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Free Content 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

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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.

Keywords: BCG; HIV; M. avium sensitin; Zambia; purified protein derivative

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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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