Significance of the tuberculin test in the elderly

Nine hundred thirty-three persons over 65 years of age, residing in long-term or extended-care facilities in Vancouver, Canada, had tuberculin tests. In addition to PPD-tuberculin, 5 TU and 250 TU, we used PPD-Battey, Candida albicans, mumps, and Trichophyton antigens. Twenty-five percent reacted to 5 TU of tuberculin with reactions of 10 mm or more. There was a progressive, substantial loss of reactivity with advancing age. Reactions to PPD-Battey greater than to PPD-T 5 TU were infrequent, suggesting that atypical mycobacterial infections were uncommon and that positive reactions to PPD-T, 250 TU, were predominantly caused by infections with Mycobacterium tuberculosis. Based on the results of both 5 TU and 250 TU, the prevalence of tuberculous infection exceeded 60 percent. Waning of tuberculin sensitivity appears to be an integral part of the aging process. Testing with nonmycobacterial antigens used in this study shed no further light on the problem of anergy in the elderly, as the number of reactors was smaller than that obtained with PPD-tuberculin.