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Tuberculosis Skin Test for the Diagnosis of Pediatric Tuberculosis: Comparison with Tuberculin Skin Test and

Susanna Esposito1, Beatrice Rita Campana1, Gaia Giorgia Arnesano1

  • 1Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

Microorganisms
|May 27, 2026
PubMed

Insights

Pediatric tuberculosis diagnosis is challenging. The new Tuberculosis Skin Test (TBST) shows promise, offering improved specificity over the Tuberculin Skin Test (TST) and comparable accuracy to Interferon-Gamma Release Assays (IGRAs) in children.

Area of Science:

  • Immunology and Infectious Diseases
  • Pediatric Diagnostics

Background:

  • Tuberculosis (TB) poses a significant global health burden, with diagnosis in children being particularly difficult due to non-specific symptoms and paucibacillary nature.
  • Current diagnostic tools like the Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRAs) have limitations in pediatric populations, including BCG-vaccinated individuals and young children.
  • TST suffers from low specificity due to cross-reactivity, while IGRAs require laboratory infrastructure and may have reduced sensitivity in early childhood.

Purpose of the Study:

  • To review the immunological principles, diagnostic performance, and practical aspects of the Tuberculosis Skin Test (TBST) in pediatric TB diagnosis.
  • To compare the efficacy of TBST against TST and IGRA in children, with a focus on BCG-vaccinated populations and those under five years old.

Main Methods:

  • Review of immunological principles of TBST utilizing Mycobacterium tuberculosis-specific antigens (ESAT-6, CFP-10).
  • Analysis of diagnostic performance data comparing TBST, TST, and IGRA in pediatric studies.
  • Evaluation of practical considerations, including operational simplicity and applicability in diverse settings.

Main Results:

  • Emerging evidence suggests TBST offers enhanced specificity compared to TST.
  • TBST demonstrates diagnostic accuracy broadly comparable to IGRA in certain pediatric settings, though consistency across studies varies.
  • Specific attention is given to TBST performance in BCG-vaccinated children and those under five years of age.

Conclusions:

  • TBST presents a promising alternative for pediatric TB diagnosis, combining TST's ease of use with IGRA's specificity.
  • Further research is needed to address evidence gaps and solidify TBST's role in clinical algorithms and public health strategies for pediatric TB.
  • TBST holds potential to improve diagnostic capabilities for Mycobacterium tuberculosis infection in vulnerable pediatric populations.

Keywords:
IGRAMycobacterium tuberculosisTBSTTSTlatent tuberculosis infectionpediatric tuberculosis

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