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High Rate of Negative Results of Tuberculin and QuantiFERON Tests Among Individuals With a History of Positive Skin Test Results

Published online by Cambridge University Press:  21 June 2016

Lloyd N. Friedman ,
Esther R. Nash ,
June Bryant ,
Susan Henry ,
Julia Shi ,
Joyce D'Amato ,
Ghada H. Khaled ,
Mark B. Russi ,
Patrick G. O'Connor  and
Stephen C. Edberg
...Show all authors
Lloyd N. Friedman*
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
Esther R. Nash
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut
June Bryant
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut
Susan Henry
Affiliation:
Central Medical Unit/APT Foundation, New Haven, Milford Hospital, Milford, Connecticut
Julia Shi
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Central Medical Unit/APT Foundation, New Haven, Milford Hospital, Milford, Connecticut
Joyce D'Amato
Affiliation:
Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
Ghada H. Khaled
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
Mark B. Russi
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
Patrick G. O'Connor
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
Stephen C. Edberg
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
Margaret A. Pisani
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
Hilary C. Cain
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut VA Connecticut Healthcare System, West Haven, Connecticut
Lynn Tanoue
Affiliation:
Yale University School of Medicine, New Haven, Milford Hospital, Milford, Connecticut Yale–New Haven Hospital, New Haven, Milford Hospital, Milford, Connecticut
David N. Weissman
Affiliation:
National Institute for Occupational Safety and Health-Health Effects Laboratory Division, Morgantown, West Virginia
*
Pulmonary and Critical Care Section, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208057, New Haven, CT 06520-8057 (Lloyd.Friedman@milfordhospital.org)
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Abstract

Objectives.

To evaluate individuals at high risk for tuberculosis exposure who had a history of a positive tuberculin skin test (TST) result in order to determine the prevalence of unsuspected negative TST results. To confirm these findings with the QuantiFERON-TB test (QFT), an in vitro whole-blood assay that measures tuberculin-induced secretion of interferon-γ.

Methods.

This survey was conducted from November 2001 through December 2003 at 3 sites where TST screening is regularly done. Detailed histories and reviews of medical records were performed. TSTs were placed and read by 2 experienced healthcare workers, and blood was drawn for QFT. Any subject with a negative result of an initial TST during the study (induration diameter, <10 mm) underwent a second TST and a second QFT. The TST-negative group comprised individuals for whom both TSTs had an induration diameter of <10 mm. The confirmed-negative group comprised individuals for whom both TSTs yielded no detectable induration and results of both QFTs were negative.

Results.

A total of 67 immunocompetent subjects with positive results of a previous TST were enrolled in the study. Of 56 subjects who completed the TST protocol, 25 (44.6%; 95% confidence interval [CI], 31.6%-57.6%) were TST negative (P<.001). Of 31 subjects who completed the TST protocol and the QFT protocol, 8 (25.8%; 95% CI, 10.4%-41.2%) were confirmed negative (P<.005).

Conclusions.

A significant proportion of subjects with positive results of a previous TST were TST negative in this study, and a subset of these were confirmed negative. These individuals' TST status may have reverted or may never have been positive. It will be important in future studies to determine whether such individuals lack immunity to tuberculosis and whether they should be considered for reentry into tuberculosis screening programs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 5 , May 2006 , pp. 436 - 441
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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