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

Abstract

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.

Value of the tuberculin skin testing and of an interferon-gamma release assay in haemodialysis patients after exposure to M. tuberculosis

“…These results suggest that erythema (irrespective of the induration response) could have a significant value in the interpretation of the TST results. However, in this study, no concomitant IGRA testing was performed [29]. In our study, joint assessment of induration and erythema has shown better correlation with the QFT results than when only induration was taken into account in the TST response.…”

Tuberculin Skin Test (TST) Indurations in Smear Positive TB Patients and Healthy Individuals in Calabar, Nigeria

“…Of the 36% apparently healthy individuals that had < 5 mm indurations, 29% were non-reactive. While this may indicate lower likelihood of progression to active or inactive disease (CDC 1995), anergy to PPD is a common feature among HIV infected individuals and this does not preclude to developing the disease (Toivgoogiin et al, 2005). Although retesting is sometimes recommended for negative results, this study did not follow up TST negative individuals to skin test for anergy.…”