The effect of ranitidine on the tuberculin skin test

The previously unreported occurrence of dysbaric osteonecrosis in an amateur sport scuba diver who had no other identified cause of avascular bone necrosis is described.     

Evaluation of status of tuberculin skin sensitivity test among medical students

BACKGROUND: The role of lipoproteins as markers of peripheral arterial disease (PAD) is not well defined. METHODS: We measured both lipid and non-lipid risk factors in 51 male patients with angiographically proven PAD and in 56 control subjects. The independent association of risk factors with PAD was evaluated by means of a multiple logistic regression analysis. RESULTS: The levels of cholesterol bound to high density lipoprotein (HDLc) and to its subfraction HDL2 were lower and triglycerides were higher in patients than in control subjects (1.0 +/- 0.3 vs 1.2 +/- 0.3, p < 0.003; 0.4 +/- 0.2 vs 0.5 +/- 0.3, p < 0.03; and 1.8 +/- 1.2 vs 1.3 +/- 0.7, p < 0.02, respectively). Total cholesterol and LDLc levels were similar in both groups. In the multiple logistic regression analysis that was done with lipid parameters, a statistically significant association of triglycerides (OR = 1.73; CI95% = 1.06-2.80) and HDLc (OR = 0.15; CI95% = 0.05-0.50) with PAD was observed, while HDL subfractions and apolipoproteins were not significantly associated. In the multiple logistic regression analysis that was done with non-lipid parameters, hypertension (OR = 5.35; CI95% = 1.86-15.4) and smoking (packs-year) (OR = 1.04; CI95% = 1.10-1.06) were the only significantly associated with PAD. When lipid and non-lipid parameters were included in the regression analysis, a statistically significant association between hypertension, smoking and HDLc with PAD was observed. CONCLUSIONS: Among lipid risk factors, a low HDLc and high triglycerides, and among non-lipid risk factors hypertension and smoking, are significantly and independently associated with lower limb arteriopathy.     

Mantoux test tuberculin reaction in Nigerians

Thirty-seven Nigerian tuberculosis patients and 75 control volunteers were Mantoux-tested with 1 or 5 or 10 tuberculin units of Tween-80 stabilised purified protein derivative (P.P.D.) in order to relate tuberculosis infection to skin reactivity. Serum transferrin and albumin levels determined by radial immunodiffusion technique showed some overlap but test patients tended to have lower values than controls. Skin reaction was not significantly affected by age which varied from 6 to 55 years or the extend of tuberculosis treatment at Mantoux testing. For comparable P.P.D. doses Mantoux readings greater than 9.9mm showed 86.5% sensitivity for tuberculosis but presented low (28%) specificity in contrast to readings greater than 15mm with specificity of 74.7%. Significantly higher proportion of test patients than controls showed skin reaction greater than 9.9mm (p < 0.05) whereas the difference was insignificant at 9mm. With improving nutrition there is need for a large-scale reappraisal of the value of intradermal tuberculin test in diagnosing active tuberculosis in Nigerian reactors.     

Instability of tuberculin and Candida skin test reactivity in HIV-infected Ugandans. The Uganda-Case Western Reserve University Research Collaboration

Anergy testing has been used as an adjunct to tuberculin testing for assessing M. tuberculosis (MTB) infection and indications for isoniazid preventive therapy in HIV-infected persons. We examined factors associated with the stability of skin test responses to purified protein derivative (PPD) and candida antigens in a cohort of HIV-infected adults followed prospectively in a tuberculosis preventive therapy trial in Uganda. PPD-positive and anergic subjects in the placebo arms of the preventive therapy study underwent repeat skin testing and immunologic testing including measurement of MTB culture filtrate (CF)-stimulated interferon gamma (IFN-gamma) and tumor necrosis factor alpha (TNF-alpha) levels in whole-blood culture supernatants. Anergy was present in 27% of 4,058 HIV-infected subjects screened for the tuberculosis preventive therapy trial compared with 10% of 682 HIV-non-infected persons. On follow-up testing of enrolled subjects, 42% of 139 initially anergic subjects were no longer anergic; two thirds of these had PPD reactions >= 5 mm. Stability of anergy was associated with intercurrent opportunistic infections and AIDS-associated dermatitis at baseline. Thirty-five percent of 313 subjects with an initial positive PPD had a negative PPD test at follow-up, 26% of whom had a positive candida skin test at the same time as the negative PPD test. Baseline MTBCF-stimulated IFN-gamma levels were significantly higher among PPD-positive subjects who remained PPD-positive than in those who were falsely negative. We conclude first that anergy is unstable and second that anergy testing is unreliable in identifying HIV-infected adults who are not infected with MTB and should not be used routinely for this purpose in assessing indications for isoniazid preventive therapy.     

