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    Tuberculin Skin Testing

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    mick sa
    The Mantoux tuberculin skin test (TST) involves injecting a small amount of purified protein derivative into the forearm to determine if a person is infected with tuberculosis. The injection produces a raised wheal under the skin that is measured between 48-72 hours later to determine if there is induration, which would indicate infection. The size of induration is compared to risk factors to determine if the result is positive or negative, with larger sizes indicating higher risk of infection. Repeating the test or using two-step testing can help account for false negatives or boosted reactions over time.

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    Tuberculin Skin Testing

    Uploaded by

    mick sa
    82 views4 pages
    The Mantoux tuberculin skin test (TST) involves injecting a small amount of purified protein derivative into the forearm to determine if a person is infected with tuberculosis. The injection produces a raised wheal under the skin that is measured between 48-72 hours later to determine if there is induration, which would indicate infection. The size of induration is compared to risk factors to determine if the result is positive or negative, with larger sizes indicating higher risk of infection. Repeating the test or using two-step testing can help account for false negatives or boosted reactions over time.

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    The Mantoux tuberculin skin test (TST) involves injecting a small amount of purified protein derivative into the forearm to determine if a person is infected with tuberculosis. The injection produces a raised wheal under the skin that is measured between 48-72 hours later to determine if there is induration, which would indicate infection. The size of induration is compared to risk factors to determine if the result is positive or negative, with larger sizes indicating higher risk of infection. Repeating the test or using two-step testing can help account for false negatives or boosted reactions over time.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    82 views4 pages

    Tuberculin Skin Testing

    Uploaded by

    mick sa
    The Mantoux tuberculin skin test (TST) involves injecting a small amount of purified protein derivative into the forearm to determine if a person is infected with tuberculosis. The injection produces a raised wheal under the skin that is measured between 48-72 hours later to determine if there is induration, which would indicate infection. The size of induration is compared to risk factors to determine if the result is positive or negative, with larger sizes indicating higher risk of infection. Repeating the test or using two-step testing can help account for false negatives or boosted reactions over time.

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    Tuberculin Skin Testing

    What is it?

    The Mantoux tuberculin skin test (TST) is the standard method of determining
    whether a person is infected with Mycobacterium tuberculosis. Reliable
    administration and reading of the TST requires standardization of procedures,
    training, supervision, and practice.

    How is the TST Administered?

    The TST is performed by injecting 0.1 ml of tuberculin purified protein derivative


    (PPD) into the inner surface of the forearm. The injection should be made with a
    tuberculin syringe, with the needle bevel facing upward. The TST is an intradermal
    injection. When placed correctly, the injection should produce a pale elevation of
    the skin (a wheal) 6 to 10 mm in diameter.

    How is the TST Read?

    The skin test reaction should be read between 48 and 72 hours after
    administration. A patient who does not return within 72 hours will need to be
    rescheduled for another skin test.

    The reaction should be measured in millimeters of the induration (palpable,


    raised, hardened area or swelling). The reader should not measure erythema
    (redness). The diameter of the indurated area should be measured across the
    forearm (perpendicular to the long axis).

    How Are TST Reactions Interpreted?

    Skin test interpretation depends on two factors:

     Measurement in millimeters of the induration


     Person’s risk of being infected with TB and of progression to disease if
    infected
    Table of Classification of the Tuberculin Skin Test Reaction
    Classification of the Tuberculin Skin Test Reaction
    An induration of 5 or more An induration of 10 or >An induration of 15 or more
    millimeters is considered positive in more millimeters is millimeters is considered posit
    considered positive in person, including persons with
    -HIV-infected persons risk factors for TB. However, tar
    -Recent immigrants (< 5 testing programs should only b
    -A recent contact of a person with TB years) from high-
    conducted among high-risk gro
    disease prevalence countries

    -Persons with fibrotic changes on -Injection drug users


    chest radiograph consistent with
    prior TB -Residents and
    employees of high-risk
    -Patients with organ transplants congregate settings

    -Persons who are -Mycobacteriology


    immunosuppressed for other laboratory personnel
    reasons (e.g., taking the equivalent
    of >15 mg/day of prednisone for 1 -Persons with clinical
    month or longer, taking TNF- conditions that place
     antagonists) them at high risk

    -Children < 4 years of


    age

    – Infants, children, and


    adolescents exposed to
    adults in high-risk
    categories

    What Are False-Positive Reactions?

    Some persons may react to the TST even though they are not infected with M.
    tuberculosis. The causes of these false-positive reactions may include, but are not
    limited to, the following:
     Infection with nontuberculosis mycobacteria
     Previous BCG vaccination
     Incorrect method of TST administration
     Incorrect interpretation of reaction
     Incorrect bottle of antigen used

    What Are False-Negative Reactions?

    Some persons may not react to the TST even though they are infected with M.
    tuberculosis. The reasons for these false-negative reactions may include, but are
    not limited to, the following:

     Cutaneous anergy (anergy is the inability to react to skin tests because of a


    weakened immune system)
     Recent TB infection (within 8-10 weeks of exposure)
     Very old TB infection (many years)
     Very young age (less than 6 months old)
     Recent live-virus vaccination (e.g., measles and smallpox)
     Overwhelming TB disease
     Some viral illnesses (e.g., measles and chicken pox)
     Incorrect method of TST administration
     Incorrect interpretation of reaction

    Who Can Receive a TST?

    Most persons can receive a TST. TST is contraindicated only for persons who have
    had a severe reaction (e.g., necrosis, blistering, anaphylactic shock, or ulcerations)
    to a previous TST. It is not contraindicated for any other persons, including
    infants, children, pregnant women, persons who are HIV-infected, or persons who
    have been vaccinated with BCG.

    How Often Can TSTs Be Repeated?

    In general, there is no risk associated with repeated tuberculin skin test


    placements. If a person does not return within 48-72 hours for a tuberculin skin
    test reading, a second test can be placed as soon as possible. There is no
    contraindication to repeating the TST, unless a previous TST was associated with
    a severe reaction.
    What is a Boosted Reaction?

    In some persons who are infected with M. tuberculosis, the ability to react to
    tuberculin may wane over time. When given a TST years after infection, these
    persons may have a false-negative reaction. However, the TST may stimulate the
    immune system, causing a positive, or boosted reaction to subsequent tests.
    Giving a second TST after an initial negative TST reaction is called two-step
    testing.

    Why is Two-Step Testing Conducted?

    Two-step testing is useful for the initial skin testing of adults who are going to be
    retested periodically, such as health care workers or nursing home residents. This
    two-step approach can reduce the likelihood that a boosted reaction to a
    subsequent TST will be misinterpreted as a recent infection.

    Can TSTs Be Given To Persons Receiving Vaccinations?

    Vaccination with live viruses may interfere with TST reactions. For persons
    scheduled to receive a TST, testing should be done as follows:

     Either on the same day as vaccination with live-virus vaccine or 4-6 weeks
    after the administration of the live-virus vaccine
     At least one month after smallpox vaccination

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