Having done my annual Tuberculosis skin test the day before we talked about it in class got my attention a little. I know we talked about it some in immunology so some of this may be a review. The Mantoux tuberculin skin test is used to determine if a person is infected with Mycobacterium tuberculosis. First step in the test is 0.1 ml of tuberculin purified protein derivative is injected in the inner surface of the forearm with the bevel of the needle facing up. The time frame in which the test is read is critical to correctly identifying a positive test. The test must be read after 48 hours but before 72 hours. So you may remember from class that the area is measured in millimeters to determine a positive test. What is measured is the raised hardened area or area of swelling and not any redness. I initially thought the report I was given was reported out incorrectly because they reported it as 0.0mm when there was clearly a small area of redness at the site of injection but the area if redness is not measured it is the raised area of which I had none. What is considered positive? According to the CDC 5mm or more in: HIV-infected persons, a recent contact of a person with TB disease, persons with fibrotic changes on chest radiograph consistent with prior TB, patients with organ transplants, or persons who are immunosuppressed for other reasons. If you have 10mm or more and Recent immigrants (< 5 years) from high-prevalence countries, injection drug users, residents and employees of high-risk congregate settings, mycobacteriology laboratory personnel, persons with clinical conditions that place them at high risk, children < 4 years of age, or infants, children, and adolescents exposed to adults in high-risk categories are also considered positive. Additionally anyone with test result greater than 15mm, even with no known risk factors. Some potential false positives include: Infection with nontuberculosis mycobacteria, previous BCG vaccination, incorrect method of TST administration, incorrect interpretation of reaction, or incorrect bottle of antigen used. False negatives can result from the following: Cutaneous anergy (anergy is the inability to react to skin tests because of a weakened immune system), recent TB infection, very old TB infection, very young age, recent live-virus vaccination, overwhelming TB disease, some viral illnesses, incorrect method of TST administration, or incorrect interpretation of reaction. So be careful and don’t get TB once your out working please!
I thought the same thing of what's considered positive because I also had 0mm as my measurement but I had no redness or swelling as opposed to a small area of redness- but still both are considered 0. It's interesting that different measurements are considered positive for different categories of history. Why is this and why wouldn't it be the same for all people being tested for TB?
ReplyDeleteAfter someone in our class had a strange reaction with this test, I became curious to see what some of the side effects associated with this skin test were so I looked them up. The most typical side effects in individuals are hives and itching. Also difficulty breathing and rash may be seen. In rare cases, necrosis, redness, swelling and blistering could happen. All side effects are treatable, but must be reported to your doctor as soon as the symptoms present.
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ReplyDeleteTuberculosis was often referred to as “consumption”, which is essentially what this disease does! Mycobacterium tuberculosis (italics) is usually the causative agent. The TB skin test produces a delayed-type hypersensitivity reaction or small area of redness near the injection site. If TB is present, a small raised area is present as well. A positive reaction is determined based on a person’s risk factors and the size of the raised area.
ReplyDeleteSince tuberculosis can be spread through aerosols, I sure hope me going into the TB room during the lab tour does not affect my annual TB skin test coming up!
This is an interesting post. I believe Holly's response is referring to me. I had a medium sized, red area of induration with no diffuse redness after receiving my TST. Although it was reported as negative, it took the nurse, nurse practitioner, and eventually the doctor to tell me so. Also, this area of induration is still present (approximately 1 1/2 weeks later), though it is somewhat smaller. Anyway, I did some research on false positives and I found several anecdotal reports of false positive TSTs while on Accutane, which I currently take. Although there doesn't seem to be any solid proof, it's an odd correlation.
ReplyDeleteI always wondered what exactly was injected into our arms when getting this skin test. It's interesting because when I first had this test done, I thought I had TB due to a little redness. Of course, this was before I knew exactly what was being tested for, but I'm curious as to why the reactions for people are so different. I never knew that you could have a false positive due to a weak immune system. I think it's interesting how with Steven, a person can also have a false positive due to medications as well. I looked up as to why we have to do the two-step test and it is because we as healthcare workers will be around people who may have this, and it is used to make sure any tests in the future will not be misinterpreted as positive because of a possible boosted reaction.
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