ROLE OF TUBERCULIN TEST AS A DIAGNOSTIC TOOL FOR TUBERCULOSIS
Abstract
Background: Childhood Tuberculosis remains one of the major public health concerns in developing countries like Pakistan and is responsible for high rates of morbidity and mortality in children. Although tuberculin skin test is very commonly used by physicians all over the world, its interpretation always remains difficult and challenging. The objective of this study was to determine the frequency of positive tuberculin skin test in vaccinated and unvaccinated children suffering from tuberculosis. Methods: This Cross-sectional study was conducted in the department of Paediatric Ayub Teaching Hospital, Abbottabad from 1st February 2015 to 30th April 2016. A total of 150 patients were observed in this study. Children of either gender who were aged 1–15 years admitted in ward with tuberculosis were included in the study by using non-probability convenient sampling technique. We injected 0.1 ml (10 units) of tuberculin purified protein derivative (PPD) into the anterior surface of the forearm and induration was read at 72 hours after administration. Data was entered and analysed using SPSS version 10. Results: Out of 150 children, 84 (56%) were males and 66 (44%) were females. The mean age was 7.8±3.84 years. Of these 75 (50%) were vaccinated and 75 (50%) were unvaccinated. In vaccinated Group 5.3% children had positive tuberculin skin test while in unvaccinated Group 2.7% children had positive tuberculin skin test and this difference was found statistically insignificant (p-value=0.40). Pulmonary TB was the diagnosis in 67 (44.7%), TBM in 65 (43.3%), abdominal TB in 7 (4.7%), disseminated TB in 4 (2.7%) and military TB in 7 (4.7%) patients. Conclusions: The positivity of tuberculin skin test in vaccinated and unvaccinated children suffering from tuberculosis was found to be insignificant in our study. We conclude that Tuberculin Skin Test should not be used as a sole diagnostic tool for diagnosing the disease in children of our region.Keywords: Vaccinated; Unvaccinated; Tuberculin skin test; Children; TuberculosisReferences
The World Health Organization and stop TB partnership. The global plan to stop tb 2011-2015: transforming the fight towards elimination of tuberculosis; 2010. [Internet]. [cited 2011 Sep 5]. Available from: http://www.stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011-2015.Pdf
CDC. Tuberculosis. Data and Statistics; 2014. [Internet]. [cited 2014 Oct]. Available from: www.cdc.gov/tb/statistics
Javaid A, Ullah I, Ali M, Basit A, Ahmad W, Younis F, et al. Smear Positive Pulmonary Tuberculosis (TB) Patients Suspected to Have Drug Resistant TB in Programmatic Management of Drug Resistant TB Unit in Khyber Pakhtunkhwa, Pakistan. Jundishapur J Microbiol 2017;10(9):e14492.
Hasan Z, Irfan M, Khan JA, Jahangir SK, Haris M, Ashraf M, et al. BCG vaccination is associated with decreased severity of tuberculosis in Pakistan. Int J Mycobacteriol 2012;1(4):201–6.
Nicol MP, Workman L, Isaacs W, Munro J, Black F, Eley B, et al. Accuracy of the Xpert MTB/RIF test for the diagnosis of pulmonary TB in children admitted to hospital in cape town, South Africa: a descriptive study. Lancet Infect Dis 2011;11(11):819–24.
O’Grady J, Maeurer M, Mwaba P, Kapata N, Bates M, Hoelscher M, et al. New and improved diagnostics for detection of drug-resistant pulmonary TB. Curr Opin Pulm Med 2011;17(3):134–41.
Nicol MP, Zar HJ. New specimens and laboratory diagnosis for childhood pulmonary TB: progress and prospects. Paediatr Respir Rev 2011;12(1):16–21.
Regatieri A, Abdelwahed Y, Perez MT, Bush LM. Testing for tuberculosis; the role of tuberculin skin test and interferon Gamma release assays. Lab Med 2011;42(1):11–6.
