Dual skin tests with Mycobacterium avium sensitin and PPD to detect misdiagnosis of latent tuberculosis infection
Dual skin tests with Mycobacterium avium sensitin and PPD to detect misdiagnosis of latent tuberculosis infection
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DOI：
10.5588/ijtld.11.0015
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发表时间：
2011-11-01
影响因子：
4
通讯作者：
von Reyn, C. Fordham
中科院分区：
文献类型：
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作者：
Larson, E. M.;O'Donnell, M.;von Reyn, C. Fordham
背景技术背景：结核菌素皮肤试验（TST）阳性可能表明对非结核分枝杆菌（NTM）的交叉免疫反应，而不是潜伏性结核感染（LTBI）。结论：通过鸟分枝杆菌致敏素（MaS）皮肤试验评估LTBI的错误分类，并确定这种错误分类如何影响LTBI危险因素的分析。在一项基于人群的调查中，参与者接受了M。结核纯化蛋白衍生物（PPD）和MaS。PPD-显性皮肤试验是大于MaS反应的反应>= 3 mm; MaS-显性皮肤试验是大于PPD反应的反应>= 3 mm。结果：在447名随机选择的人中，135名（30%）PPD试验阳性。其中，21例（16%）为MaS显性，因此可归因于NTM，并被错误归类为LTBI。5-14 mm的PPD反应比>= 15 mm的PPD反应更容易被错误分类（OR = 5.0，95%CI 1.9-13.2）。调整错误分类只有一个很小的影响LTBI.CONCLUSIONS的风险因素的分析：一个相当数量的人被诊断为LTBI实际上是敏感的NTM。使用双重皮肤测试将减少误诊，防止不必要的治疗。
BACKGROUND: A positive tuberculin skin test (TST) may indicate cross-reacting immunity to non-tuberculous mycobacteria (NTM) and not latent tuberculosis infection (LTBI).OBJECTIVES: To assess misclassification of LTBI, as assessed by skin testing with Mycobacterium avium sensitin (MaS), and to determine how this misclassification affects the analysis of risk factors for LTBI.METHODS: In a population-based survey, participants underwent skin testing with M. tuberculosis purified protein 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.