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Yalçin SS, Güler C. The influence of childhood BCG vaccination on tuberculin reactivity in adults with different risk factors. Trop Doct 2016; 35:26-8. [PMID: 15712540 DOI: 10.1258/0049475053001732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Songül Yalçin
- Section of Social Pediatrics, Department of Child Health, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Torres-Gonzalez P, Soberanis-Ramos O, Martinez-Gamboa A, Chavez-Mazari B, Barrios-Herrera MT, Torres-Rojas M, Cruz-Hervert LP, Garcia-Garcia L, Singh M, Gonzalez-Aguirre A, Ponce de Leon-Garduño A, Sifuentes-Osornio J, Bobadilla-del-Valle M. Prevalence of latent and active tuberculosis among dairy farm workers exposed to cattle infected by Mycobacterium bovis. PLoS Negl Trop Dis 2013; 7:e2177. [PMID: 23638198 PMCID: PMC3636137 DOI: 10.1371/journal.pntd.0002177] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human tuberculosis caused by M. bovis is a zoonosis presently considered sporadic in developed countries, but remains a poorly studied problem in low and middle resource countries. The disease in humans is mainly attributed to unpasteurized dairy products consumption. However, transmission due to exposure of humans to infected animals has been also recognized. The prevalence of tuberculosis infection and associated risk factors have been insufficiently characterized among dairy farm workers (DFW) exposed in settings with poor control of bovine tuberculosis. METHODOLOGY/PRINCIPAL FINDINGS Tuberculin skin test (TST) and Interferon-gamma release assay (IGRA) were administered to 311 dairy farm and abattoir workers and their household contacts linked to a dairy production and livestock facility in Mexico. Sputa of individuals with respiratory symptoms and samples from routine cattle necropsies were cultured for M. bovis and resulting spoligotypes were compared. The overall prevalence of latent tuberculosis infection (LTBI) was 76.2% (95% CI, 71.4-80.9%) by TST and 58.5% (95% CI, 53.0-64.0%) by IGRA. Occupational exposure was associated to TST (OR 2.72; 95% CI, 1.31-5.64) and IGRA (OR 2.38; 95% CI, 1.31-4.30) adjusting for relevant variables. Two subjects were diagnosed with pulmonary tuberculosis, both caused by M. bovis. In one case, the spoligotype was identical to a strain isolated from bovines. CONCLUSIONS We documented a high prevalence of latent and pulmonary TB among workers exposed to cattle infected with M. bovis, and increased risk among those occupationally exposed in non-ventilated spaces. Interspecies transmission is frequent and represents an occupational hazard in this setting.
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Affiliation(s)
- Pedro Torres-Gonzalez
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Orbelin Soberanis-Ramos
- Department of Public Health, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Areli Martinez-Gamboa
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Barbara Chavez-Mazari
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Ma Teresa Barrios-Herrera
- Department of Microbiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Martha Torres-Rojas
- Department of Microbiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Luis Pablo Cruz-Hervert
- Centro de Investigacion sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca Morelos, Mexico
| | - Lourdes Garcia-Garcia
- Centro de Investigacion sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca Morelos, Mexico
| | | | - Adrian Gonzalez-Aguirre
- Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Alfredo Ponce de Leon-Garduño
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- * E-mail:
| | - Miriam Bobadilla-del-Valle
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Abstract
After more than a century of relying on skin testing for the diagnosis of latent TB infection, clinicians now have access to blood-based diagnostics in the form of interferon γ release assays (IGRAs). These tests are generally associated with higher sensitivity and specificity for diagnosis of latent TB infection. This article reviews the indications for testing and treatment of latent TB infection in the overall context of a TB control program and describes how IGRAs might be used in specific clinical settings and populations, including people having close contact with an active case of TB, the foreign born, and health-care workers.
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Affiliation(s)
- Neil W Schluger
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY 10032, USA.
