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High rate of negative results of tuberculin and QuantiFERON tests among individuals with a history of positive skin test results.

Authors
Friedman-LN; Nash-ER; Bryant-J; Henry-S; Shi-J; D'Amato-J; Khaled-GH; Russi-MB; O'Connor-PG; Edberg-SC; Pisani-MA; Cain-HC; Tanoue-L; Weissman-DN
Source
Infect Control Hosp Epidemiol 2006 May; 27(5):436-441
NIOSHTIC No.
20032686
Abstract
Objectives. To evaluate individuals at high risk for tuberculosis exposure who had a history of a positive tuberculin skin test (TST) result in order to determine the prevalence of unsuspected negative TST results. To confirm these findings with the QuantiFERON-TB test (QFT), an in vitro whole-blood assay that measures tuberculin-induced secretion of interferon-gamma. Methods. This survey was conducted from November 2001 through December 2003 at 3 sites where TST screening is regularly done. Detailed histories and reviews of medical records were performed. TSTs were placed and read by 2 experienced healthcare workers, and blood was drawn for QFT. Any subject with a negative result of an initial TST during the study (induration diameter, < 10 mm) underwent a second TST and a second QFT. The TST-negative group comprised individuals for whom both TSTs had an induration diameter of < 10 mm. The confirmed-negative group comprised individuals for whom both TSTs yielded no detectable induration and results of both QFTs were negative. Results. A total of 67 immunocompetent subjects with positive results of a previous TST were enrolled in the study. Of 56 subjects who completed the TST protocol, 25 (44.6%; 95% confidence interval [CI], 31.6%-57.6%) were TST negative (). Of 31 subjects P <.001 who completed the TST protocol and the QFT protocol, 8 (25.8%; 95% CI, 10.4%-41.2%) were confirmed negative (). P <.005 conclusions. A significant proportion of subjects with positive results of a previous TST were TST negative in this study, and a subset of these were confirmed negative. These individuals' TST status may have reverted or may never have been positive. It will be important in future studies to determine whether such individuals lack immunity to tuberculosis and whether they should be considered for reentry into tuberculosis screening programs.
Keywords
Statistical-analysis; Risk-factors; Analytical-models; Risk-analysis; Analytical-methods; Blood-tests; In-vitro-studies; Screening-methods; Screening-programs; Immunodiagnosis; Immunological-tests
Contact
LN Friedman, Yale University, School of Medicine, Yale New Haven Hospital, New Haven, CT 06520
CODEN
ICEPE3
Publication Date
20060501
Document Type
Journal Article
Fiscal Year
2006
NTIS Accession No.
NTIS Price
ISSN
0899-823X
Source Name
Infection Control and Hospital Epidemiology
State
CT; WV; MA
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