scholarly journals "MANTOUX TESTING IN UVEITIS PATIENTS AND TREATMENT OF PRESUMED INTRAOCULAR TUBERCULOSIS IN WESTERN UP"

2021 ◽  
pp. 17-19
Author(s):  
Jaishree Dwivedi ◽  
Sandeep Mithal ◽  
Santosh Santosh ◽  
Ganesh Singh
Keyword(s):  
Visual Acuity ◽  
Skin Testing ◽  
Clinical Status ◽  
Clinical Findings ◽  
Positive Tuberculin Skin Test ◽  
Tuberculin Skin Testing ◽  
Purified Protein Derivative ◽  
Systemic Corticosteroids ◽  
History Of ◽  
Intraocular Tuberculosis

Tuberculosis is re-emergingasaglobalhealthproblem.Itisaslowlyprogressive,chronic,granulomatous infectioncausedby M.tuberculosiswhichusuallyaffectslungs,butcanalsoaffectotherorganslikeCVS,GI,CNS,SKINandEYES. Choroidal tubercles and tuberculomas are reported to be the most common intraocular manifestations of TB and the most commonintraocularclinicalpresentationappearstobeposterioruveitis. ThediagnosisofocularTBisconsideredinsettingsof1.IsolationofM.tuberculosisfromocularfluidsortissuespecimen.Byamicrobiologicalorhistopathologicalstudy,PCR. 2.AspresumedoculardiseasesuggestiveofTBwithprovensystemicactivedisease. 3.Presumedoculardiseasewithoutevidenceofactivesystemicdisease. DiagnosticCriteriaForPresumedIntraocularTbUveitiswere. 1.Ocular findings consistent with possible intraocular TB with no other cause of uveitis suggested by history of symptoms,or ancillarytestings. 2.StronglypositiveMANTOUX OR TUBERCULINSKINTESTING(>10mmareaofinduration/necrosis) 3.Responsetoantituberculartherapywithabsenceofrecurrences. The aims of our study were to evaluate prevalence of Mantoux positive in newly referred uveitis patients in whom systemic evaluationwasperformedandtoassesstheoutcomeoftreatmentforpresumedintraoculartuberculosisinselectedpatients. MATERIALANDMETHOD The studywas conductedin theRetinaClinic atUpgradeddepartmentof Ophthalmology,LLRM medicalcollege,Meerut,India.Itwasaprospective,noncomparative,interventionalcaseseries. PatientsofocularinflammationreferredtoRetinaClinicwhounderwentsystemicevaluationwereincludedinthestudy A total of patients who satisfy the inclusion criteria , underwent systemic evaluation which include blood tests, chest radiograph,and tuberculin skin testing (0.05 _g purified protein derivative in 0.1 ml,equivalent to 2.5 tuberculin units) Both erythema and induration was measured at 48 hours,and the result were judged to be positive if induration was more than 10 mm Antituberculosis therapyi.eisoniazid300mg/day,rifampin600mg/day,ethambutol 15mg/kg/day,andpyrazinamide25–30 mg /kg/ day for the first 2 months ,thereafter rifampin and isoniazid were used for another 4–7 months was initiated for patients who had clinical findings consistent with possible intraocular tuberculosis,a positive tuberculin skin test result Responsetotherapywasassessedintermsofincreaseordecreaseorresolution OBSERVATIONAND RESULT Ofthe total 32patients 9patients havepositive tubercular contact history and30patientswere mantouxpositive.(94%),ofwhich78%havetheirindurationsizeof>15mmand8patientshavepositivex-rayfindings.(25%) Out of these 32 patients, 25 received antituberculous therapy for 9 months. In addition all of these patients also received systemicprednisone(1mg/kg/day)untilaclinicaleffectwasseenandthenaslowreductionofdosewasdone. 7patientsweredroppedoutfromthestudy. Out of these 25 patients which were started on treatment, 24 patients (96%) showed improvement in their clinical status, 19 patients (76%) showed improvement in their visual acuity after treatment and 35.6 % patients attained visual acuity of 6/9 or better. CONCLUSION Treatment with antitubercular therapy combined with systemic corticosteroids induces resolution of inflammation with no recurrences. So, mantoux testing should remain an integral part of the systemic work-up for uveitis patients.

