LETTER
Delayed Tuberculin Reactivity in Indochinese Persons
Miguel A. Muniain, MD;
Jesus Rodriguez-Bano, MD; and
Jose L. Corral, MD
15 April 1997 | Volume 126 Issue 8 | Pages 661-662
TO THE EDITOR:
The study by Robertson and colleagues [1] evaluated the utility of a variant of delayed tuberculin reactivity for the evaluation of patients with suspected tuberculous infection in a high-risk population. The approach is ingenious, but we would like to make some comments.
The appropriate criterion for defining a positive skin-test reaction depends on the population being tested. In a recent report by the Ad Hoc Committee of the Scientific Assembly on Microbiology, Tuberculosis, and Pulmonary Infections [2], a reaction of 5 mm was considered positive in close contacts of infectious cases and in patients who had fibrotic lesions on chest radiography. In a group of patients in which 26% of chest radiographs suggested tuberculosis, it would be unusual to have only 29% of tuberculin purified protein derivative (PPD) test results identified as positive. A possible explanation is that the authors considered the positivity of PPD to be 10 mm.
We would like to know how many patients had induration greater than 5 mm in the PPD readings and whether including the results of these patients as positives would substantially change the results. If that is the case, the paper would support the concept that in populations with a high prevalence of tuberculosis, 5 mm of induration after PPD testing should be considered positive. Second PPD tests would then be limited to patients with induration less than 5 mm.
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Author and Article Information
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Macarena University Hospital, Seville, Spain 41007
1. Robertson JM, Burtt DS, Edmonds KL, Molina PL, Kiefe CI, Ellner JJ. Delayed tuberculin reactivity in persons of Indochinese origin: implications for preventive therapy. Ann Intern Med. 1996; 124:779-84.
2. Treatment of tuberculosis and tuberculosis infection in adults and children. Ad Hoc Committee of the Scientific Assembly on Microbiology, Tuberculosis, and Pulmonary Infections. Clin Infect Dis. 1995; 21:9-27.
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