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Aim: To evaluate the role of combined Mantoux test and serum angiotensin-converting enzyme (ACE) levels in the diagnosis of ocular tuberculosis (TB) and ocular sarcoidosis. Materials and Methods: A prospective and observational study including patients with bilateral granulomatous uveitis diagnosed both radiologically and clinically as ocular TB or ocular sarcoidosis within a six-month period. CT Thorax/CT abdomen was done, and findings were noted. Mantoux test and serum ACE levels were recorded, and findings were correlated. Results: The study included a total of 60 patients: 32 patients with ocular TB and 28 patients with ocular sarcoidosis. Using Mantoux test, 84.4% in the TB group tested positive and were correctly identified (sensitivity), and 96.4% in the sarcoid group tested negative and were correctly identified as sarcoidosis. Hence, the association between Mantoux test and diagnoses was statistically significant (P < 0.001). In the TB group, 25 subjects had normal and seven had elevated serum ACE levels. In the sarcoidosis group, 22 subjects had elevated and six had normal serum ACE levels. Hence, 78.1% were correctly identified with normal serum ACE levels (sensitivity) in the TB group and 78.6% were identified with elevated serum ACE levels in the sarcoidosis group, and the proportion difference was statistically significant (P < 0.001). Conclusion: Mantoux test and serum ACE levels are cost-effective investigations and can be used for the diagnosis of ocular TB and sarcoidosis when combined with clinical and radiological evidence. The combined use of serum ACE and Mantoux test is useful in differentiating between sarcoidosis and TB.

Lichen Scrofulosorum (LS) is an uncommon tuberculid that was initially described by Hebra in 1868 and typically affects children and young adults. Tuberculids are hypersensitivity reactions in the skin caused by internal Mycobacterium tuberculosis infection. These eruptive lesions result from bacilli spreading through the bloodstream in a host with high resistance to Mycobacterium tuberculosis. Although uncommon, this condition can be a valuable indicator of tuberculosis. Patients with LS typically exhibit a strong tuberculin reaction, concomitant tuberculous involvement of lymph nodes, bone, or other organs, and they show a good response to Antitubercular Therapy (ATT). Hereby, the authors present a case report of a 35-year-old female who presented with multiple papules on her face for five years. A detailed examination revealed no tuberculin reaction, no lymph node involvement, and a good response to ATT. Therefore, LS is a tuberculid that may resemble several other dermatological disorders, necessitating a thorough effort to verify the diagnosis.

Introduction. For early immunodiagnostics of tuberculosis (TB) in Russia, the Mantoux test (MT) has been used for decades; since 2013, the recombinant tuberculosis antigen (RTA) test has seen widespread use. The objective of this retrospective analytic observational cohort study was to evaluate the results of immunodiagnostics for TB in children with newly diagnosed active TB. Materials and methods. We studied data from Russian TB institutions on the results of MT and RTA assay in children with active and inactive TB first detected in 2013–2018, as well as children with active TB first detected in Moscow in 2017–2022. Results and discussion. In 2013–2018, out of 12,902 examined children with active TB, 11,673 (90.5%) had positive results of both skin tests and 198 (1.5%) had negative results. A negative RTA assay result with positive MT was found in 861 (6.7%) patients, and a positive RTA assay result with negative MT in 170 (1.3%). The sensitivity of the RTA assay in detecting active TB was 91.3%, while the sensitivity of MT was 97.2% (p 0.01). Similar data were obtained in the same regions in 14,127 children with inactive TB: the sensitivity of MT was higher than that of the RTA assay — 97.2% versus 95.2% (p 0.01). In Moscow, due to the small number of observations in 2022, it was not possible to show statistical reliability of the difference between the sensitivity of MT and RTA assay in detecting active TB in 2017–2022 (95.8% and 92.1% respectively; p 0.5). For the results obtained in 2017–2021, the difference was significant (p 0.05). Conclusion. The sensitivity of MT is higher than that of the RTA assay in screening children for TB. It is recommended to use the more sensitive MT test for screening children; screening with the RTA assay will increase the number of undetected and undiagnosed cases of active TB in children. Currently, MT cannot be excluded from the algorithm of early TB diagnosis in children.

Double antibody positive renal vasculitis (anti GBM antibody and pANCA) is a rare form of small vessel vasculitis associated with poor outcome. It is difficult to decide which antibody is the precursor in these cases. We report here such a rare case of double antibody positive renal vasculitis which was started on anti tubercular medicine for a positive mantoux test and interferon gamma release assay. The possible reasons for these antibodies in this may be a complication of COVID-19 infection or vaccine, adverse drug effect of antitubercular medicines or a paradoxical reaction during the tuberculosis treatment. The patient could not survive beyond two months of diagnosis because of rapidly declining renal functions. This case highlights the importance of a meticulous clinical approach, supports two week tuberculosis medicines trial and an early and careful dealing of non responders during tuberculosis treatment especially in patients whose diagnosis is not microbiologically confirmed.

Double antibody positive renal vasculitis (anti GBM antibody and pANCA) is a rare form of small vessel vasculitis associated with poor outcome. It is difficult to decide which antibody is the precursor in these cases. We report here such a rare case of double antibody positive renal vasculitis which was started on anti tubercular medicine for a positive mantoux test and interferon gamma release assay. The possible reasons for these antibodies in this may be a complication of COVID-19 infection or vaccine, adverse drug effect of antitubercular medicines or a paradoxical reaction during the tuberculosis treatment. The patient could not survive beyond two months of diagnosis because of rapidly declining renal functions. This case highlights the importance of a meticulous clinical approach, supports two week tuberculosis medicines trial and an early and careful dealing of non responders during tuberculosis treatment especially in patients whose diagnosis is not microbiologically confirmed. [ABSTRACT FROM AUTHOR]

Background: Mantoux test, a type IV hypersensitivity reaction, is commonly used to screen children for possible tuberculosis. It is applied on the volar surface of forearm. Sunlight ultra- violet rays (UV) have recently been shown to induce immune suppression that alters the skin response to Mantoux test negatively. Objective: The study aimed to evaluate the inner thigh as a possible site for Mantoux test in children attending Federal Medical Centre Owerri whom their primary attending Physicians requested a Mantoux test. Methods: This was a cross sectional study conducted between June and October 2011. Concomitant intradermal injection of 0.1ml of purified protein derivative on the volar aspect of the forearm and the inner thigh was carried out. Induration was measured concurrently in 106 consecutive children, between the ages of 3months and 15 years. Using volar surface of forearm as gold standard, values of inner thigh induration at a set cut-off was determined. Students’ test, Pearson correlation coefficient and the Chisquare were used to compute data. Results: The mean diameter of induration on the inner thigh (12.51 ±3.44mm) was higher than mean diameter of induration on the volar surface of the arm (11.03±6.34mm). This is however not statistically significant. There were (29) children who had reactive induration on the inner thigh whilst 19 had similar induration on the volar surface of the forearm. In the presence of factor(s) that negatively affects the response of the skin to Mantoux test; the inner thigh induration yield was higher. There was a strong positive correlation between the two site measurements. Conclusions: The inner thigh as a site for Mantoux test in children has shown potential for higher yield.