Apparent Resurgence of Tuberculosis in Urban Children

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 647-649
Author(s):  
Laura S. Inselman ◽  
Nadia B. El-Maraghy ◽  
Hugh E. Evans
Keyword(s):  
New York ◽  
Skin Testing ◽  
Treatment Programs ◽  
Tuberculin Skin Testing ◽  
Purified Protein Derivative ◽  
City Community ◽  
Adequate Funding ◽  
Risk Areas ◽  
Tuberculosis In Children ◽  
The City

An apparent increase in incidence of pulmonary and extrapulmonary forms of tuberculosis was observed in children in an inner-city community in New York City. This occurred during years in which the case rates of tuberculosis declined in the city and the nation. Two unusual presentations of childhood tuberculosis are described. This experience suggests that physicians should be more aware of the diagnosis of tuberculosis in children and that routine tuberculin skin testing with 5 TU of purified protein derivative (PPD) should be continued, with emphasis on testing in high-risk areas. Adequate funding of detection and treatment programs may prevent reemergence of this disease.

Tuberculosis Surveillance Practices in Long-Term Care Institutions

1995 ◽  
Vol 16 (3) ◽  
pp. 148-151
Author(s):  
Gary Naglie ◽  
Margaret McArthur ◽  
Andrew Simor ◽  
Monika Naus ◽  
Angela Cheung ◽  
...  
Keyword(s):  
Skin Test ◽  
Long Term Care ◽  
Skin Testing ◽  
The Elderly ◽  
Positive Tuberculin Skin Test ◽  
Tuberculin Skin Testing ◽  
Term Care ◽  
Policies And Procedures ◽  
Testing Practices

AbstractObjecitves:To identify the tuberculosis (TB) skin-testing practices of long-term care facilities for the elderly in Toronto, Ontario.Design:A telephone survey using a 25-item questionnaire.Setting:Twenty-nine nursing homes (NHs) and 26 Homes for the Aged (HFAs) in metropolitan Toronto.Results:Thirty-one percent of facilities (17 of 55) had no formal tuberculin skin-testing program, including 52% of NHs (15 of 29) versus 8% of HFAs (2 of 26; P= 0.001). Ninety-two percent of HFAs (24 of 26) compared with 45% of NHs (13 of 29), obtained preadmission or admission skin-test status of residents (P= 0.0005). Annual testing was performed at 46% of HFAs (12 of 26) and 27% of NHs (8 of 29; P= 0.28). Of facilities that carried out any skin testing, 64% of HFAs (16 of 25) versus 32% of NHs (6 of 19) measured induration to establish test positivity (P=0.068). Fifty-two percent of HFAs (13 of 25), compared with 21% of NHs (4 of 19), recorded the actual size of induration in the patient record (P=0.085). Only 28% of HFAs (7 of 25) and 21% of NHs (4 of 19) correctly defined a positive tuberculin skin test.Conclusions:TB surveillance practices in long-term care institutions in Toronto are inadequate and often yield results that do not predict the risk of infection and cannot be used to investigate outbreaks. Tuberculin skin-testing practices were better at HFAs, which are subject to provincial legislation regarding TB surveillance, than at NHs, which are not subject to this legislation. Staff at HFAs and NHs require education regarding tuberculin skin-testing policies and procedures.

scholarly journals Serum Antibody Responses to 10 Mycobacterium tuberculosis Proteins, Purified Protein Derivative, and Old Tuberculin in Natural and Experimental Tuberculosis in Rhesus Monkeys

2011 ◽  
Vol 18 (12) ◽  
pp. 2154-2160 ◽  
Author(s):  
Fangui Min ◽  
Yu Zhang ◽  
Ren Huang ◽  
Wende Li ◽  
Yu'e Wu ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Rhesus Monkeys ◽  
Skin Testing ◽  
Serum Antibody ◽  
Antibody Responses ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Tuberculin Skin Testing ◽  
Purified Protein Derivative ◽  
Diagnostic Potential

