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The effect of open heart surgery on tuberculin skin test reactivity

Michal Stein1, Batia Sela-Razon, Ilan Linder

  • 1Pediatric Infectious Disease Unit, E. Wolfson Medical Center, Holon, Israel 58100.

Annals of the New York Academy of Sciences
|September 6, 2007
PubMed

Insights

Cardiopulmonary bypass (CPB) may affect tuberculosis skin tests. Prolonged CPB (>3 hours) in children undergoing heart surgery can lead to negative tuberculin skin test (TST) results, impacting latent TB diagnosis.

Area of Science:

  • Immunology
  • Cardiovascular Surgery
  • Infectious Diseases

Background:

  • Cardiopulmonary bypass (CPB) is known to cause temporary immune suppression.
  • Interpreting tuberculin skin tests (TST) can be challenging in immunocompromised patients.
  • Latent tuberculosis requires accurate diagnosis for effective management.

Purpose of the Study:

  • To determine if CPB affects TST interpretation in children.
  • To assess the extent of cellular immunity depression after open-heart surgery.
  • To correlate TST results with CPB duration.

Main Methods:

  • Fifteen children with latent tuberculosis (TST ≥10 mm) undergoing open-heart surgery were studied.
  • TST was repeated 48-72 hours post-surgery.
  • Induration size before and after surgery was compared; relation to CPB time analyzed.

Main Results:

  • No significant difference in TST induration size was observed pre- and post-surgery (mean 14.7 mm vs. 13 mm).
  • CPB duration ranged from 38 to 204 minutes (mean 110 minutes).
  • Two children with CPB exceeding 3 hours showed negative TST post-surgery (P=0.01), unlike others.

Conclusions:

  • Most children maintained TST reactivity after open-heart surgery.
  • Extended CPB duration (>3 hours) is associated with negative TST results.
  • CPB may transiently suppress cellular immunity, potentially affecting TST interpretation in specific cases.

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