Comparing Tuberculin Anergy Skin Test Reactions and Lymphoblastic Transformation in Medical Student
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 11 No. 2 (2021),
15 June 2021
,
Page 32680
https://doi.org/10.32598/ijmtfm.v11i2.32680
Abstract
Background: Tuberculin Skin Test (TST) reaction is an accepted screening test for diagnosing acute and latent Tuberculosis (TB) infection among at-risk populations. It is performed with a standard Protein Purified Derivative (PPD) solution. The skin reaction of PPD is unreliable to distinguish natural infection from the Bacillus Calmette Guerin (BCG) effect. The present survey aimed to determine the prevalence of Tuberculin Anergy (TA) reactions among medical students. Accordingly, we evaluated its sensitivity, specificity, and efficiency by applying the Recall Panel Antigen Test (RPAT) and the Lymphoblastic Transformation Test (LTT).
Methods: The participants were sequentially enrolled in this study according to the designed protocol. The current study was conducted on healthy medical students before registering for the hospital training course. All research subjects were healthy, having a cicatrix of Bacillus Calmette Guerin (BCG) vaccination on the arm, and at a young age (20-24 years).
Results: In total, 180 medical students met the inclusion criteria of the study. The study subjects’ Mean±SD age was 22±3.07 years (male=89, female=91). Moreover, 75 (42%) subjects presented a TA reaction in the first step of TST screening. Furthermore, 13 (64%) individuals presented a negative result of the RPAT. The sensitivity and specificity of the TST reactions, compared with the LTT were 100% and 94.4 %, respectively.
Conclusion: Significant TA reactions were found among medical students with positive cicatrix post-vaccinated. The obtained data suggested that the BCG protection for individuals may be decreased as time expired. Consequently, the medical students will especially be at high risk for TB infection during the clinical training course. The collected data highlighted the patient-safety from the viewpoint of forensic medicine.
- Bacillus Calmette Guerin (BCG) vaccine
- Anergy
- Tuberculin Skin test
- Medical students
- Iran
How to Cite
References
Masoumi Asl H, Alborzi A, Pourabbas B, Kalani M. QuantiFERON-TB gold and tuberculin skin test for the diagnosis of latent tuberculosis infection in children. Iran J Med Sci. 2015; 40(5):411-7. [PMID] [PMCID]
Ebrahimi Kalan M, Yekrang Sis H, Kelkar V, Harrison SH, Goins GD, Asghari Jafarabadi M, et al. The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran. BMC Public Health. 2018; 18(1):174. [DOI:10.1186/s12889-018-5066-9] [PMID] [PMCID]
Pradipta IS, Forsman LD, Bruchfeld J, Hak E, Alffenaar JW. Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis. J Infect. 2018; 77(6):469-78. [DOI:10.1016/j.jinf.2018.10.004] [PMID]
Sharma D, Sharma J, Deo N, Bisht D. Prevalence and risk factors of tuberculosis in developing countries through health care workers. Microb Pathog. 2018; 124:279-83. [DOI:10.1016/j.micpath.2018.08.057] [PMID]
Kinikar A, Chandanwale A, Kadam D, Joshi S, Basavaraj A, Pardeshi G, et al. High risk for latent tuberculosis infection among medical residents and nursing students in India. PLoS One. 2019; 14(7):e0219131. [DOI:10.1371/journal.pone.0219131] [PMID] [PMCID]
de Vries G, van Hunen R, Meerstadt-Rombach FS, van der Valk PDLPM, Vermue M, Keizer ST. Analysing tuberculosis cases among healthcare workers to inform infection control policy and practices. Infect Control Hosp Epidemiol. 2017; 38(8):976-82. [DOI:10.1017/ice.2017.100] [PMID]
Stephenson L, Byard RW. An atlas overview of characteristic features of tuberculosis that may be encountered at autopsy. Forensic Sci Med Pathol. 2020; 16(1):143-51. [DOI:10.1007/s12024-019-00161-y] [PMID]
Di Paolo M, Papi L, Malacarne P, Gori F, Turillazzi E. Healthcare-associated infections: Not only a clinical burden, but forensic point of view. Curr Pharm Biotechnol. 2019; 20(8):658-64. [DOI:10.2174/1389201020666190618122649] [PMID]
Siracusa M, Scuri S, Grappasonni I, Petrelli F. Healthcare acquired infections: Malpractice and litigation issues. Ann Ig. 2019; 31(5):496-506. [DOI:10.7416/ai.2019.2310 ] [PMID]
Jensen PA, Lambert LA, Iademarco MF, Ridzon R, CDC. Guidelines for preventing the transmission of mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005; 54(RR-17):1-141. [PMID]