ABSTRACTOld tuberculin (OT) and purified protein derivative (PPD) are widely used for tuberculin skin testing (TST) in diagnosis of tuberculosis (TB) but often yield poor specificity and anergy in reaction. Therefore, it is necessary to develop new serological methods as a possible auxiliary diagnostic method for TB. In this study, we characterized the dynamic antibody responses of 10 purified recombinant antigens, PPD, and OT in rhesus monkeys experimentally infected withMycobacterium tuberculosisand analyzed the time to antibody detection, antibody levels, and their association with the infectious doses. The antibodies were detected as early as 4 weeks after infection in response to 5 antigens (CFP10, CFP10-ESAT-6, U1, MPT64, and Ag85b). Antibodies against most of the other antigens were detected between 4 and 12 weeks after infection. The levels of antibodies were dose dependant. We further evaluated the serodiagnostic potential of these antigens by using indirect enzyme-linked immunosorbent assay in 71 TST-positive and 90 TST-negative serum samples from monkeys. For all 12 antigens, the median optical density values of TST-positive monkeys were statistically significantly higher than those of TST-negative monkeys (P< 0.001). Among those antigens, Ag85b and CFP10 showed higher diagnostic potential than others. A combination of results from Ag85b, the 38-kDa antigen (Ag38kDa), and Ag14kDa reaches a sensitivity of 95.77%, indicating that these antigens may be ideal cocktails in TB diagnosis.

The Importance of Two-Step Tuberculin Skin Testing for Newly Employed Healthcare Workers

2006 ◽  
Vol 27 (5) ◽  
pp. 512-514 ◽  
Author(s):  
Elizabeth C. Frenzel ◽  
Georgia A. Thomas ◽  
Hend A. Hanna
Keyword(s):  
Tuberculin Skin Test ◽  
Skin Test ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Older Age ◽  
Second Step ◽  
Tuberculin Skin Testing ◽  
Test Results ◽  
History Of ◽  
Male Sex

At the time of hire, 4059 of 6522 healthcare workers required a 2-step tuberculin skin test; 114 workers (2.8%) demonstrated a boosted reaction after the second step. Boosted reactions were significantly associated with male sex and older age. A verbal history of previous tuberculin skin test results was not a reliable indicator of baseline tuberculin skin test status at the time of hire.

Transmission of Multidrug-Resistant Mycobacterium tuberculosis Among Persons Exposed in a Medical Examiner's Office, New York

1995 ◽  
Vol 16 (3) ◽  
pp. 160-165
Author(s):  
Xilla T. Ussery ◽  
Jennifer A. Bierman ◽  
Sarah E. Valway ◽  
Teresa A. Seitz ◽  
George T. DiFerdinando ◽  
...  
Keyword(s):  
New York ◽  
Mycobacterium Tuberculosis ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Positive Tuberculin Skin Test ◽  
Positive Pressure ◽  
Tuberculin Skin Testing ◽  
Environmental Investigation ◽  
Environmental Controls ◽  
Mdr Tb

AbstractObjective:To determine the prevalence of and risk factors for having a positive tuberculin skin test (TST) result among employees at a medical examiner's office (MEO).Design:Cohort study, environmental investigation.Setting:Several employees at a medical examiner's office were found to have positive TST results after autopsies were performed on persons with multidrug-resistant tuberculosis (MDR-TB).Participants:Employees of the MEO.Results:Of 18 MEO employees, 5 (28%) had a positive TST result; 2 of these 5 had TST conversions. We observed a trend between TST conversion and participation in autopsies on persons with MDR-TB (2 of 2 converters versus 3 of 13 employees with negative TST; relative risk=4.3; 95% confidence interval 1.61 to 11.69; P=0.l0). The environmental investigation revealed that the autopsy room was at positive pressure relative to the rest of the MEO and that air from the autopsy room mixed throughout the facility.Conclusions:A systematic approach to preventing transmission of Mycobacterium tuberculosis in autopsy suites should include effective environmental controls and routine tuberculin skin testing of employees.