Background: Tuberculosis (TB) is a serious illness that mainly affects the lungs. The Mantoux tuberculin skin test (TST) is one method of determining whether a person is infected with Mycobacterium tuberculosis. Reliable administration and reading of the TST requires standardization of procedures, training, supervision, and practice. Aims and Objectives: The objective was to determine the sensitivity and specificity of Mantoux test in pediatric patients for the diagnosis of TB. It also assists to study various presentations of TB in Mantoux test-positive patients. Materials and Methods: From August 2022 to January 2023, a single tertiary care facility named Saraswathi Institute of Medical Sciences, Hapur hosted this observational study after approval from the Institutional Ethical Committee. Participants in the trial included all children up to 15 years of age who has received Bacillus Calmette-Guérin at birth, were suspected of having TB and had been referred to a pediatric TB clinic. TST by 5 Tuberculin Unit Purified Protein Derivative-Standard was used to see induration of various sizes. The sensitivity, specificity, positive predictive value, negative predictive value and other metrics were calculated during the study by statistical software. Results: Out of 480 patients 36.87% (n=177) had TB with TST cut off≥15 mm indurations, while 169 patients had no induration. Most common age group affected was 5–10 years (48.59%) followed by 0–5 years (30.51%) and 10–15 years (20.90%) with male: female ratio = 1.2:1. Most common etiology for TST positive patients was pulmonary TB (PTB) (29.30%), extra PTB (50.10%), disseminated TB (12.90%) and latent TB (07.70%). The sensitivity of the test was 95.857% with 95% confidence interval (91.64–98.31%), specificity was 95.176% (92.16–97.29%). Its positive and negative predictive values were 91.525% and 97.689% respectively. Conclusion: TB can be diagnosed with the Mantoux test because of its high sensitivity and specificity but it should be explained carefully to avoid inaccurate interpretations.

Tuberculosis is a chronic granulomatous infection that is quite common and a threat to many developing countries. However, extrapulmonary cases involving tubercular skin and soft tissue abscess formation are rare, accounting for 1 or 2% of cases of Mycobacterium TB infections with skin and soft tissue involvement. The typical extrapulmonary tuberculosis symptoms and indications are nonspecific, making diagnosis difficult and time-consuming. We present a case of right arm tubercular cold abscess in a child related to mycobacterium tuberculosis, which was diagnosed by Ziehl-Neelson stain FNAC (Fine needle Aspiration cytology) and Mantoux test (18mm) induration. Due to its rare manifestation, it often gets misdiagnosed or overlooked. A proper diagnosis will ensure a proper treatment plan. Our case further depicts the collaborative effort of healthcare professionals. The patient came back complaining about the increased swelling in his right arm. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a serious illness that mainly affects the lungs. The Mantoux tuberculin skin test (TST) is one method of determining whether a person is infected with Mycobacterium tuberculosis. Reliable administration and reading of the TST requires standardization of procedures, training, supervision, and practice. Aims and Objectives: The objective was to determine the sensitivity and specificity of Mantoux test in pediatric patients for the diagnosis of TB. It also assists to study various presentations of TB in Mantoux test-positive patients. Materials and Methods: From August 2022 to January 2023, a single tertiary care facility named Saraswathi Institute of Medical Sciences, Hapur hosted this observational study after approval from the Institutional Ethical Committee. Participants in the trial included all children up to 15 years of age who has received Bacillus Calmette-Guérin at birth, were suspected of having TB and had been referred to a pediatric TB clinic. TST by 5 Tuberculin Unit Purified Protein Derivative-Standard was used to see induration of various sizes. The sensitivity, specificity, positive predictive value, negative predictive value and other metrics were calculated during the study by statistical software. Results: Out of 480 patients 36.87% (n=177) had TB with TST cut off=15 mm indurations, while 169 patients had no induration. Most common age group affected was 5-10 years (48.59%) followed by 0-5 years (30.51%) and 10-15 years (20.90%) with male: female ratio = 1.2:1. Most common etiology for TST positive patients was pulmonary TB (PTB) (29.30%), extra PTB (50.10%), disseminated TB (12.90%) and latent TB (07.70%). The sensitivity of the test was 95.857% with 95% confidence interval (91.64-98.31%), specificity was 95.176% (92.16-97.29%). Its positive and negative predictive values were 91.525% and 97.689% respectively. Conclusion: TB can be diagnosed with the Mantoux test because of its high sensitivity and specificity but it should be explained carefully to avoid inaccurate interpretations. [ABSTRACT FROM AUTHOR]

Abstract Aim Until now, the performance of interferon-γ release assay (IGRA) and Mantoux tests remains unclear in infant tuberculous meningitis (TBM). Therefore, a systematic review is performed to evaluate the sensitivity of IGRA and Mantoux tests for the diagnosis of infant TBM in low and intermediate tuberculosis (TB) burden countries, while following PRISMA. Methods Several databases, including PubMed, EBSCO, Embase, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials, were searched. Articles describing the results of IGRA or Mantoux tests among infant TBM were included for analysis. Data, such as age, sex, Mantoux test or IGRA, and cerebrospinal fluid (CSF) microbiological examinations (such as acid-fast bacilli (AFB) smear, TB PCR, and TB culture), were extracted from each study. Results A total of 31 articles were enrolled for further analysis, including 48 cases. The mean age was 9.4 ± 5.8 months and boys accounted for 57.1% of infants (24/42). Mantoux test was positive in 57.4% (27/47) of tested infants and IGRA was positive in 77.8% (7/9) of infants. In addition, among the infants with confirmed TB, 18 (52.9%, 18/34) of them have positive Mantoux responses and 7 (20.0%, 7/35) have positive IGRA results. Conclusions In low or intermediate TB burden countries, the Mantoux test has a poor performance for diagnosing TBM among infants, and IGRAs appear to have a moderate sensitivity for the diagnosis of infant TBM.

