Mycobacterium avium sensitin and PPD to detect misdiagnosis of latent tuberculosis infection
Dual skin tests with
BACKGROUND:A positive tuberculin skin test (TST) may indicate cross-reacting immunity to non-tuberculous mycobacteria (NTM) and not latent tuberculosis infec- tion (LTBI). OBJECTIVES: To assess misclassification of LTBI, as assessed by skin testing with Mycobacterium avium
sensitin (MaS), and to determine how this misclassifica- tion affects the analysis of risk factors for LTBI. METHODS: In a population-based survey, participants underwent skin testing with M. tuberculosis purified pro- tein derivative (PPD) and MaS. A PPD-dominant skin test was a reaction
that was ≥ 3 mm larger than the MaS reaction; a MaS-dominant skin test was a reaction that was ≥ 3 mm larger than the PPD reaction. RESULTS: Of 447 randomly selected persons, 135 (30%) had a positive PPD test. Of these, 21 (16%) were MaS- dominant, and were therefore attributable to
NTM and misclassified as LTBI. PPD reactions of 5–14 mm were more likely to be misclassified than those ≥ 15 mm (OR = 5.0, 95%CI 1.9–13.2). Adjusting for misclassification had only a small impact on the analysis of risk factors for LTBI. CONCLUSIONS: A substantial number of
individuals who are diagnosed with LTBI are actually sensitized to NTM. Using dual skin testing would reduce misdiagnosis and prevent unnecessary treatment.
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Document Type: Research Article
Boston University School of Public Health, Boston, Massachusetts, USA
Division of Pulmonary Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
Glades Health Initiative Inc, Belle Glade, Florida, USA
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Brumback Health Center, Belle Glade, Florida, USA
2020 Company LLC, Atlanta, Georgia, USA
Publication date: November 1, 2011
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