The effects of BCG immunization and human immunodeficiency virus infection on dual skin test reactions to purified protein derivative and Mycobacterium avium sensitin among adults in Zambia
Abstract:SETTING: University hospital in Lusaka, Zambia.
OBJECTIVE: To determine the effects of childhood bacille Calmette-Guérin (BCG) immunization and human immunodeficiency virus (HIV) infection on dual skin test reactions to purified protein derivative (PPD) and Mycobacterium avium sensitin (MAS) in a developing country.
DESIGN: Descriptive cross-sectional study.
RESULTS: Dual skin testing was performed on 112 adults, 58 HIV-positive and 54 HIV-negative. Forty-seven (42%) of 112 had PPD reactions ≥10 mm and 52 (46%) had MAS reactions ≥10 mm. PPD reactions ≥10 mm were present in 30 (63%) of 48 BCG-positive subjects compared to 17 (27%) of 64 BCG-negative subjects (P < 0.001). Nineteen (33%) of 58 PPD or MAS skin test positive subjects were PPD dominant, 15 (26%) were MAS dominant, and 24 (41%) were non-dominant. MAS dominant and non-dominant reactions were significantly reduced in HIV-positive subjects, and non-dominant reactions were increased in BCG-positive subjects.
CONCLUSIONS: Childhood BCG immunization is associated with PPD reactions ≥10 mm among adults. Reduced PPD reaction rates in HIV-positive adults appear to be due to a loss of BCG-induced PPD reactivity. Prior infection with M. avium complex is detectable in a significant proportion of adults in a developing country.
Document Type: Regular Paper
Affiliations: 1: Infectious Disease Section, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, New Hampshire, USA 2: Department of Community Medicine, University Teaching Hospital, Lusaka, Zambia 3: Department of Medicine, University Teaching Hospital, Lusaka, Zambia 4: Department of Pediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia 5: Centre for Infectious Diseases, Department of Medicine, University College London Medical School, London, UK
Publication date: March 1, 1999
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