Context: The diagnosis and management of ocular tuberculosis (OTB) is largely a mystery, and the fact that it is a great imitator of various ocular pathologies adds to the difficulty in the diagnosis of patients. Aims: The aim of this study was to assess the role of the Mantoux test in the diagnosis of OTB. Settings and Design: This was a retrospective chart review of patients who were diagnosed to have and treated as OTB in 1 year at our tertiary care center in Western India. Methods: The study population included 34 patients who presented to us and were diagnosed to have OTB, using standards published by the Department of Health Research, Ministry of Health and Family Welfare, Government of India, and the Indian Council of Medical Research. Results: A total of 34 patients were diagnosed to have OTB in the study period of 1 year between January 1, 2021, and December 31, 2021. Of these 34 patients; 14 were male and 20 were female. The Mantoux test had been done in 32/34 patients. It was positive in 26 patients and negative in six patients. Looking specifically at the six patients in whom the Mantoux was negative, apart from having ocular signs of tuberculosis (TB), they had positive findings suggestive of old/active TB on contrast-enhanced chest computed tomography scan. Of the 34 patients, only five patients were treated based only on the clinical signs of OTB with only a positive Mantoux test, but even they all showed a response to treatment. Conclusions: There is a definite role of the Mantoux test when interpreted considering the clinical phenotype and radiology findings in OTB.

Among the most prevalent types of extrapulmonary TB is abdominal (TB). The diagnosis of abdominal TB is difficult. This disorder is thought to be a good imitator of other abdominal illnesses. To reduce morbidity and mortality, early diagnosis, antitubercular medication start-up, and surgical treatment are crucial. Only seldom is surgery necessary because most patients benefit from antitubercular therapy. Imaging is crucial to the diagnosis and care of these individuals. The following patient, aged about 53 years old female, complained of stomach pain, vomiting, loss of appetite, and weight loss when she first arrived. A swollen ileocaecal junction with a cystic lesion was discovered on an ultrasound of the whole abdomen. The patient received antitubercular medication for six months, and she responded favorably to it.

Aim: Until now, the performance of interferon-γ release assay (IGRA) and Mantoux tests remains unclear in infant tuberculous meningitis (TBM). Therefore, a systematic review is performed to evaluate the sensitivity of IGRA and Mantoux tests for the diagnosis of infant TBM in low and intermediate tuberculosis (TB) burden countries, while following PRISMA. Methods: Several databases, including PubMed, EBSCO, Embase, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials, were searched. Articles describing the results of IGRA or Mantoux tests among infant TBM were included for analysis. Data, such as age, sex, Mantoux test or IGRA, and cerebrospinal fluid (CSF) microbiological examinations (such as acid-fast bacilli (AFB) smear, TB PCR, and TB culture), were extracted from each study. Results: A total of 31 articles were enrolled for further analysis, including 48 cases. The mean age was 9.4 ± 5.8 months and boys accounted for 57.1% of infants (24/42). Mantoux test was positive in 57.4% (27/47) of tested infants and IGRA was positive in 77.8% (7/9) of infants. In addition, among the infants with confirmed TB, 18 (52.9%, 18/34) of them have positive Mantoux responses and 7 (20.0%, 7/35) have positive IGRA results. Conclusions: In low or intermediate TB burden countries, the Mantoux test has a poor performance for diagnosing TBM among infants, and IGRAs appear to have a moderate sensitivity for the diagnosis of infant TBM. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is one of the main causes of mortality among infectious diseases. The prevalence of tuberculosis is very high in developing countries such as India. Mantoux test is frequently used for the diagnosis of latent or active tuberculosis despite low sensitivity and specificity. However, the Mantoux test is a crucial test in a resource-less setup for the diagnosis of TB. Therefore, the main purpose of this study was to find the dropout rate and dropout reasons in Mantoux testing. Methodology: All suspected TB patients attending out-patient department and further tested for Mantoux test. Results: Of the total 789 Mantoux tests, 459 (58%) were negative, 195 (25%) were positive, and 135 (17%) were dropouts. One of the main reasons for dropout was patients did not give importance to the Mantoux test. Conclusion: Dropout rate in Mantoux testing can be reduced by patient counseling regarding TB and Mantoux test by the doctor.

Introduction: Globally, tuberculosis (TB) is the second leading cause of deaths related to an infectious disease, after HIV. Tuberculin skin testing (TST) which is also called Mantoux test or purified protein derivative (PPD) test remains a useful tool to diagnose TB in children. Current recommendation is to use 2 TU PPD RT23 for all diagnostic purposes. TST or Mantoux test is considered positive if the induration is 10 mm or more. Due to non-availability of 2 TU, unstandardized TST with 5, 10 TU RT23 is in practice which can cause problems in reading of test results. Objectives: The objectives of the study were to compare the tuberculin reaction sizes to 2 TU and 5 TU doses of RT 23 with Tween 80 at 46–48 h and 76–78 h. Methodology: All children who were aged < 18 years and are known case of TB were included in the study. Each child was administered dual intradermal injections with 2 TU and 5 TU doses of tuberculin on the volar aspect of the forearm until a wheal was visible at the injected area. The reactions to both the tests were read at 46–48 h and 70–72 h. Institutional Ethics Committee approval was taken before start of the study. The statistical analysis was performed using SPSS 22 version software. Results A total number of cases included in the study during the study period were 81 cases, out of which 52 (64.19%) were male and 29 (35.8%) were female. Among those 81 cases, the mean reaction to 2 TU at 46–48 h was 12.79 mm and at 76–78 h was 15.33 mm. The mean reaction to 5 TU at 46–48 h was 18.89 mm and at 76–78 h was 22.80 mm. Among the cases, the mean size of induration at 46–48 h was lesser than that of 76–78 h in both 2 TU and 5 TU and it was statistically significant. Reactions to 2 TU and 5 TU PPD can be made comparable using the equation, 5 TU = (2 TU × 0.599) + 11.233 at 46–48 h and 5 TU = (2 TU × 0.074) + 21.66 at 76–78 h. ConclusionThus to conclude, cutaneous hypersensitivity to 2 TU PPD can be made comparison using the equation, 5 TU = (2 TU × 0.599) + 11.233 at 46–48 h and 5 TU = (2 TU × 0.074) + 21.66 at 76–78 h.