Patient's self-interpretation of tuberculin skin tests

BACKGROUND: In the outpatient use of tuberculin skin testing (purified protein derivative [PPD]), it is at times inconvenient to have a patient revisit for interpretation. Therefore, we assessed patients' ability to self-interpret these test results. METHODS: In keeping with prior custom, patients were seen by an experienced nurse, who performed skin testing with PPD intermediate strength as well as mumps and Candida anergy control tests in some cases, and explained the procedure. The patients were asked to return 48 to 72 h later, at which time one of the researchers recorded their test interpretations before they were again evaluated by the nurse. RESULTS: Sixty-eight patients were studied, of whom 59 returned at appropriate interval. Eighteen patients had a positive PPD test reaction of 10 to 20 mm induration, which only one patient correctly identified as a positive test result. However, positive anergy control tests were correctly interpreted in 10 of 27 cases. CONCLUSION: The small number of positive PPD test result recognition by these patients may be partially attributed to their lack of education, as well as foreign birth and denial of illness. PPD results should be checked by an experienced professional.     

Risk factors for a positive tuberculin skin test among employees of an urban, midwestern teaching hospital

This study was performed to investigate: (1) the role of gut-derived endotoxin/bacterial translocation in the pathogenesis of sepsis, and (2) the possible effects of selective decontamination of the digestive tract (SDD) on mortality in rats following 40 per cent full-thickness scald injury. In the SDD-treated group, Enterobacteriaceae and yeasts were eradicated from the caecal mucosa, while the mucosal flora consisting of mainly anaerobes was well preserved, within 3 days. The incidence of bacterial translocation to the mesenteric lymph nodes (MLN) and viscerae was significantly lowered on postburn days 1, 3 and 5 (P < 0.05-0.01). Meanwhile, pretreatment with SDD resulted in reductions of the faecal endotoxin levels in different segments of intestinal tract to less than 0.5 per cent (0.04-0.45 per cent) of the untreated control; there was also a significant attenuation of the elevation of endotoxin concentrations in both portal and systemic blood. Intestinal diamine oxidase (DAO) activity returned to baseline on day 5 in rats receiving SDD but not in controls. The 5-day survival rate in the SDD-treated group was elevated by 26.7 per cent as compared with controls (P < 0.05). These data suggested that endotoxin/bacterial translocation took place early and commonly, which in turn contributed to postburn sepsis and mortality. SDD was effective in preventing gut origin endotoxaemia and bacterial translocation, and improving the survival rate in rats following severe thermal injuries.     

Experiences with the tuberculin tine test in serial tests

During the past year the tuberculin tine test, frequently used in Switzerland to indicate tuberculin allergy, was again the subject of controversy. A retrospective study analysed results of tuberculin tests in school children (average age 15) obtained by the Basle School Health Service during 1976--1978. A total of 4919 tine tests were read during this period. 2416 of the total of 3405 tine-negative pupils were also tested with 10 TU PPD Berna according to Mantoux. 357 (14.8%) showed positive reactions. Since not all tine-negative pupils were submitted to a Mantoux test, it must be assumed that 14.8% false negatives were missed in the group not further tested. On this basis, a sensitivity of 74.4% was calculated for the tine test. It is a debatable point whether this is sufficient for practical use.     

The cost-effectiveness of preventing tuberculosis in physicians using tuberculin skin testing or a hypothetical vaccine

BACKGROUND: Tuberculin skin testing using the purified protein derivative is recommended as part of a tuberculosis control program for health care workers. However, compliance with skin testing programs has been poor and their cost-effectiveness is unknown. METHODS: A Markov-based decision analysis was performed to determine the cost-effectiveness of tuberculin skin testing over the entire lifetimes of physicians who are now in medical school. Assumptions were deliberately chosen to present a conservative estimate of cost-effectiveness. Indirect costs were not included. RESULTS: Annual testing cost $29,000 per life-year saved and $39,000 per case of pulmonary tuberculosis prevented. In contrast, particulate respirators have been shown to cost millions of dollars per case prevented. Skin testing every 6 months was cost-effective in a subpopulation at high risk of infection (> or = 1.8-fold). During their entire lifetimes, physicians now in medical school can expect to avert 137 cases of pulmonary tuberculosis, prevent 7 tuberculosis deaths, and save 182 life-years because of skin testing programs. Improved compliance with annual skin testing and prophylactic isoniazid could more than triple this benefit. If available, a moderately effective vaccine would be even more cost-effective than tuberculin skin testing programs. CONCLUSIONS: Tuberculin skin testing is cost-effective and should be an integral part of any tuberculosis control program. Vaccination may one day be a feasible and cost-effective alternative to skin testing programs.     

