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Choosing Appropriate Criteria for Tuberculin Positivity and Conversion in a Long-Term Care Facility

Published online by Cambridge University Press:  21 June 2016

Robert R. Muder ,
Carole Brennen  and
Kwan Ting Yu
Robert R. Muder*
Affiliation:
Infectious Disease Section, Veterans Affairs Medical Center, and the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Carole Brennen
Affiliation:
Infectious Disease Section, Veterans Affairs Medical Center, and the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Kwan Ting Yu
Affiliation:
Infectious Disease Section, Veterans Affairs Medical Center, and the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Infectious Disease Section, VA Medical Center, University Drive C, Pittsburgh, PA 15240
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Abstract

Objectives:

The Centers for Disease Control and Prevention has issued new criteria for conversion of the tuberculin skin test; in persons over 35 years of age, an increase in induration of at least 15 mm is considered indicative of new tuberculous infection. We reviewed our experience in a tuberculosis control program in a long-term care facility to assess the applicability of the new criteria to our patient population.

Design:

Retrospective review of seven years of tuberculosis control records and outbreak investigation.

Setting:

Long-term care Veterans Affairs hospital.

Patients:

All patients in the facility between 1985 and June 1992 who received routine admission and annual tuberculin skin testing or who were evaluated for possible exposure to active tuberculosis. A total of 2,342 skin tests were performed.

Results:

Mean increase in skin test diameter in patients with at least two prior negative tests and known exposure to active tuberculosis was 13.9 ± 4.7 mm. Frequency distribution histograms of skin test sizes of initial tuberculin testing in the entire population indicated 10 mm induration as a reasonable criterion for initial positivity.

Conclusions:

In our long-term care population, an increase in skin test induration of 10 mm may indicate new tuberculous infection. Criteria for skin test conversion derived from ambulatory populations in other geographic areas may not apply in all situations. Prevalence of infection with Mycobacterium tuberculosis and prevalence of skin test reactivity due to nontuberculous mycobacteria are likely to influence the predictive value of criteria for tuberculin conversion in a given population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 9 , September 1993 , pp. 523 - 526
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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References

1. Stead, WW. Tuberculosis among elderly persons: an outbreak in a nursing home. Ann Intern Med 1981;94:606–610.CrossRefGoogle ScholarPubMed
2. Stead, WW, Lofgren, JP, Warren, E, Thomas, C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312:1483–1487.CrossRefGoogle ScholarPubMed
3. Centers for Disease Control. Prevention and control of tuberculosis in facilities providing long-term care to the elderly. MMWR 1990;39(RR-10):7–20.Google Scholar
4. Brennen, C, Muder, RR, Muraca, PW. Occult endemic tuberculosis in a long-term care facility. Infect Control Hosp Epidemiol 1988;9:548–552.CrossRefGoogle Scholar
5. Centers for Disease Control. Screening for tuberculosis and tuberculous infection in high-risk populations, and the use of preventive therapy for tuberculous infection in the United States: recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR 1990;39(RR-8):1–12.Google Scholar
6. American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am Reu Respir Dis 1990;142:725–735.CrossRefGoogle Scholar
7. Bass, JB, Sanders, RV, Kirkpatrick, MD. Choosing an appropriate cutting point for conversion in annual tuberculin skin testing. Am Rev Respir Dis 1985;132:379–381.Google ScholarPubMed
8. Edwards, LB, Acquaviva, FA, Livesay, VT, Cross, FW, Palmer, CE. An atlas of sensitivity to tuberculin, PPD-B, and histoplasmin in the United States. Am Rev Respir Dis 1969;99(suppl):1–32.Google ScholarPubMed
9. Stead, WW, To, T. The significance of the tuberculin skin test in elderly persons. Ann Intern Med 1987;107:837–842.CrossRefGoogle ScholarPubMed
10. Gordin, FM, Perez-Stabile, EJ, Reid, M, et al. Stability of positive tuberculin tests: are boosted reactions valid? Am Rev Respir Dis 1991;144:560–563.CrossRefGoogle ScholarPubMed
11. de March-Ayuela, P. Choosing an appropriate criterion for true or false conversion in serial tuberculin testing. Am Rev Respir Dis 1990;141:815–820.CrossRefGoogle ScholarPubMed
12. Narain, R, Chandrasekhar, P, Naganna, K. A fresh look at the definition of tuberculous infection and new infection. Indian J Med Res 1976;64:336–357.Google Scholar