For the immunodiagnosis of tuberculosis infection, in addition to standard skin tests (Mantoux test with 2 TU PPD-L and Diaskintest), in vitro tests are currently used, one of which is the T-spot.TB test.Purpose of research. Evaluate the T-SPOT test as a method of early detection of tuberculosis infection in children and adolescents and its role as an additional method in solving the problem of the need for chemoprophylaxis.Materials and methods. The analysis of the results of T-SPOT.TB in 794 children aged 2 to 17 years inclusive in the period from 2016 to 2019 was carried out. Two groups were allocated: 1 group (n = 596) — children who underwent T-SPOT.TB as the main methodology; Group 2 — 198 children with positive skin test results for a recombinant tuberculosis allergen after screening. The results of T-SPOT.TB were evaluated taking into account the data of previous immunodiagnostics and associated pathology.Results. It is established that T-SPOT.TB. can be used as an independent method in case of rejection of skin tests. The level of latent tuberculosis infection is higher among children with concomitant pathology according to the results of T-SPOT.TB twice.Conclusion. T-SPOT.TB can be an alternative method for diagnosing tuberculosis infection during screening. In children with concomitant pathology of the T-SPOT.TB can serve as the leading method of tuberculosis immunodiagnosis. A positive T-SPOT.TB can serve as an additional method for deciding on the appointment of preventive chemotherapy.

Objectives: The aim of this study is to determine the concordance between QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) in children vaccinated with Bacillus Calmette–Guerin (BCG). Methods: This cross-sectional study was done at a pediatric tertiary care center in 33 BCG-vaccinated children aged 6 months–15 years suspected of Mycobacterium tuberculosis infection or in contact with a patient with open tuberculosis (TB). All patients were tested for TST with purified protein derivative-S 5 tuberculin units and QFT-GIT assays. Concordance was evaluated between TST and QFT assay by kappa coefficient (k). Agreement between the tests was classified into categories: poor if k < 0.20, fair (k = 0.21–0.40), moderate (k = 0.41–0.60), good (k = 0.61–0.80), and very good (k = 0.81–1.00). Results: Both the TST and QFT assay were positive in 13 and negative in eight children, respectively, resulting in an agreement of 63% (κ = 0.31). Eight children were 4 years of age, TST specificity was 50% with a positive predictive value of 66.7%. In patients with contact with a patient having TB, TST specificity was 33.3%. Considering TST of 15 mm and above as positive, TST specificity increased to 63.2% and a positive predictive value was 56.3%. Conclusion: The concordance of TST and QFT-GIT is low in children with previous BCG vaccination and especially in children

Abstract Background HIV-associated tuberculosis (TB) is a major cause of death among pregnant women in South Africa. Isoniazid prevention therapy (IPT) strategy was implemented in South Africa concurrently with life-long antiretroviral therapy (ART) to reduce the TB-associated morbidity and mortality in individuals living with HIV. This study assessed the extent of the implementation of IPT and the performance of the Mantoux test by geographic settings of health facilities and residences of pregnant women living with HIV in the Eastern Cape, South Africa. Methods We conducted a data analysis of 1709 pregnant women enrolled in the new electronic database of the prevention of mother-to-child transmission programme of the East London Prospective Cohort Study. Relevant data on place of residence and antenatal care, performance of the Mantoux test and subsequent initiation of IPT were obtained. Descriptive and inferential statistics were employed to analyse the geographical variations and accessibility to Mantoux test and IPT. Results The analysis shows that Mantoux test was performed on 803 pregnant women (47%) with significant geographical variation. After controlling for relevant covariates, pregnant women who resided in rural areas (AOR:0.63; CI: 0.47–0.84) compared to those who resided in urban areas were significantly less likely to receive Mantoux test. The rate of uptake of IPT was 79% with significant geographic variations. In the unadjusted model, rural place of residence (UOR:0.68; CI: 0.49–0.96) was independently associated with lower likelihood of uptake of INH prophylaxis; however, the effect was not significant after controlling for important covariates. Conclusions The high uptake rate of isoniazid prevention therapy in pregnant women living with HIV at the study sites is commendable; however, concerted efforts are needed to address the inequality gaps in the roll-out of IPT. Poor performance of Mantoux test is a serious concern and requires the attention of TB programme managers and other relevant authorities.

To assess the difference of Mantoux test result of under-five children who bad had BCG vaccination and those who bad not, a cross sectional study was conducted in the out patient child clinic of Dr. Pirngadi Hospital, Medan. This study was conducted from February 6, 1990 until March 3, 1990 comprising 328 under-five children (164 who bad received BCG vaccination and 164 who bad not). We found positive Mantoux tests in 86.0% of under-five children who bad BCG vaccination and 9.2% of under-five children who not bad (P

Aims and Objective: This retrospective study evaluates the importance of Mantoux test and Erythrocyte Sedimentation Rate (ESR) levels in pediatric tuberculosis and also signifies the impact of this test in treatment planning and implementation in pediatric cleft lip and palate patients. Methodology: Retrospective analyses of the records of 2010 pediatric cleft lip and palate patients below 5 years age were performed, and patients with elevated ESR subjected to Mantoux test were identified. The parameters included were age, sex, ESR levels, type of cleft, history of contact with TB & BCG vaccination, Mantoux conversion, chest X-ray findings, number of smear-positive pulmonary tuberculosis. Results: Out of 2010 patients with cleft lip and palate, 180 patients were subjected to Mantoux test due to high ESR levels. Among these, 54 (30%) patients found as Mantoux positive, in which 45 patients were identified as smear-positive pulmonary tuberculosis patients; as a result, surgery was deferred and they underwent antituberculous therapy. Most of the Mantoux-positive cases were found in patients with ESR range of 20–30 mm, i.e., 38 patients (71%), and common age group was 6 months–1 year. The most commonly involved cleft type was: unilateral cleft lip and palate having 36 patients (66.7%). The overall incidence of tuberculosis was 2%. Conclusion: Although the correlation of Mantoux test with elevated ESR was not significant in our study, it could be of value as a screening tool along with the Mantoux test, which is sensitive but nonspecific in the diagnosis of active tuberculosis. Together, they could be a valuable screening tool in any community or hospital for diagnosis of the disease. [ABSTRACT FROM AUTHOR]

The article analyses the efficacy of vaccination and its influence on the nature of tuberculosis process in children perinatally exposed to HIV. The study analysed hospital records, hospital discharge summaries and outpatient medical records of children under 14 with tuberculosis: there were 109 HIV-infected children and 97 children perinatally exposed to HIV (but not HIV-infected). The postvaccinal immunity status was assessed by the presence and size of the vaccination scar and the response to the Mantoux test. The clinical efficacy of the BCG vaccination was assessed by the severity of tuberculosis in vaccinated and non-vaccinated children. It was shown that immunization with BCG vaccine (BCG-M) was safe and efficacious in children born to HIV-infected women but not infected with HIV. At the same time the vaccine did not demonstrate sufficient immunological and clinical efficacy in HIV-infected children: the response to the Mantoux test, 2 TU, was positive only in one third of all vaccinated children; there was no statistically significant difference in the frequency of disseminated processes in vaccinated children as compared to the non-vaccinated children perinatally exposed to HIV. A conclusion was made that children born to HIV-infected mothers but not infected with HIV must be vaccinated during the neonatal period. The vaccination of HIV- infected children is not advisable due to its low clinical efficacy and the risk of development of disseminated complications, for instance, the generalized BCG infection in HIV-infected children may develop over a period of 3 years after vaccination.