APIC position paper: responsibility for interpretation of the PPD tuberculin skin test. Association for Professionals in Infection Control and Epidemiology, Inc

Although the deletion of one of the 9-bp repeats in region V of mitochondrial DNA is very common in Asians, Asian-derived populations and Africans, the triplication of the 9-bp segment was described only a few times, mostly on individuals from Asian origin. Here, we report for the first time the presence of the 9-bp triplication in Europeans. The triplication was initially found in one Brazilian individual. Sequencing of the hypervariable segments I (HVSI) and II (HVS2) of the control region and RFLP analysis of the coding region classified the mtDNA as belonging to the European haplogroup H. Since white Brazilians are predominantly of Portuguese descent, we screened 96 unrelated Northern Portuguese for the 9-bp triplication and found its presence in two of them (2.1%). One of these had an mtDNA haplotype identical to that of the Brazilian individual, while the other differed in a single base change in HVS2. The fact that the 9-bp triplication has reached polymorphic frequencies in Northern Portugal and that it has apparently differentiated into at least two lineages defined by the mutuation in HVS2 suggests that it probably occurred a long time ago.     

Humoral immune response against antigen 60 in BCG-vaccinated infants

An ELISA assay based on the A-60 antigen complex from Mycobacterium bovis BCG cytoplasm was used to detect anti-mycobacterial antibodies of different classes in the sera of 63 BCG-vaccinated infants during the 6-month post-vaccination period. The mean IgM and IgA levels increased, whereas the mean IgG level decreased after BCG vaccination. However, in a minority of cases only Ig levels were above the cut-off line: this was true for IgM in 11/63 (17%) cases and for IgA in 14/63 (22%) of cases but none of the tested infants was anti-A60 IgG ELISA positive. Fifty-two infants (83%) were tuberculin-positive eight weeks after vaccination, and no significant difference in mean antibody levels of tuberculin-positive and negative cases was observed, except for IgG (p < 0.05).     

The diagnosis of allergy to rifampicin confirmed by skin test

Multiple exostoses syndrome is a rare autosomal dominant disorder that affects the enchondral skeleton during growth. The formation of numerous exostoses causes deformities of bones and joints. Degenerative malignant changes are described. A careful follow up during paediatric age is required. Three new cases in the same family are reported in this paper.     

Atopic skin test re-evaulated. IV. The use of compound 48/80 in routine skin testing

Investigations have been made on the reactivity of snail agglutinin from Helix pomatia (anti-AHP) with blood group active neutral and acid glycoprotein (NGP and AGP) prepared from non-A meconium. It is clearly demonstrated that anti-AHP reacts only with NGP, but not with AGP, in anti-AHP-non-A meconium system. After desialization, however, the AGP was reactive to anti-AHP. The effects of alpha-N-acetyl-D-galactosaminase, blood group decomposing enzymes and mild alkaline treatment on the reactivity of NGP and desialized AGP (DAGP) were studied by the immunochemical techniques and the structure responsible for the reaction is briefly discussed: the occurrence of terminal or subterminal alpha-D-GalNAc residues as reactant to anti-AHP may be deduced.     

Glare test in clinical ophthalmology]

Hemoperfusion with local heparin before and protamine after the column was used in the treatment of patients with grave craniocerebral injury. Effect of such treatment on the cerebral perfusion pressure (CPP) is analyzed. The treatment did not increase the liquor pressure but decreased it by 20-25 mm H2O in both groups of patients. CPP in the survivors improved and normalized. In the other group (dead patients) CPP did not change, despite a decrease of the liquor pressure, and remained high. These values can be prognostically important.     

Performance of the single intradermal comparative tuberculin test in identifying cattle with tuberculous lesions in Irish herds

The sensitivity of the single intradermal comparative tuberculin test, as applied in the Republic of Ireland, was estimated in 353 cattle with tuberculous lesions. These cattle had been removed from 47 herds which were depopulated owing to chronic or extensive infection with Mycobacterium bovis. The test had a sensitivity of 90.9 per cent, because 321 (90.9 per cent) of the 353 cattle with tuberculous lesions gave a positive or inconclusive result, and 32 gave a negative result. These 32 negative cattle came from 17 (36 per cent) of the 47 depopulated herds.