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Diagnosing and Treating Latent TB Infection (LTBI) : Module 14 - March 2010
Diagnosing and Treating Latent TB Infection (LTBI) : Module 14 - March 2010
Diagnosing and Treating Latent TB Infection (LTBI) : Module 14 - March 2010
Diagnosing and
Treating Latent TB
Infection (LTBI)
Project Partners
QuantiFERON® -
Gold and In-Tube
T-SPOT.TB ®
Tuberculin Skin Test (TST)
THEN NOW
Standard Tuberculin Preparations
Current preparations of tuberculin contain
a purified protein derivative (PPD) of
Koch’s Old Tuberculin
The two standard preparations are:
• USA: PPD-S – dose of 0.1 ml contains 5
tuberculin units (TU) of PPD
• UK: PPD-RT-23 – dose of 0.1 ml contains
2 TU (equivalent to 5TU of PPD-S)
Administering the TST
Locate and clean
site, stretch skin with
thumb
Inject 0.1 ml of 5 TU
PPD-S intradermally
at a 10°-15° angle, on
volar surface of lower
arm using a 27-gauge needle, bevel up
Produce a wheal 6 - 10mm in diameter
Do not massage injection site
Reading the TST
Record site, date and time
of injection as well as PPD
lot number
Measure reaction in 48 to 72
hours
Measure induration (palpable
swelling), not erythema
Forearm: Transversely to the
long axis of the forearm. Record in mm!
Ensure trained health care professional
measures and interprets the TST
TST Interpretation
≥ 5 mm ≥ 10 mm
HIV-infection Recent immigrants
Other Injection drug users
immunosuppressed Lab personnel
Recent contact Residents/employees of
Fibrotic CXR changes congregate settings
Organ transplant Persons with clinical risk
recipients factors
≥ 15 mm Children < 5-years-old
or child/adolescent
Consider significant exposed to high-risk
“positive” for all adult
What factors might produce a
false-positive TST result?
False-Positive TST (2)
Factors that may cause false-positive TST
are:
Non-tuberculous mycobacteria (NTM)
BCG vaccination
• Consider a positive TST result to indicate TB
infection if risk factors are present
BCG and TST Interpretation
BCG is the most widely used vaccine in
the world
Wang, et al – meta-analysis
• Effect of BCG vaccination on TST results was
less after 15 years
• Positive TST with indurations of >15 mm
more likely to be result of TB infection than of
BCG vaccination
T-SPOT.TB
(Oxford Immunotec Ltd, Oxford, UK)
• Measures peripheral blood mononuclear cells
that produce IFN-γ
Blood Assays for M. tuberculosis (2)
There is limited data on how these tests
perform in certain populations:
• Children (≤ 5yrs)
• Recent contacts
Special Situations
LTBI Treatment: INH Resistant
Contacts of INH-resistant TB:
• 4-6 months of rifampicin (longer for children
and immunocompromised) daily
• Consider use of rifabutin in HIV-infected
patients on rifampicin-incompatible protease
inhibitors