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Fjällbrant H, Ridell M, Larsson LO. BCG scar and tuberculin reactivity in children and adults. ACTA ACUST UNITED AC 2008; 40:387-92. [PMID: 18418799 DOI: 10.1080/00365540701732905] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bacille Calmette-Guérin (BCG) vaccination generally leads to scar formation and tuberculin skin test (TST) reactivity. This study aimed at analysing these 2 parameters and their correlation in a setting with a low prevalence of tuberculosis. Retrospectively, we analysed 314 children and 390 adults living in Sweden and known from records or individual recall to have undergone BCG vaccination. A BCG scar was present in 161 (51%) of the children and in 340 (87%) of the adults. Among children with a scar, 94 (58%) were TST-positive (>or=6 mm) compared to 23 (15%) of 154 children lacking a visible scar. Among adults with a scar, 258 (76%) were TST- positive compared to 23 (46%) of 50 with no scar. Out of 152 non-vaccinated adults, 142 (94.4%) were TST-negative. When 175 TST-negative health care students were BCG-vaccinated in a prospective part of the study, 174 (99%) were found to develop a scar. In essence, the study showed a positive correlation between scar presence and TST reactivity. Furthermore, BCG vaccination of adults in the present setting resulted in consistent scar formation, while scar prevalence in previously vaccinated children was low.
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Affiliation(s)
- Harald Fjällbrant
- Institute of Internal Medicine, Department of Respiratory Medicine and Allergology, The Sahlgrenska Academy of Göteborg University, Göteborg, Sweden.
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García-Sancho F MC, García-García L, Jiménez-Corona ME, Palacios-Martínez M, Ferreyra-Reyes LD, Canizales-Quintero S, Cano-Arellano B, Ponce-de-León A, Sifuentes-Osornio J, Small P, DeRiemer K. Is tuberculin skin testing useful to diagnose latent tuberculosis in BCG-vaccinated children? Int J Epidemiol 2006; 35:1447-54. [PMID: 17008360 DOI: 10.1093/ije/dyl213] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The tuberculin skin test (TST) is the most commonly used tool to detect infection with Mycobacterium tuberculosis. We sought to determine whether tuberculin skin testing is useful to detect latent infection by M. tuberculosis in a population that was vaccinated with the Bacille Calmette Guérin (BCG) vaccine. METHODS We performed a cross-sectional study during October 2000-February 2001, enrolling first and sixth graders from a random, stratified sample of public elementary schools in Orizaba, Veracruz, Mexico. We assessed the relationship between sociodemographic and epidemiological information, BCG scars, and TST reactivity. RESULTS There were 858 children enrolled in the study with a completed questionnaire and TST result. The prevalence of a positive TST result (> or =10 mm) was 12.4%. Controlling for BCG scar, age, and other characteristics, close contact with pulmonary tuberculosis patients (odds ratio 6.56, 95% confidence interval 2.05-21.07, P = 0.001) was independently associated with TST reactivity. CONCLUSIONS TST results helped identify children in a BCG-vaccinated population who had recent exposure to persons with pulmonary tuberculosis, were probably infected with M. tuberculosis, and could benefit from treatment for their latent tuberculosis infection.
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Affiliation(s)
- Ma Cecilia García-Sancho F
- Instituto Nacional de Salud Pública, Cerrada de Fray Pedro de Gante No. 50 Col. Sección XVI, Deleg. Tlalpan, C.P. 14000, Mexico, DF, Mexico
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Abstract
Interpretation of tuberculin reactions in revaccinated children is somewhat controversial among paediatricians. In this study, the effect of the number of BCG vaccines on tuberculin reactivity is evaluated. In 2810 healthy children aged 7 to 14 years with purified protein derivative (PPD) testing. Children were grouped according to the concordance of the number of the reported/documented vaccinations to the number of scars. Group 1 and 2 comprised of children 7 to 10 years of age and 11 to 14 years of age respectively, who had non-concordant scar numbers, and Group 3 and 4 included 7 to 10 and 11 to 14 years old children with concordant scar numbers. Mean tuberculin induration sizes were 8.0 +/- 5.7 mm for Group 1, 10.6 +/- 4.9 mm for Group 2, 9.8 +/- 4.9 mm for Group 3 and 10.9 +/- 4 mm for Group 4. As the time interval after the last dose of vaccination increased, mean induration sizes decreased in Group 1 and Group 3. In contrast, the mean reaction sizes of Group 2 and Group 4 showed a positive correlation with the period after the last dose of vaccine. It seems advisable that an induration size > or = 15 mm should not be attributed to BCG vaccination in countries with a high tuberculosis infection prevalence and routine BCG revaccination policies. A detailed investigation for tuberculosis infection and disease should be performed in those cases.
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Affiliation(s)
- N Kuyucu
- Dr. Sami Ulus Children's Hospital, Telsizler, Ankara, Turkey.
