyte Secretions for Detection of Subclinical Tuberculosis Infection in Asymptomatic Contacts

Raqib

Kamal

Rahman

et al. 2004

Clin Vaccine Immunol

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We have previously demonstrated that Mycobacterium bovis BCG-specific immunoglobulin G antibodies in lymphocyte secretions (ALS) can be employed as a marker for active tuberculosis (TB). We aimed to determine whether the ALS method allows detection of subclinical TB infection in asymptomatic individuals. A prospective study of family contacts (FCs) of patients with active TB and healthy controls was performed. Thirteen of 42 FCs had high ALS responses, including 6 FCs who subsequently developed active TB. No correlation was observed between the tuberculin skin test and the ALS responses in the FCs (r ‫؍‬ 0.1, P ‫؍‬ 0.23). Among patients with active TB, BCG-specific ALS responses steadily declined from the time of diagnosis through 6 months following antimycobacterial chemotherapy (P ‫؍‬ 0.001). The ALS assay enabled detection of infection in exposed symptom-free contacts, who are at greater risk for developing active TB. The method may also allow discrimination between effective treatment of active infection and suboptimal response to therapy.With the emergence of multidrug-resistant Mycobacterium tuberculosis and the pandemic of human immunodeficiency virus, tuberculosis (TB) is a reemerging infectious disease concern worldwide. About one-third of the world's population is believed to be latently infected with M. tuberculosis (7). Immunocompetent individuals with M. tuberculosis infection have a 10% risk during their lifetimes of developing active disease, becoming new foci for transmission, with half of this risk being in the first 2 years after exposure (5, 25). It is therefore important to identify people at risk for recent infection with M. tuberculosis, i.e., close contacts of patients with infectious pulmonary TB, persons having clinical conditions associated with an increased risk for progression to active TB (for example, human immunodeficiency virus infection, injection drug use, and fibrotic lesions on chest radiograms), children, and those who are in an early active phase of their infection (1, 4).Determination of the prevalence of latent infection is helpful for better understanding the epidemiology of TB and for designing and evaluating TB control strategies (1). The accurate diagnosis of latent or subclinical TB infection is an important component of many TB control programs and depends largely on tuberculin skin testing (TST). In developed countries, in the absence of a better method, the TST using M. tuberculosis purified protein derivative (PPD) is currently used nearly exclusively. However, in developing countries with high rates of M. bovis BCG vaccine use, TST is unreliable because of the broad antigenic cross-reactivity of PPD with environmental nontuberculous strains and the BCG vaccine. About 10 to 20% of patients with proven TB and without any apparent immunosuppression have negative TST results (13,20). The sensitivity of TST is low, especially in critically ill and immunosuppressed patients with disseminated TB (14). Therefore, there is substantial need for methods to accurately discri...

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“…Thus, when tuberculosis infection occurs in a population with BCG vaccination, in anticipation of the occurrence of false-negative test results for tuberculosis infection one must administer periodic chest X-rays and symptom screening for at least 2 years, during which the cumulative incidence of active tuberculosis reaches 80%. 13,17 There are some limitations of the present study. Firstly, the measurement of skin reactions might have been influenced by the bias and the variability of the single examiner who determined all of the results.…”

Section: Diagnostic Accuracy Of Erythema Measurementmentioning

confidence: 87%

“…This is the characteristic distribution of the skin response following TST when a population with BCG vaccination is exposed to an infectious tuberculosis case. 6,13 The natural logarithm of the erythema measurement was linearly correlated with with tuberculosis infection in groups 1-3 and less than half of such students in group 4. Thus, measures that deal with subjects who have false-negative test results must be incorporated into any control program.…”

Section: Diagnostic Accuracy Of Erythema Measurementmentioning

confidence: 91%

Validity of Using Tuberculin Skin Test Erythema Measurement for Contact Investigation during a Tuberculosis Outbreak in Schoolchildren Previously Vaccinated with BCG

Toivgoogiin¹,

Toyota²,

Yasuda³

et al. 2005

Journal of Epidemiology

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BACKGROUND: Few studies have examined the validity of administering tuberculosis control measures based on tuberculin skin test (TST) erythema measurement. The present study aimed to clarify the relationship between the erythema and the induration seen following TST and to evaluate the validity of diagnosing tuberculosis infection based on the erythema following TST in school-aged contacts who had been vaccinated with bacillus Calmette-Guérin (BCG) in infancy. METHODS: A 56-month longitudinal study from January 1999 through September 2003 followed 566 junior high school students in Kochi City who were contacts of an infectious tuberculosis case. To evaluate the diagnostic accuracy of the erythema and induration following TST of the contacts, false-positive and false-negative TST results were noted. RESULTS: The natural logarithm of the erythematous response size was linearly related to the induration size. When the size of the erythematous response was used to determine the presence of tuberculosis infection, the proportion of infected children increased with increasing exposure to the index case. When the TST results in the contact investigation were interpreted together with the change in the size of the erythematous response from that observed at the regular school-entry checkup, false positive test results were avoidable among the students who had a large erythematous response after the contact investigation TST, but whose response was only slightly larger than their erythematous response following the school-entry TST. Among the students whose TST results were negative, 1.9% developed tuberculosis. CONCLUSION: Both erythema and induration measurement were equally effective for identifying tuberculosis infection in schoolchildren vaccinated with BCG.

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Frost Revisited: The Modern Epidemiology of Tuberculosis

Cited by 117 publications

References 24 publications

Discordance among Commercially Available Diagnostics for Latent Tuberculosis Infection

Discordance among Commercially Available Diagnostics for Latent Tuberculosis Infection

Use of Antibodies in Lymphocyte Secretions for Detection of Subclinical Tuberculosis Infection in Asymptomatic Contacts

Validity of Using Tuberculin Skin Test Erythema Measurement for Contact Investigation during a Tuberculosis Outbreak in Schoolchildren Previously Vaccinated with BCG

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