The article compares results reported in national and foreign literature concerning tuberculosis detection by various in vivo (skin tests such as the Mantoux test and Diaskintest® (a skin test with a recombinant tuberculosis allergen)) and in vitro methods (IGRA tests). A positive reaction to the Mantoux test, which has been used for over 100 years as part of mass immunization against tuberculosis, can be indicative of both earlier vaccination and of infection caused by virulent Mycobacteria tuberculosis. Given the mass scale of BCG vaccination, the positive reaction to tuberculin loses its predictive value for assessing the risk of tuberculosis. Diaskintest®, a recombinant tuberculosis allergen, was developed in Russia in early 2000s, authorized in 2008 and has been used in the national healthcare system since 2009. This is a recombinant fusion protein ESAT6-CFP10 produced using Echerichia coli BL21(DE3)/pCFP-ESAT. Differential diagnosis between post vaccination (BCG) and bacterial allergic reactions using Diaskintest® demonstrated high efficacy of the product - detection of tuberculosis in people with a positive reaction to the test was much higher than that of the Mantoux test. Both Diaskintest® and IGRA tests usually do not produce false negative reactions. Therefore no additional examination of non-infected people is needed, and the preventive therapy is given only to those people who have a high risk of developing tuberculosis.

Background: Tuberculosis (TB) is one of the main causes of mortality among infectious diseases. The prevalence of tuberculosis is very high in developing countries such as India. Mantoux test is frequently used for the diagnosis of latent or active tuberculosis despite low sensitivity and specificity. However, the Mantoux test is a crucial test in a resource-less setup for the diagnosis of TB. Therefore, the main purpose of this study was to find the dropout rate and dropout reasons in Mantoux testing. Methodology: All suspected TB patients attending out-patient department and further tested for Mantoux test. Results: Of the total 789 Mantoux tests, 459 (58%) were negative, 195 (25%) were positive, and 135 (17%) were dropouts. One of the main reasons for dropout was patients did not give importance to the Mantoux test. Conclusion: Dropout rate in Mantoux testing can be reduced by patient counseling regarding TB and Mantoux test by the doctor. [ABSTRACT FROM AUTHOR]

Ocular tuberculosis can manifest in a wide variety of clinical presentations. The prevalence is higher in endemic areas as a cause of granulomatous uveitis. While posterior segment manifestations are well known, anterior segment granulomas alone are relatively rare. We report two cases of unilateral iris granulomata in two young patients who presented with decreased vision and redness and were found to have well-circumscribed iris granulomas. Both underwent systemic evaluation and had a negative Mantoux test. Biopsy pathology of the lesions revealed granulomatous inflammation but were negative for PCR, staining, and culture for TB. One patient turned out to have multiple pulmonary lesions. The ocular condition initially worsened with steroid therapy alone and improved and resolved completely after starting a 9 months course of anti-tubercular therapy (ATT). [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) remains one of the deadliest communicable diseases worldwide. The introduction of early and rapid diagnostic test such as Cartridge Based Nucleic Acid Amplification Test (CBNAAT) creates opportunities for improvement in early and fast detection of TB and drugresistance. Aim: To determine the prevalence of Tubercular cases in clinically diagnosed TB patients and to determine the prevalence of Rifampicin resistance by CBNAAT. Materials and Methods: This prospective observational study involved a total of 107 children from January 2018 to June 2019, fulfilling the inclusion criteria who were clinically diagnosed and found positive in conventional tests for TB. CBNAAT was used to confirm Mycobacterium tuberculosis (MTB) for the diagnosis of childhood TB and compare with other conventional methods. Chi-square test for the proportion was applied and p-value <0.05 taken as significant. Results: Of the 107 patients studied, 44.9% were female and 55.1% were male. The age range was 3 months to 12 years. The cases were confirmed by CBNAAT in clinically suspected case of TB was found to be 17.8% (19 cases out of 107 patients). CBNAAT was able to detect MTB in 14% (15 cases out of 107 patients) of the gastric aspirate/sputum sample. Out of 107 patients, 69 children were clinically diagnosed as Neurotuberculosis and 13% (9 out of 69 cases) cases were confirmed by CBNAAT in Cerebrospinal Fluid (CSF). OF which 29 patients had CSF analysis suggestive of Tubercular Meningitis (TBM). Out of 29 patients, 10 (34.5%) cases were confirmed by CBNAAT. This test showed a significant association with positive Mantoux test (p-value 0.020) and CSF analysis (p-value 0.021) suggestive of TBM. Conclusion: CBNAAT should be used in preference to conventional methods as the initial diagnostic test for patients suspected of having TB. CBNAAT positivity shows significant association with positive Mantoux test and CSF analysis suggestive of TBM. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to determine the concordance between QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) in children vaccinated with Bacillus Calmette–Guerin (BCG). Methods: This cross-sectional study was done at a pediatric tertiary care center in 33 BCG-vaccinated children aged 6 months–15 years suspected of Mycobacterium tuberculosis infection or in contact with a patient with open tuberculosis (TB). All patients were tested for TST with purified protein derivative-S 5 tuberculin units and QFT-GIT assays. Concordance was evaluated between TST and QFT assay by kappa coefficient (k). Agreement between the tests was classified into categories: poor if k < 0.20, fair (k = 0.21–0.40), moderate (k = 0.41–0.60), good (k = 0.61–0.80), and very good (k = 0.81–1.00). Results: Both the TST and QFT assay were positive in 13 and negative in eight children, respectively, resulting in an agreement of 63% (κ = 0.31). Eight children were <4 years of age of which only one patient had a positive TST and QFT-GIT, and TST and QFT-GIT were negative in two patients resulting in an agreement of 37.5% (κ = 0.063). Among children 4 years of age and older, 12 patients had a positive TST and QFT-GIT and 6 patients had a negative TST and QFT-GIT resulting in an agreement of 72% (κ = 0.41). Among 12 children who had been in contact with an adult having open TB, both the TST and QFT-GIT were positive in 6 patients and negative in two patients, respectively, resulting in an agreement of 66% (κ = 0.41). TST specificity was only 29.6% with a positive predictive value of 42.4% as compared to QFT-GIT. Among children <4 years of age, TST specificity was only 28.6% with a positive predictive rate of 16.7%, and among children >4 years of age, TST specificity was 50% with a positive predictive value of 66.7%. In patients with contact with a patient having TB, TST specificity was 33.3%. Considering TST of 15 mm and above as positive, TST specificity increased to 63.2% and a positive predictive value was 56.3%. Conclusion: The concordance of TST and QFT-GIT is low in children with previous BCG vaccination and especially in children <4 years of age. QFT-GIT may help to rule out false-positive TST. [ABSTRACT FROM AUTHOR]