No authors. The role of BCG vaccine in the prevention and control of tuberculosis in the United States. A joint statement by the advisory council for the elimination of tuberculosis and the advisory committee on immunization practices. MMWR Recomm Rep. 1996; 45(RR-4):1-18. https://pubmed.ncbi.nlm.nih.gov/8602127/
Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: What is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006; 10(11):1192–204. [PMID]
Zhu B, Dockrell HM, Ottenhoff THM, Evans TG, Zhang Y. Tuberculosis vaccines: Opportunities and challenges. Respirology. 2018; 23(4):359-68. [DOI:10.1111/resp.13245] [PMID]
Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, et al. Effect of BCG vaccination against mycobacterium tuberculosis infection in children: Systematic review and meta-analysis. BMJ. 2014; 349:g4643. [DOI:10.1136/bmj.g4643] [PMID] [PMCID]
Rezai MS, Tabrizi R, Haghdoost AA, Afshari M, Abedi S, Akbari M, et al. Estimating the prevalence of positive tuberculin skin test reactions in general population and high-risk groups: A meta-analysis. Int J Prev Med. 2017; 8:97. [DOI: 10.4103/ijpvm.IJPVM_140_17] [PMID] [PMCID]
Mostafavi E, Nasehi M, Hashemi-Shahraki A, Esmaeili S, Ghaderi E, Sharafi S, et al. Comparison of the tuberculin skin test and the QuantiFERON-TB gold test in detecting latent tuberculosis in health care workers in Iran. Epidemiol Health. 2016; 38:e2016032. [DOI:10.4178/epih.e2016032] [PMID] [PMCID]
Pelly TF, Santillan CF, Gilman RH, Cabrera LZ, Garcia E, Vidal C, et al. Tuberculosis skin testing, anergy and protein malnutrition in Peru. Int J Tuberc Lung Dis. 2005; 9(9):977-84. [PMID] [PMCID]
Wang L, Turner MO, Elwood RK, Schulzer M, FitzGerald JM. A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements. Thorax. 2002; 57(9):804-9. https://thorax.bmj.com/content/57/9/804.short
Fjällbrant H, Ridell M, Larsson LO. The tuberculin skin test in relation to immunological in vitro reactions in BCG-vaccinated healthcare workers. Eur Respir J. 2001; 18(2):376-80. [DOI:10.1183/09031936.01.00086901] [PMID]
Snider DE. Bacille Calmette-Guérin vaccinations and tuberculin skin test. JAMA 1985; 253(23):3438-9. [DOI:10.1001/jama.1985.03350470090027]
American thoracic society. Diagnostic standards classification of tuberculosis. Am Rev Respi Dis. 1990; 142(3):725-35. [DOI:10.1164/ajrccm/142.3.725] [PMID]
No author. BCG vaccination. Br Med J (Clin Res Ed) . 1983; 286(6368):876-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1547168/
Smith JA, Reichman LB. Lymphocyte transformation. An aid in the diagnosis of tuberculosis in patients with nonreactive skin tests. Am Rev Respir Dis. 1972; 106(2):194-201. [DOI:10.1164/arrd.1972.106.2.194] [PMID]
Smith I. Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clin Microbiol Rev. 2003; 16(3):463-96. [DOI:10.1128/CMR.16.3.463-496.2003] [PMID] [PMCID]
Raviglione MC, Pio A. Evolution of WHO policies for tuberculosis control, 1948–2001. Lancet. 2002; 359(9308):775-80. https://www.sciencedirect.com/science/article/abs/pii/S0140673602078807
Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, et al. Effect of BCG vaccination against mycobacterium tuberculosis infection in children: Systematic review and meta-analysis. BMJ. 2014; 349:g4643. [DOI:10.1136/bmj.g4643] [PMID] [PMCID]
Abubakar I, Pimpin L, Ariti C, Beynon R, Mangtani P, Sterne JA, et al. Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Guérin vaccination against tuberculosis. Health Technol Assess. 2013; 17(37):1-372, v-vi. [DOI:10.3310/hta17370] [PMID] [PMCID]
Nguipdop-Djomo P, Heldal E, Rodrigues LC, Abubakar I, Mangtani P. Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: A retrospective population-based cohort study. Lancet Infect Dis. 2016; 16(2):219-26. [DOI:10.1016/S1473-3099(15)00400-4]
Zoloth SR, Safyer S, Rosen J, Michaels D, Alcabes P, Bellin E, Braslow C. Anergy compromises screening for tuberculosis in high-risk populations. Am J Public Health. 1993; 83(5):749-51. [DOI:10.2105/AJPH.83.5.749] [PMID] [PMCID]
Woeltje KF, Kilo CM, Johnson K, Primack J, Fraser VJ. Tuberculin skin testing of hospitalized patients. Infect Control Hosp Epidemiol. 1997; 18(8):561-5. [DOI:10.2307/30141266] [PMID]
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