Skin test reactions to Mycobacterium tuberculosis purified protein derivative and Mycobacterium avium sensitin among health care workers and medical students in the United States
OBJECTIVE: To use skin testing with Mycobacterium avium sensitin (MAS) to determine contemporary rates of infection with non-tuberculous mycobacteria (NTM) and their effect on reactions to M. tuberculosis purified protein derivative (PPD).
DESIGN: Dual skin testing was performed with PPD and MAS on 784 health care workers and medical students in the northern and southern US. MAS reactions that were ≥5 mm and also ≥3 mm larger than the PPD reaction were defined as MAS dominant and due to NTM.
RESULTS: MAS reactions were ≥5 mm in 40% and ≥15 mm in 18% of subjects; 95% were MAS dominant. MAS dominant reactions were more common in the south than the north (P < 0.001). PPD reactions were ≥15 mm in 3% of subjects. PPD reactions ≥15 mm were more common among males, foreign born subjects and subjects with BCG immunization (all P < 0.001). MAS dominant reactions were found in 82% of subjects with 5–9 mm PPD reactions and 50% with 10–14 mm PPD reactions; these reactions were more common among whites (P = 0.046), US-born (P = 0.038) and subjects without BCG immunization (P = 0.004).
CONCLUSIONS: Infections with NTM are responsible for the majority of 5–14 mm PPD reactions among US-born health care workers and medical students subject to annual tuberculin testing.
Document Type: Regular Paper
Affiliations: 1: Infectious Disease Section and Clinical Research Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA 2: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia, USA 3: University of North Carolina Hospitals, Chapel Hill, North Carolina, USA 4: University of Texas Health Center, Tyler, Texas, USA
Publication date: 2001-12-01
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