Diagnosis of Latent Tuberculous Infection
Authors: Lauren F. Collins, Carolina Geadas, Jerrold J. Ellner
Journal: Annals of Internal Medicine (2016)

Letters20 September 2016Diagnosis of Latent Tuberculous InfectionLauren F. Collins, MD, Carolina Geadas, MD, and Jerrold J. Ellner, MDLauren F. Collins, MDFrom Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, Carolina Geadas, MDFrom Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, and Jerrold J. Ellner, MDFrom Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0192 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Although increases in TST diameter on repeated testing are a form of boosting, “the epidemiologic scenario of household exposure followed by a large increase in TST reaction most likely represents TST conversion and new infection with M. tuberculosis” (1). Further TST conversion in Whalen and colleagues' study was associated with the index case's acid-fast bacillus smear status and proximity of exposure.Data do not corroborate the theoretical advantage of IGRAs in specificity for BCG-vaccinated persons. In Brazil, prior BCG immunization (determined by the presence of a scar from vaccination) of TST converters did not influence concordance or discordance ...References1. Whalen CC, Chiunda A, Zalwango S, Nshuti L, Jones-Lopez E, Okwera A, et al. Immune correlates of acute Mycobacterium tuberculosis infection in household contacts in Kampala, Uganda. Am J Trop Med Hyg. 2006;75:55-61. [PMID: 16837709] CrossrefMedlineGoogle Scholar2. Ribeiro-Rodrigues R, Kim S, Coelho da Silva FD, Uzelac A, Collins L, Palaci M, et al. Discordance of tuberculin skin test and interferon gamma release assay in recently exposed household contacts of pulmonary TB cases in Brazil. PLoS One. 2014;9:e96564. [PMID: 24819060] doi:10.1371/journal.pone.0096564 CrossrefMedlineGoogle Scholar3. Kampmann B, Whittaker E, Williams A, Walters S, Gordon A, Martinez-Alier N, et al. Interferon-gamma release assays do not identify more children with active tuberculosis than the tuberculin skin test. Eur Respir J. 2009;33:1374-82. [PMID: 19196815] doi:10.1183/09031936.00153408 CrossrefMedlineGoogle Scholar4. Sauzullo I, Massetti AP, Mengoni F, Rossi R, Lichtner M, Ajassa C, et al. Influence of previous tuberculin skin test on serial IFN-γ release assays. Tuberculosis (Edinb). 2011;91:322-6. [PMID: 21664872] doi:10.1016/j.tube.2011.05.004 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center, Durham, North Carolina, and Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1522. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnosis of Latent Tuberculosis Infection: Too Soon to Pull the Plug on the Tuberculin Skin Test Lauren F. Collins , Carolina Geadas , and Jerrold J. Ellner Diagnosis of Latent Tuberculous Infection Colin L. Crawford Diagnosis of Latent Tuberculous Infection Thomas C. Bailey Metrics 20 September 2016Volume 165, Issue 6Page: 448KeywordsBacille calmette guerinBacillusDisclosureEpidemiologyInfectious diseasesPopulation statisticsScarsScreening guidelinesSpecificityTuberculosis ePublished: 20 September 2016 Issue Published: 20 September 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...