Association between tuberculin skin test result and clinical presentation of tuberculosis disease

BMC Infectious Diseases

William R Mac Kenzie²  Gregory P Bisson¹  Kevin P Cain⁴  Roque Miramontes²  Charles M Heilig²  Eleanor S Click²  Sara C Auld³ 

[1] Department of Medicine, Infectious Diseases Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA;Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, USA;Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, USA;US Centers for Disease Control and Prevention, Kisumu, Kenya

关键词: Pulmonary tuberculosis;    Miliary tuberculosis;    Tuberculin test;   

Others  :  1145713
DOI  :  10.1186/1471-2334-13-460

 received in 2013-07-07, accepted in 2013-09-27,  发布年份 2013

【 摘 要 】

Background

The tuberculin skin test (TST) is used to test for latent tuberculosis (TB) infection and support the diagnosis of active TB. However, little is known about the relationship between the TST result and the clinical presentation of TB disease.

Methods

We analyzed US TB surveillance data, 1993–2010, and used multinomial logistic regression to calculate the association between TST result (0–4 mm [negative], 5–9 mm, 10–14 mm, and ≥ 15 mm) and clinical presentation of disease (miliary, combined pulmonary and extrapulmonary, extrapulmonary only, non-cavitary pulmonary, and cavitary pulmonary). For persons with pulmonary disease, multivariate logistic regression was used to calculate the odds of having acid-fast bacilli (AFB) positive sputum.

Results

There were 64,238 persons with culture-confirmed TB included in the analysis, which was stratified by HIV status and birthplace (US- vs. foreign-born). Persons with a TST ≥ 15 mm were less likely to have miliary or combined pulmonary and extrapulmonary disease, but more likely to have cavitary pulmonary disease than non-cavitary pulmonary disease. Persons with non-cavitary pulmonary disease with a negative TST were significantly more likely to have AFB positive sputum.

Conclusions

Clinical presentation of TB disease differed according to TST result and persons with a negative TST were more likely to have disseminated disease (i.e., miliary or combined pulmonary and extrapulmonary). Further study of the TST result may improve our understanding of the host-pathogen relationship in TB disease.

【 授权许可】

   
2013 Auld et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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