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Free Content Density of tuberculin skin reaction and its association with tuberculosis infection as defined by dual tuberculin testing

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OBJECTIVE: To determine whether the density of tuberculin skin reactions is associated with tuberculosis infection.

METHODS: In a national tuberculin survey in Tanzania, 1983–1987, all eligible children in a random sub-sample of schools underwent dual tuberculin skin testing with PPD-RT23 and PPD-scrofulaceum. The density of reactions to RT23 was classified as proposed by Palmer. A larger reaction to PPD-scrofulaceum than to PPD-RT23 is suggestive of infection with environmental mycobacteria. Tuberculosis infection was defined based on dual skin test results applying a range of possible definitions.

RESULTS: A total of 10782 children aged 5–14 years and without BCG scar were included in the analysis. Large skin reactions to RT23 were generally firmer than small ones. After taking the size of the skin reaction to RT23 into account, its density was not associated with the size of the skin reaction against PPD-scrofulaceum. In particular, the density of reactions in the range 6–11 mm was not associated with tuberculosis infection according to any of the definitions used.

CONCLUSION: This study suggests that the density of reaction was not associated with tuberculosis infection in Tanzanian school children after taking the size of the induration into account.
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Keywords: density; dual testing; infection; tuberculin; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Royal Netherlands Tuberculosis Association (KNCV) and International Tuberculosis Surveillance Centre (ITSC), The Hague, The Netherlands 2: National Tuberculosis and Leprosy Programme, Dar es Salaam, Tanzania

Publication date: 2000-11-01

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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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