Lalvani A. Diagnosing tuberculosis infection in the 21st century: New tools to tackle an old enemy. Chest 2007;131(6):1898–906.
Hillemann D, Rüsch-Gerdes S, Boehme C, Richter E. Rapid Molecular Detection of Extrapulmonary Tuberculosis by the Automated GeneXpert MTB/RIF System. J Clin Microbiol 2011;49(4):1202–5.
Shah I. Interpretation of Tuberculin Skin Testing in Children Vaccinated With BCG. Pediatr Oncall [Internet]. 2012 Oct [cited 2014 Oct 2]; Available from: http://pediatriconcall.com/Journal/Article/FullText.aspx?artid=517&type=J&tid=&imgid=&reportid=367&tbltype=
Nayak S, Acharjya B. Mantoux test and its interpretation. Indian Darmatol Online J 2012;3(1):2–6.
Flynn JL, Chan J. Tuberculosis: latency and reactivation. Infect Immun 2001;69(7):4195–201.
Nelson LJ, Wells CD. Global epidemiology of childhood tuberculosis [Childhood TB]. Int J Tuberc Lung Dis 2004;8(5):636–47.
Zulqarnain A, Iqbal I, Haq MA. Immune response of Tuberculin Test and Diagnostic BCG in Children Suffering from Tuberculosis. [Internet]. Medical Forum Monthly 2014. [cited 2014 July]. Available from: http://www.medforum.pk/index.php/article-database/9-articles/26-immune-response-of-tuberculin-test-and-diagnostic-bcg-test-in-children-suffering-from-tuberculosis
Imran M. BCG-A diagnostic tool in childhood tuberculosis. J Postgrad Med Assoc 1987;37(11):295–6.
Gocmen A, Kiper N, Ertan U, Kalayci O, Ozcelik U. Is the BCG test of diagnostic value in tuberculosis? Tuber Lung Dis 1994;75(1):54–7.
Gofama MM, Garba AM, Mohammad AA. Mantoux test reactions among children managed for tuberculosis in Maiduguri, Nigeria. Scand J Infect Dis 2011;43(1):15–8.
Pelly TF, Santillan CF, Gilman RH, Cabrera LZ, Garcia E, Vidal C, et al. Tuberculosis skin testing, energy and protein malnutrition in Peru. Int J Tuberc Lung Dis 2005;9(9):977–84.
National Health and Nutrition Examination Survey. Tuberculin Skin Test Procedures Manual. [Internet] [cited 2011 Jan]. Available from: https://wwwn.cdc.gov/nchs/data/nhanes/2001-2002/manuals/2001TBmanual.pdf
Bozaykut A, Ipek IO, Ozkars MY, Seren LP, Atay E, Atay Z. Effect of BCG vaccine on tuberculin skin tests in 1-6-year old children. Acta Paediatr 2002;91(2):235–8.
Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis 2006;10(11):1192–204.
Reid JK, Ward H, Marciniuk D, Hudson S, Smith P, Hoeppner V. The effect of neonatal bacilli Calmette-Guérin vaccination on purified protein derivative skin test results in Canadian aboriginal children. Chest 2007;131(6):1806–10.
Pineiro R, Mellado MJ, Cilleruelo MJ, Garcia-Ascaso M, Medina-Claros A, Garcia-Hortelano M. Tuberculin skin test in bacilli Calmette-Guerin-vaccinated children. How should we interpret the result? Eur J Pediatr 2012;171(11):1625–32.
Wang L, Turner MO, Elwood RK, Schulzer M, FitzGerald JM. A meta-analysis of the effect of bacilli Calmette-Guerin vaccination on tuberculin skin measurements. Thorax 2002;57(9):804–9.
Berti E, Galli L, Venturini E, de Martini M, Chiappini E. Tuberculosis in childhood: a systematic review of national and international guidelines. BMC Infect Dis 2014;14(Suppl 1):S3.
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