This review presents modern views on the problems of immunodiagnosis of tuberculosis. We have examined the advisability of the use of immunological methods for diagnosis of active tuberculosis and detection of latent tuberculous infection. It is shown that nowadays the use of serological diagnostic methods is not recommended because of contradictory information about their accuracy and limited diagnostic significance. Advantages and disadvantages of current methods of assessment of cell-mediated immune response that are used as screening tests for diagnosis of latent tuberculosis have been analyzed. We point to advisability of combination of different methods that are available nowadays with the use of skin tests as the first step of diagnosis, and improvement of techniques of antigens injections that are used for them.

Background: Health-care workers (HCWs) are at increased risk of acquiring tuberculosis (TB) than the general population. While national-level data on the burden of TB in general population is available from reliable sources, nationally representative data on latent tuberculosis infection (LTBI) burden in HCWs in the high burden countries is lacking. Methods: A prospective study was carried out to assess the risk of TB infection among HCWs who directly engage in medical duties. HCWs were recruited between January 2014 and December 2015. A structured questionnaire was used for risk assessment of TB infection among HCWs, including sociodemographic characteristics (e.g., age, gender, period of professional work, and employed position), knowledge of TB prevention and control, and history of professional work. A single-step tuberculin skin test (TST) using 5 international units (IU; 0.1 ml) of tuberculin (purified protein derivative from Mycobacterium bovis Bacillus Calmette–Guérin [BCG]). TB infection was determined using a TST induration ≥10 mm as a cutoff point for TST positivity. TST-positive participants were further subjected to detailed clinical evaluation and chest radiography to rule out active TB. The associations between TB infection and the sociodemographic characteristics, duration of possible exposure to TB while on medical duties, BCG vaccination, and knowledge about TB were estimated using Chi-square test. A two-sided P < 0.05 indicated statistical significance. Results: A total of 206 eligible HCWs signed the informed consent and completed the questionnaires between January 2014 and December 2015. The age of the participants ranged from 18 to 71 years, with a mean age of 27.13 years. TST induration size (mean 6.37 mm) the TST results suggested that 36.8% (76/206) were infected with TB using a TST induration ≥10 mm as a cut-off point. All 76 TST-positive HCWs showed no evidence of active TB in clinical evaluation and chest radiography. However, during the study, two HCWs developed pulmonary TB (both TST baseline test negative). Statistical analysis suggested that age, duration of employment as a health-care professional, literacy status, and working in medical wards/OP/Intensive Care Unit were significantly associated with TB infection. Conclusions: Many studies propose serial tests of LTBI as effective occupational protection strategies. However, practically, it is not feasible because it has to be done at frequent intervals, but how frequently to be done is not clear. Another concern is even if found to have LTBI, there are no clear consensus guidelines about the treatment in high prevalence settings. The prevalence of LTBI is so high in countries like India that affected HCWs could not be exempted from working in high-risk areas. The depth of knowledge of TB prevention and control among HCWs should be improved by regular infection control training.