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Larsson LO, Bentzon MW, Berg Kelly K, Mellander L, Skoogh BE, Strannegård IL, Lind A. Palpable lymph nodes of the neck in Swedish schoolchildren. Acta Paediatr 1994; 83:1091-4. [PMID: 7841711 DOI: 10.1111/j.1651-2227.1994.tb12992.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We studied 3592 Swedish schoolchildren, 8 or 9 years old, examined for palpable submandibular, cervical and supraclavicular lymph nodes. All children were skin tested with 2 TU PPD RT23 and with 0.1 microgram of Mycobacterium avium sensitin or 0.1 microgram of M. scrofulaceum sensitin. A total of 991 children had palpable lymph nodes in any of the three locations. Among them, 811 had lymph nodes in one location, 162 in two locations and 18 in three. In 312 children, the lymph nodes were > or = 5 mm in size in any location. The most common location was submandibular. Boys had a significantly higher prevalence of palpable lymph nodes than girls. There was also seasonal variation. Children infected by atypical mycobacteria (sensitin reaction > or = 6 mm) did not have a higher prevalence of palpable lymph nodes than those not infected.
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Affiliation(s)
- L O Larsson
- Department of Pulmonary Medicine, University of Göteborg, Sweden
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Hoskyns EW, Simpson H, Monk P. Use of the 1 tuberculin unit (TU) Mantoux test in the assessment of tuberculous infection in children following neonatal BCG vaccination. Thorax 1994; 49:1006-9. [PMID: 7974293 PMCID: PMC475238 DOI: 10.1136/thx.49.10.1006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND BCG vaccination alters the response to tuberculin testing and influences the potential validity of the Heaf test in the diagnosis of tuberculosis. This study used a purified protein derivative 1 tuberculin unit (TU) Mantoux test with a cut off of 5 mm induration as an indicator of tuberculous infection in high risk children to determine whether this would distinguish infection from previous neonatal BCG vaccination. METHODS Children at high risk of tuberculosis on chest radiography, Heaf test, or contact history who had been screened in the contact tracing clinic and referred for further assessment were included in the study. After clinical examination, chest radiography, and Mantoux testing they were assigned to three groups (tuberculous disease, chemoprophylaxis, or no treatment) and followed up for 6-24 months in the outpatient clinic and subsequently by postal questionnaire. RESULTS Comparison of the Heaf and Mantoux tests showed a difference in the results with 82% of cases positive by the Heaf test and 59% positive by the Mantoux test. Using the Mantoux test result in combination with clinical and radiographic findings 194 children were allocated to the three groups as follows: primary tuberculosis (5), chemoprophylaxis (101), no treatment (88). During follow up for a mean (range) time of 46 (11-102) months four additional cases received treatment for primary tuberculosis, two in the chemoprophylaxis group and two in the untreated group. CONCLUSIONS The use of the 1 TU Mantoux test after neonatal BCG vaccination reduced the number of children receiving treatment from 129 to 93-that is, by 36%. Although the numbers are small, there was no increase in the later development of tuberculosis.
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Affiliation(s)
- E W Hoskyns
- Department of Child Health, Royal Infirmary, Leicester, UK
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Scheinin T, Nhu-Nguyen TM, Kontiainen S. T cell responses to PPD in BCG-vaccinated children with insulin-dependent diabetes mellitus and controls. Acta Paediatr 1994; 83:337-8. [PMID: 8038543 DOI: 10.1111/j.1651-2227.1994.tb18109.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kröger L. Influence of MPR revaccination on tuberculin and sensitin skin reactions in children. Acta Paediatr 1994; 83:232-4. [PMID: 8193510 DOI: 10.1111/j.1651-2227.1994.tb13058.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Many viral diseases, as well as viral vaccines, have a transient effect in depressing cell-mediated immunity. The study group consisted of 52 children, aged 6.0-6.3 years. Thirty (57%) of them had been revaccinated against measles, parotitis and rubella (MPR vaccination). In MPR-revaccinated children, the mean skin reaction sizes were 4.7 mm, 4.1 mm, 4.3 mm and 2.1 mm to tuberculin, Mycobacterium avium, M. scrofulaceum and M. fortuitum sensitins, respectively. In non-revaccinated children (n = 22), the respective mean skin reaction sizes were 3.0 mm, 2.8 mm, 2.9 mm and 0.8 mm. The difference between re- and non-revaccinated children was statistically significant with regard to reactions to M. fortuitum sensitin (p < 0.05). These results suggest that the influence of viral revaccination is different from natural infection or primary vaccination. The mechanism of stimulation of cell-mediated immunity--either specific or non-specific--is unknown.
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Affiliation(s)
- L Kröger
- Department of Pediatrics, Kuopio University Hospital, Finland
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