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The case against anergy testing as a routine adjunct to tuberculin skin testing
B S Slovis1, J D Plitman, D W Haas
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn, USA.
JAMA
|May 2, 2000
Summary
Anergy testing does not improve the interpretation of negative tuberculin skin tests for tuberculosis screening or diagnosis. Its results do not predict disease progression, making it unreliable for clinical decisions.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- Tuberculin skin testing (TST) is a common method for screening latent tuberculosis infection and guiding isoniazid prophylaxis.
- Anergy testing, using control antigens, is sometimes employed to interpret non-reactive TST results.
- Concerns exist regarding the standardization and validity of anergy testing protocols and interpretation.
Purpose of the Study:
- To evaluate the clinical utility and validity of anergy testing in interpreting negative tuberculin skin test results.
- To determine if anergy testing aids in diagnosing tuberculosis or predicting disease progression.
Main Methods:
- Review of existing literature and clinical practices regarding anergy testing and tuberculin skin testing.
- Analysis of the impact of control antigen reactivity on TST interpretation and clinical decision-making.
- Assessment of anergy testing's predictive value for tuberculosis progression in HIV-negative and HIV-positive individuals.
Main Results:
- Anergy testing lacks standardized protocols for antigen selection, response criteria, and interpretation.
- Reactivity to control antigens does not influence decisions regarding latent tuberculosis infection or prophylaxis.
- Anergy testing results do not predict the risk of progression to active tuberculosis in any patient group.
- Negative TST results, even with positive reactions to other antigens, do not rule out latent or active tuberculosis.
Conclusions:
- Anergy testing is not a useful tool for screening asymptomatic tuberculosis infection.
- Anergy testing does not aid in the diagnosis of active tuberculosis.
- Microbiologic evaluation remains essential when tuberculosis infection is suspected, irrespective of TST or anergy test results.
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