Koebner phenomenon, also known as isomorphic response, is the appearance of active skin lesions in sites of epidermal injury. This manifestation is characteristic of different dermatological diseases, such as lichen planus, vitiligo and psoriasis. We present the case of a psoriatic patient who experienced Koebner phenomenon after Mantoux test, followed by eruption of generalized plaque psoriasis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate on a large group of patients whether Mantoux tuberculin skin test (TST) result is associated with BCG immunotherapy effectiveness and whether it can predict occurrence of moderate to severe toxicity.Materials and Methods: We analysed group of 823 patients with intermediate and high risk NMIBCs who were treated with BCG. The study included 412 patients with the history TST and 411 without TST. A standard dose of Statens Serum Institute tuberculin RT23 was used. The reaction was read 48-72 hours later by evaluating the diameter of palpable induration. The size of the induration was considered positive when the measurement was greater than or equal to 6 mm and excessively positive when bigger than 26 mm. Whole BCG immunotherapy schedule consisted of 27 instillations.Results: The patients were followed for median 61 months. The 5-year recurrence and progression free survival (RFS, PFS) did not differ between the groups in both total study population and in tumour subgroup analysis. TST result in both total study population and in subgroups was not statistically associated with RFS, PFS and cancer specific survival.The moderate-to-severe toxicity was observed in 181(44%) TST patients, and in 196(47%) patients without TST. Incidence of toxicity was not statistically different and also not statistically associated with TST result in any of the tumour subgroups of TST group.Conclusion: This study shows, that TST does not have value in prediction of bladder cancer recurrence, progres-sion nor cancer specific survival. Also it doesn't have a value in predicting therapy toxicity. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinico-radiological features and long-term outcomes in patients with tubercular dacryoadenitis (TbD) Methods: Retrospective, observational study of TbD patients who underwent a thorough clinical examination, orbital imaging study, and tailored ancillary investigations. Polymerase chain reaction (PCR) and microscopy were done in specific cases. A 4-drug anti-tubercular therapy (ATT) was started and clinical response was monitored in all. Patients with a minimum follow-up of 6 months "off-ATT" were included. Results: All patients were women and three presented with pain, blepharoptosis, and bilateral involvement. In all, ESR was raised, Mantoux test was positive and orbital imaging revealed enlarged lacrimal gland/s. Positive PCR and granulomatous inflammation on microscopy were seen in two patients. At a mean follow-up of 17.25 months, all women responded with no relapse or clinical recurrence. Conclusion: Bilateral lacrimal gland enlargement, positive Mantoux & PCR with early response to ATT may provide sufficient evidence for diagnosing TbD. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis can affect any organ system of the body, including the genitourinary tract. Genitourinary TB is the most common form of extra pulmonary TB accounting for 27% (14-41%) worldwide. Aim and objectives: To study distribution of GU TB in relation to age, sex, anatomical site, signs and symptoms and to study various diagnostic modalities, treatment and role of surgery in GU TB. Materials and methods: This study was a cross sectional study done at department of Urology, King George hospital, Visakhapatnam. The study was done over a period of 30 months, which was from September 2014 to February 2017. All the patients reporting to the hospital with proven genitourinary tuberculosis or diagnosed after coming to the hospital were included in the study. Total number of cases was 35. 10 were males and 25 were females. History, physical examination, laboratory and radiological investigations were done on the patients and the primary focus of the disease and organs involved are determined. All the patients received treatment as indicated. Results: Most of the patients (33 out of 35) belonged to low socio-economic status and came from rural settings. Of them 10(28.57%) were males and 25(71.43%) were females. The mean age of patients was 36 years (range 16-60years). 2 patients were <20 years, 11 patients were between 21-30 years, 11 patients were between 31-40 years, 8 patients were between 41-50 years and 3 were above 50 years. In this study, kidney was involved in 19 cases and was the most common organ involved, followed by bladder (14 cases) and ureter(10 cases). Irritative voiding symptoms were the most common symptom seen in 23 cases. Flank pain was noted in 20 cases, sterile pyuria in 22 cases and hematuria in 7 cases. Six(17.14%) out of thirty five patients had renal failure at the time of presentation and diagnosis. Nephrectomy was done in 12 cases. Nephrectomy with augmentation cystoplasty and ureteric reimplantation was done in another 6 cases. Ileal conduit was done in 6 cases. Ureteric reimplantation with psoas hitch was done in 3 cases. Conclusion: Genitourinary tuberculosis is often silent and has nonspecific clinical features. Irritative voiding symptoms are the common presentation. Kidney is the most commonly affected organ in GU TB. GU TB is a disease of young adults, with majority affected in the 3rd and 4th decades. CT scan is replacing IVU as an imaging modality of choice in GU TB. Diagnosis of GU TB can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens and the difficulty to isolate or grow TB bacilli. Hence a strong clinical suspicion is necessary for correct diagnosis. Anti-tubercular therapy is the mainstay of treatment. Genitourinary tuberculosis results in sequel which may require major organ removing and reconstructive surgeries. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical aspects and result of Man- toux test in superficial lymphadenitis caused by Mycobacterium tuberculosis (MTB) compared to that caused by non-MTB organ- isms. Methods This was a cross sectional study conducted on 86 pa- tients aged between 3 months and 14 year-old with enlargement of the superficial lymph nodes, 43 with tuberculosis superficial lym- phadenitis (TSL) and 43 with non-tuberculosis superficial lymphad- enitis (NTSL). The diagnoses of TSL and NTSL were confirmed by histopathological examination. Clinical symptoms and Mantoux test were examined in this study. Results In the TSL group, most children (70%) were in the age of >5-14 year-old, while in the NTSL, most (46%) were 1-5 years old. The most frequent chief complaint in the TSL group was fever (37%), while in the NTSL group, cough (49%) (p=0.004). Failure to thrive and loss of appetite were more frequently found in the TSL (70% and 35%) compared to the NTSL group (0 and 3%) (p=0.004). Most enlarged nodes in TSL were multiple (67%), while in NTSL, solitary (72%) (p

Background: Mantoux test, a type IV hypersensitivity reaction, is commonly used to screen children for possible tuberculosis. It is applied on the volar surface of forearm. Sunlight ultraviolet rays (UV) have recently been shown to induce immunosuppression that alters the skin response to Mantoux test negatively. Objective: The study aimed to evaluate the inner thigh as a possible site for Mantoux test in children attending Federal Medical Centre Owerri whom their primary attending Physicians requested a Mantoux test. Methods: This was a cross sectional study conducted between June and October 2011. Concomitant intradermal injection of 0.1ml of purified protein derivative on the volar aspect of the forearm and the inner thigh was carried out. Induration was measured concurrently in 106 consecutive children, between the ages of 3months and 15 years. Using volar surface of forearm as gold standard, values of inner thigh induration at a set cut-off was determined. Students’t test, Pearson correlation coefficient and the Chi square were used to compute data. Results: The mean diameter of induration on the inner thigh (12.51 ±3.44mm) was higher than mean diameter of induration on the volar surface of the arm (11.03±6.34mm). This is however not statistically significant. There were (29) children who had reactive induration on the inner thigh whilst 19 had similar induration on the volar surface of the forearm. In the presence of factor(s) that negatively affects the response of the skin to Mantoux test; the inner thigh induration yield was higher. There was a strong positive correlation between the two site measurements. Conclusions: The inner thigh as a site for Mantoux test in children has shown potential for higher yield.

This report reviews clinical cases, and their possible causes of unexpected local and systemic adverse effects associated with a novel skin test using recombinant tuberculosis allergen (RTA, Diaskintest) in 2—11 years old children. This preparation consists of a M. tuberculosis ESAT6/CFP10 fusion protein produced in E. coli, and, in Russia, it has been used as a tool for preventive screening for tuberculosis since 2009. The most common side effects developed within 1 to 12 h after injection and were represented as local or non-life threatening systemic symptoms: fever up to 39°C lasting up to 24 h, painful excessive edema with reddening on the forearm, and, sometimes herpes-like blisters on the skin. In 72 h, the papula at the injection site was moderate, but the hyperemia around it was considerable. We argue that the most likely reason for this type of response could be the development of Type III hypersensitivity (associated with immune complexes), and/or antibody-independent anaphylactoid response to the ESAT6/CFP10 protein or contaminating bacterial culture components. To prevent possible side effects, we recommend to observe the patients for not less than 15 min after the injection of RTA, and to be ready to respond in case of anaphylaxis development.

Information about retraction of an articleAnalysis conducted by the members of the editorial board has revealed the direct borrowing without reference to the specific source of citations in the following articles:The article by Aksenova V.A., Baryshnikova L.A. Klevno N.I. Modern approaches to screening for tuberculosis infection in children and adolescents in Russia and the article by Aksenova V.A., Baryshnikova L.A., Klevno N.I., Sokolskaya E.A., Dolzhenko E.N., Shuster A.M., Martyanov V.A. New opportunities for screening and diagnosis of various manifestations of tuberculosis infection in children and adolescents in Russia // Zdorove rebenka = Child health – 2012 - No. 6(41) – p. 118-124.Based on the decision of the Editorial Board of the journal Medical Council dated January 17, 2020, the following article has been retracted:Aksenova V.A., Baryshnikova L.A. Klevno N.I. Current approaches to screening for tuberculosis infection in children and adolescents in Russia// Meditsinskiy sovet = Medical Council – 2015 - No. 4 – p. 30-35.The article presents the results of a multicenter study conducted in Russia in 2008-2014. The study identified categories of children and adolescents at the highest risk of TB and screening methods for tuberculosis in the child population. The study was conducted on the territory of Russia in four stages. The first stage was to develop new methods of examination and selection of children for preventive treatment at tuberculosis dispensary. Based on the study results and Annex to Order of the Ministry of Health and Social Development of Russia of October 29, 2009 №855, a method using Diaskintest (0.2 microgram recombinant tuberculosis allergen in standard dilution, CFP10-ESAT6 protein) for TB detection and follow-up of risk groups in the territory of the Russian Federation is proposed.

