Interpretation of repeated tuberculin tests - Boosting, conversion, and reversion
Interpretation of repeated tuberculin tests - Boosting, conversion, and reversion
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DOI：
10.1164/ajrccm.159.1.9801120
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发表时间：
1999-01-01
影响因子：
24.7
通讯作者：
Menzies, D
中科院分区：
文献类型：
--
作者：
Menzies, D
结核菌素皮肤试验是世纪开发的少数几种仍在临床医学中使用的试验之一。第一个结核菌素试验材料由Robert Koch制备（1）;其用于检测结核病（TB）感染的用途于1907年由von Pirquet首次描述（2）。鉴于使用的历史如此之长，对这一检验的解释方面仍然存在争议似乎令人惊讶。然而，这反映了受结核病影响的人群的变化，以及结核病感染的真阳性检测的相对频率，以及与卡介苗（BCG）接种或非结核分枝杆菌相关的假阳性检测，以及最近的人类免疫缺陷病毒（HIV）流行。在高风险人群中，使用重复结核菌素试验检测新的感染已经出现了特殊的问题，危险人群，如活动性病例的最初结核菌素阴性接触者和职业暴露工人。这表明，结核菌素反应可因以下原因而缩小（逆转）或扩大：（1）给药、阅读或生物学反应差异的随机变异性;（2）先前存在的对分枝杆菌抗原的迟发型超敏反应的免疫学回忆（加强）;或（3）新感染（转化）。
The tuberculin skin test is one of the few tests developed in the 19th century that is still in present use in clinical medicine. The first tuberculin test material was prepared by Robert Koch (1); its use for detection of tuberculosis (TB) infection was first described in 1907 by von Pirquet (2). Given such a long history of use, it may seem surprising that aspects of interpretation of this test remain controversial. However, this reflects changes in the populations affected with tuberculosis and their relative frequency of true positive tests from TB infection, and false-positive tests associated with bacillus Calmette-Guèrin (BCG) vaccination, or nontuberculous mycobacteria, as well as the recent human immunodeficiency virus (HIV) epidemic.Particular problems have arisen with use of repeated tuberculin tests to detect new infection in high-risk populations such as initially tuberculin-negative contacts of active cases, and workers with occupational exposure. This has revealed that tuberculin reactions may decrease in size (reversion) or increase in size because of:(1) random variability from differences in administration, reading, or biologic response;(2) immunologic recall of preexisting delayed type hypersensitivity to mycobacterial antigens (boosting); or (3) new infection (conversion).