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(Chest. 1999;115:1757-1758.)
© 1999 American College of Chest Physicians

Tuberculin Skin Testing

Anita L. Sullivan , MB and Martin B. Allen, MB ChB, FCCP*

Staffordshire, UK

To the Editor:

We read with interest the article by Kendig et al (May 1998)1 and the subsequent correspondence by Dr. Scott (October 1998).2

Interpreting the reaction to tuberculin protein administered by intradermal injection (Mantoux test) has several problems. There is variation in reading between health-care professionals and the general public, difficulty in ensuring correct placement, and uncertainty in the concept of sequentially greater concentrations.1 ,2 ,3 ,4

In the United Kingdom, the multiple-puncture (Heaf) test is most commonly used. A standardized dose and depth of injection is provided when a fixed head apparatus is used.5 Selby and colleagues6 examined how well the general public read the Heaf test. Using a self-read card, 550 patients undergoing tuberculin skin testing were found to grade the reaction as accurately as a trained respiratory nurse. This contrasts sharply with the Mantoux test, where poor reproducibility has been found with medical and nonmedical health professionals,1 as well as with the general public.3 ,4

Interpretation of the Heaf test appears to be more reproducible than the Mantoux test in tuberculin skin testing.

Correspondence to: Martin B. Allen, FCCP, Department of Respiratory Medicine, North Staffordshire Hospital, Newcastle Road, Stoke on Trent, Staffordshire ST4 6QG, UK

References

  1. Kendig, EL, Kirkpatrick, BV, Carter, WH, et al (1998) Underreading of the tuberculin skin test reaction. Chest 113,1175-1177[Abstract/Free Full Text]
  2. Scott, GC (1998) Misreading of the tuberculin skin test [letter]. Chest 114,1225[Free Full Text]
  3. Colp, C, Goldfarb, A, Wei, I, et al (1996) Patient's self-interpretation of tuberculin skin tests. Chest 110,1275-1277[Abstract/Free Full Text]
  4. Howard, TP, Solomon, DA (1988) Reading the tuberculin skin test: who, when and how? Arch Intern Med 148,2457-2459[Abstract]
  5. . British Thoracic Society. (1998) Guidelines: chemotherapy and management of tuberculosis in the United Kingdom; recommendations 1998. Thorax 53,536-548[Abstract/Free Full Text]
  6. Selby, CD, Allen, MB, Leitch, AG (1990) How well do the general public read Heaf skin tests? Respir Med 84,245-248[Medline]

Tuberculin Skin Testing

Edwin L. Kendig, Jr., MD*

Richmond, VA

To the Editor:

As noted in the paper (May 1998),1-1 the American Academy of Pediatrics (AAP) recommends that only the Mantoux test be utilized and that tests be read by a health-care professional 48 to 72 h after application of the test. Recommendation for interpretation of tuberculin skin test reactions by the Centers for Disease Control and Prevention (CDC), the American Thoracic Society (ATS), and the AAP vary only in the approach to patients with no identifiable risk factors. For these individuals, the CDC and ATS recommend >= 15-mm induration as the criterion for a positive skin test reaction. The AAP concurs, except for those children in that same group who are <= 4 years; for these, the AAP requires >= 10-mm induration. For all patients with a risk factor (eg, those in contact with a known or suspected infectious case of tuberculosis), a reaction of >= 5-mm is considered positive.

In summary, the CDC, ATS, and AAP determine interpretation of the positive tuberculin skin test reaction at different levels of induration, depending on the patient's age and risk of infection. This cannot be accomplished with the Heaf test. The Heaf test now is rarely used in the United States.

Correspondence to: Edwin L. Kendig, Jr., MD, Laburnum House, 1300 Westwood Ave, Richmond, VA 23227

References

  1. Kendig, EL, Kirkpatrick, BV, Carter, WH, et al (1998) Underreading of the tuberculin skin test reaction. Chest 113,1175-1177




This Article
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