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Interaction between C-Tb and PPD given concomitantly in a split-body randomised controlled trial.

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|December 22, 2018
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Concomitant administration of purified protein derivative (PPD) and a Mycobacterium tuberculosis-specific skin test (C-Tb) showed no interaction in active tuberculosis patients. Both PPD and C-Tb demonstrated similar diagnostic sensitivities for TB detection.

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Area of Science:

  • Immunology
  • Infectious Diseases
  • Mycobacterial Research

Background:

  • Tuberculosis (TB) diagnosis often relies on skin tests like purified protein derivative (PPD) and Mycobacterium tuberculosis-specific tests (C-Tb).
  • Both PPD and C-Tb contain Region of Difference 1 (RD1) antigens, raising questions about potential interactions when administered together.

Purpose of the Study:

  • To evaluate the interaction between PPD and C-Tb when given concomitantly or separately in patients with newly diagnosed, culture-positive TB.
  • To compare the diagnostic sensitivities of PPD, C-Tb, and QuantiFERON-TB Gold In-Tube (QFT) in active TB patients.

Main Methods:

  • A randomized study involving 456 adult patients with active TB across seven clinics in South Africa.
  • Participants received either C-Tb alone, PPD alone, or both C-Tb and PPD simultaneously via the Mantoux technique.
  • Induration measurements were taken after 48-72 hours, with QuantiFERON-TB Gold In-Tube (QFT) performed concurrently.

Main Results:

  • No significant interaction was observed between PPD and C-Tb during concomitant administration, with similar mean induration sizes.
  • The sensitivity of C-Tb (78%) was comparable to PPD (81%) and QFT (84%), although QFT had a notable rate of indeterminate results (19%).
  • All tested methods showed reduced sensitivity in TB patients with a CD4 count below 100 cells/μl.

Conclusions:

  • Concomitant injection of PPD does not affect C-Tb induration in active TB patients.
  • PPD and C-Tb exhibit similar diagnostic sensitivities for active TB.
  • Reduced sensitivity of all tests in immunocompromised individuals (CD4 <100 cells/μl) highlights diagnostic challenges in this population.