LETTER
Tuberculin Booster Reactions and Conversions
Richard Sobel, MD
1 September 1994 | Volume 121 Issue 5 | Pages 387-388
TO THE EDITOR:
Menzies and colleagues [1] remind us that the PPD (booster) response is a nonspecific reflection of "all mycobacterial sensitization." Their data and conclusions are consistent with those of a study published by myself and colleagues several years ago [2]. We investigated an Israeli kibbutz school population to clarify the reasons for a high prevalence of positive and strongly positive PPD responses in a seventh-grade class. All but one of the school children had received bacille Calmette–Guérin immunization at birth. Responses were more prevalent and stronger in the older children and were associated with responses to PPd-G (Mycobacterium scrofulaceum). Chest radiographs were normal in the children with positive PPD responses; none of the children developed tuberculosis during the subsequent 15-year follow-up period. In this population with an extremely low prevalence of tuberculosis, even a PPD response of greater than 20 mm did not indicate tuberculosis. We speculated that frequent exposure to atypical mycobacteria in the soil of this farm community could account for the high prevalence of positive PPD responses.
1. Menzies R, Vissandje B, Rocher E, St. Germain Y. The booster effect in two-step tuberculin testing among young adults in Montreal. Ann Intern Med. 1994; 120:190-8.
2. Sobel R, Zabelle S, Scharf SM. Increased prevalence of strongly positive tuberculin skin reactions in children from a desert agricultural community in Israel. Pediatr Infect Dis J. 1987; 6:766-8.
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