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Choosing an appropriate criterion for true or false conversion in serial tuberculin testing.

P De March-Ayuela1

  • 1Dispensari Malalties del Tòrax, Departament de Sanitat i Seguretat Social, Generalitat de Catalunya, Barcelona, Spain.

The American Review of Respiratory Disease
|April 1, 1990
PubMed
Summary

Evaluating tuberculosis infection criteria, this study found current methods for identifying true conversion are inadequate. Many recently infected individuals may escape diagnosis, indicating a need for revised screening protocols.

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Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • Tuberculosis (TB) infection is a significant global health concern.
  • Accurate identification of recent TB infections is crucial for effective control strategies.
  • Current criteria for diagnosing tuberculin conversion have not been rigorously evaluated against infection risk.

Purpose of the Study:

  • To assess the validity of five distinct criteria for true tuberculin conversion.
  • To compare these criteria against the annual risk of tuberculosis infection in a general population.
  • To identify limitations in current diagnostic standards for recent TB infections.

Main Methods:

  • Prospective evaluation of a general population aged 16-69 with initial PPD tests showing <6 mm induration.

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  • A second PPD test was administered between 1976-1986, with a 1-5 year interval for most participants.
  • Analysis included both Bacillus Calmette-Guerin (BCG)-vaccinated and non-vaccinated individuals.

    • Main Results:

    • In BCG-vaccinated individuals, none of the evaluated criteria were acceptable for true conversion.
    • In non-vaccinated individuals, only specific criteria (e.g., <10mm to ≥18mm with ≥12mm increase) showed compatibility with infection risk.
    • A high annual conversion rate was observed in subjects with two negative tests, exceeding the annual infection risk, suggesting criteria shortcomings.

    Conclusions:

    • Current tuberculin conversion criteria are insufficient for accurately diagnosing recent tuberculosis infections.
    • Tuberculin conversion upon retesting does not reliably correlate with new epidemiological infections.
    • Revised diagnostic approaches are necessary, considering factors beyond simple induration changes.