Background Tuberculosis (TB) infection is highly prevalent in Indonesia. The source of transmission of TB to a child is usually via an adult with sputum smear-positive pulmonary tuberculosis. The Mantoux test is a diagnostic tool for tuberculosis infection. The BCG vaccine has been used for the prevention of TB, but its efficacy is still debated. Objective To assess for an association between Mantoux test results and BCG vaccination in children who had contact with adult pulmonary tuberculosis and to assess for differences in Mantoux test induration with regards to nutritional status, age, type of TB contact, and time duration since BCG vaccination in BCG-vaccinated and BCG-unvaccinated children. Methods A cross-sectional study was conducted in FebruaryMarch 2011 on infants and children (aged 3 months to five years), who had household contact with adult pulmonary TB. We performed tuberculin (Mantoux) skin tests to detect TB infection in the children. Subjects were consisted of two groups: BCG-vaccinated and BCG-unvaccinated. Results Subjects were 100 children (50 BCG-vaccinated and 50 BCG-unvaccinated subjects). Positive Mantoux test results were observed in 9 vaccinated subjects and 33 unvaccinated subjects. The mean diameters of induration in the vaccinated and unvaccinated groups were 7.6 mm and 9.6 mm, respectively (95%CI of difference -4.25 to 0.20; P=0.074). In children who had household contact with sputum smear-positive adult pulmonary TB, BCG vaccination was a protective factor against TB infection, with an odds ratio (OR) of 0.113 (95%CI 0.045 to 0.286; P=0.0001). There were no significant differences in Mantoux test induration associated with nutritional status, age, type of TB contact, and duration since BCG vaccination, between the two groups. Conclusion BCG vaccination has a protective effect on TBexposed children, based on Mantoux test results. However, there are no differences in Mantoux test induration associated with nutritional status, age, type of TB contact, or duration since BCG vaccination, between the BCG-vaccinated and BCGunvaccinated groups.

Introduction: Mantoux test aids in the diagnosis of tuberculosis (TB), however its application and interpretation are dependent on multiple factors. Methodology: A prospective study enrolling 400 children (aged 2-12) suspected to have tuberculosis. All participants received Mantoux test with two different strengths (1 TU and 5 TU) of Purified Protein Derivative (PPD) on different forearms. The test was read by two readers after 48 ± 2 and 72 ± 2 hours. Primary outcome was difference in the size of induration when read by two readers (interobserver variability). Secondary outcomes were difference in the size of induration at different intervals, with different strengths of PPD and percentage positivity of Mantoux test in TB patients. Results: Statistically significant difference was seen in the size of induration when read by two different readers, with fair to moderate agreement when read at 48 and 72 hours (1 TU: p = 0.002, k = 0.52 and p = 0.1, k = 0.73 respectively, 5 TU: p = 0.001, k = 0.39 and p = 0.0009, k = 0.33 respectively). Tendency of under-reading occurred when size of induration was close to significant level (10-14 mm). Size of induration was similar when read at 48 or 72 hours (1 TU: p = 0.9, 5 TU: p = 1.0). Mantoux positivity rate in patients with TB was more with 5 TU as compared to 1 TU (61.2% vs. 16.3%). Conclusions: There is significant interobserver variability with a tendency to under-read around the cutoff point. The use of 5 TU PPD at 48 hours by a trained physician can aid in early and more reliable diagnosis of TB. [ABSTRACT FROM AUTHOR]

Background The Mantoux method of tuberculin skin testing has been used in tuberculosis (TB) screening of healthcare workers (HCWs) in the UK National Health Service (NHS) for many years. More recently, there have been problems with the supply of the Mantoux test solution presenting a challenge to its continued use. Aims To review results of Mantoux testing and determine factors associated with positive Mantoux result, i.e. tuberculin reactivity, in NHS HCWs, with a view to streamlining the TB screening process. Methods A retrospective descriptive study. We extracted data on HCW demographics, country of birth, previous stay or work in a high TB prevalence country, TB contact, Bacillus Calmette-Guerin (BCG) vaccination, previous tuberculin skin test (TST) and Mantoux results from the occupational health records of HCWs who had a Mantoux test during 1 January 2007 to 31 December 2010 inclusive. Results We reviewed the records of 246 HCWs. Overall, 46% were Mantoux positive (defined as ≥6 mm skin induration). Factors associated with positive Mantoux result were BCG vaccination [odds ratio (OR) 2.30; 95% confidence interval (CI) 1.14-4.66]; stay or work in a high TB prevalence country (OR 7.52; CI 2.76-20.46) and previous TST (OR 2.78; CI 1.25-6.19). Conclusions BCG vaccination, stay or work in a high TB prevalence country and previous TST were associated with positive Mantoux results. These factors could be used to predict Mantoux results, with the potential of substituting Mantoux testing. [ABSTRACT FROM AUTHOR]

The tuberculin skin test is widely used in the diagnosis of latent tuberculosis infection Blistering skin lesion from the test is rarely observed. In this manuscript, I report a patient who develops a bullous lesion from the test and I review the related literature.

The Mantoux Tuberculin Skin Test (TST) is the standard method for detecting latent tuberculosis and has been provided by pharmacists since at least 2006. In the largest published study of pharmacy-based TST involving 578 patients, the most common reason for obtaining the test were employment or school requirements.Pharmacists have demonstrated high rates of follow-up for the reading of the test, reported to be 92.8% to 94.4%. The biggest barrier to pharmacy-based TST is that a prescription is required for the two tuberculosis (TB) purified protein derivative products available on the market in the United States. States have adopted three strategies to enable pharmacy-based TST prescribing: 1) collaborative practice agreements; 2) statewide protocols; and 3) independent prescribing. These three approaches are reviewed, with a focus on the New Mexico statewide protocol and the recent statutory authority in Idaho that grants pharmacists independent prescriptive authority for TST. States may consider pursuing more autonomous models of TST prescribing given the safety and track record of this service at pharmacies. Type: Commentary