Interferon-γ Release Assay vs. Tuberculin Skin Test for Tuberculosis Screening in Exposed Healthcare Workers: A Longitudinal Multicenter Comparative Study

2015 ◽  
Vol 36 (5) ◽  
pp. 569-574 ◽  
Author(s):  
Jean-Christophe Lucet ◽  
Dominique Abiteboul ◽  
Candice Estellat ◽  
Carine Roy ◽  
Sylvie Chollet-Martin ◽  
...  
Keyword(s):  
High Risk ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Interferon Γ ◽  
Tuberculin Skin Testing ◽  
Tuberculosis Screening ◽  
Clinical Trial Registration ◽  
Current Function ◽  
History Of ◽  
Release Assay

OBJECTIVEHealthcare workers (HCWs), especially those caring for patients with tuberculosis (TB), are at high risk of acquiring that disease. The poor specificity of tuberculin skin testing (TST) prompted us to evaluate the effectiveness of the interferon-γ release assay (IGRA) in comparison with TST in a large prospective, multicenter, 1-year study of HCWs with occupational exposure to TB.METHODSHCWs from high-risk units at 14 university hospitals were invited to participate and underwent both TST and IGRA (first Quantiferon TB Gold-IT®, QFT-G, then T-SPOT.TB® if QFT-G was indeterminate) at baseline and after 1 year. We collected demographic characteristics, country of birth, history of TB, immunosuppression, past exposure to TB, history of BCG vaccination, results of most recent TST, job category, and duration of current function.RESULTSAmong 807 HCWs enrolled, current or past TST at baseline was positive (≥15 mm) in 282 (34.9%); the IGRA was positive in 113 (14.0%) and indeterminate in 3 (0.4%). After 1 year, 594 HCWs had both an IGRA and TST (or prior TST≥15 mm) at baseline and an IGRA and TST (if indicated). The conversion rate was 2.5% (9 of 367) with TST and 7.6% (45 of 594) with IGRA, with poor agreement between the 2 tests. Using only QFT-G, conversion (9.9%) and reversion (17.8%) rates were higher for baseline QFT-G positive quantitative values <1 IU/mL.CONCLUSIONTST and the IGRA yielded discordant results. The value of IGRA in addition to TST remains undetermined; the two should be jointly interpreted in decision-making (clinical trial registration NCT00797836).Infect Control Hosp Epidemiol 2015;00(0): 1–6

scholarly journals Interferon-Gamma Release Assays Are a Better Tuberculosis Screening Test for Hemodialysis Patients: A Study and Review of the Literature

2012 ◽  
Vol 23 (3) ◽  
pp. 114-116 ◽  
Author(s):  
J Grant ◽  
J Jastrzebski ◽  
J Johnston ◽  
A Stefanovic ◽  
J Jastrabesky ◽  
...  
Keyword(s):  
Interferon Gamma ◽  
Skin Testing ◽  
Latent Tuberculosis ◽  
Poor Response ◽  
Tuberculin Skin Testing ◽  
Dialysis Patients ◽  
Tuberculosis Screening ◽  
Dialysis Unit ◽  
Interferon Gamma Release Assays ◽  
History Of

Diagnosing latent tuberculosis (TB) infection (LTBI) in dialysis patients is complicated by poor response to tuberculin skin testing (TST), but the role of interferon-gamma release assays (IGRAs) in the dialysis population remains uncertain. Seventy-nine patients were recruited to compare conventional diagnosis (CD) with the results of two IGRA tests in a dialysis unit. Combining TST, chest x-ray and screening questionnaire results (ie, CD) identified 24 patients as possible LTBI. IGRA testing identified 22 (QuantiFERON Gold IT, Cellestis, USA) and 23 (T-spot.TB, Oxford Immunotec, United Kingdom) LTBI patients. IGRA and CD correlated moderately (κ=0.59). IGRA results correlated with history of TB, TB contact and birth in an endemic country. TST was not helpful in identifying LTBI patients in this population. The tendency for IGRAs to correlate with risk factors for TB, active TB infection and history of TB argues for their superiority over TST in dialysis patients. There was no superiority of one IGRA test over another.

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