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. 2013 Oct 4:13:460.
doi: 10.1186/1471-2334-13-460.

Association between tuberculin skin test result and clinical presentation of tuberculosis disease

Sara C Auld  1 , Eleanor S Click, Charles M Heilig, Roque Miramontes, Kevin P Cain, Gregory P Bisson, William R Mac Kenzie
Affiliations

Association between tuberculin skin test result and clinical presentation of tuberculosis disease

Sara C Auld et al. BMC Infect Dis. .

Abstract

Background: The tuberculin skin test (TST) is used to test for latent tuberculosis (TB) infection and support the diagnosis of active TB. However, little is known about the relationship between the TST result and the clinical presentation of TB disease.

Methods: We analyzed US TB surveillance data, 1993-2010, and used multinomial logistic regression to calculate the association between TST result (0-4 mm [negative], 5-9 mm, 10-14 mm, and ≥ 15 mm) and clinical presentation of disease (miliary, combined pulmonary and extrapulmonary, extrapulmonary only, non-cavitary pulmonary, and cavitary pulmonary). For persons with pulmonary disease, multivariate logistic regression was used to calculate the odds of having acid-fast bacilli (AFB) positive sputum.

Results: There were 64,238 persons with culture-confirmed TB included in the analysis, which was stratified by HIV status and birthplace (US- vs. foreign-born). Persons with a TST ≥ 15 mm were less likely to have miliary or combined pulmonary and extrapulmonary disease, but more likely to have cavitary pulmonary disease than non-cavitary pulmonary disease. Persons with non-cavitary pulmonary disease with a negative TST were significantly more likely to have AFB positive sputum.

Conclusions: Clinical presentation of TB disease differed according to TST result and persons with a negative TST were more likely to have disseminated disease (i.e., miliary or combined pulmonary and extrapulmonary). Further study of the TST result may improve our understanding of the host-pathogen relationship in TB disease.

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Figures

Figure 1
Figure 1
Selection of United States TB cases reported to CDC during 1993 through 2010 for inclusion in the analysis of the relationship between tuberculin skin test (TST) results and clinical presentation. *CXR = chest radiograph.
Figure 2
Figure 2
Association between TST result and clinical presentation of disease relative to a TST of 0–4 mm and relative to non-cavitary pulmonary disease, stratified by HIV status and birthplace and adjusted for age and sex (N = 64,238). The log of the adjusted odds ratio and their 95% confidence intervals are presented.
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References

    1. Huebner RE, Schein MF, Bass JB. The tuberculin skin test. Clin Infect Dis. 1993;17(6):968–975. doi: 10.1093/clinids/17.6.968. - DOI - PubMed
    1. Stead WW. Managment of health-care workers after inadvertent exposure to tuberculosis - a guide for the use of preventive therapy. Ann Intern Med. 1995;122(12):906–912. doi: 10.7326/0003-4819-122-12-199506150-00003. - DOI - PubMed
    1. American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1376–1395. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. - PubMed
    1. Holden M, Dubin MR, Diamond PH. Frequency of negative intermediate-strength tuberculin sensitivity in patients with active tuberculosis. N Engl J Med. 1971;285(27):1506–1509. doi: 10.1056/NEJM197112302852704. - DOI - PubMed
    1. Nash D, Douglass J. Anergy in active pulmonary tuberculosis. A comparison between positive and negative reactors and an evaluation of 5 TU and 250 TU skin test doses. Chest. 1980;77(1):32–37. doi: 10.1378/chest.77.1.32. - DOI - PubMed

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