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Clinical Testing Guidance For Tuberculosis: Tuberculin Skin Test Tuberculosis TB

Overview

Indications and Contraindications

Reading and Interpretation of Results

Follow-Up and Repeat Testing

Special Populations

Quality Control and Assurance

# Clinical Testing Guidance for Tuberculosis: Tuberculin Skin Test

## Key Points
– The tuberculin skin test (TBST) is a vital tool in diagnosing
tuberculosis (TB).
– It involves injecting a protein derivative and reading the reaction after 48-72
hours.
– While effective, it has limitations like false positives and
requires trained personnel.

## Background
The TBST is commonly used to detect latent TB infections.
It’s based on a response to the Bacillus Calmette-Guérin (BCG) vaccine, indicating
potential exposure to TB bacteria.

## About the TB Skin Test
The test involves injecting 0.1 mL of tuberculin antigen into the
derma. After 48-72 hours, a healthcare provider reads the
reaction for induration.

## Advantages and Disadvantages
### Advantages:
– Non-invasive.
– Cost-effective in many settings.
– Easy to administer once trained.

### Disadvantages:
– Pain at injection site.
– Potential false positives (due to other infections or BCG immunity).

– Requires skilled readers.

## Who Can Administer and Read TB Skin Tests?
Only trained healthcare providers can perform and interpret tests, emphasizing the need for proper training.

## TB Skin Test Training Materials
Materials include CDC guidelines, official trainings, and visual
aids for injection techniques.

## Determining an Approach
Consider age (e.g., children) and use two-step testing for high-risk individuals or those with unknown TB status.

## Bacille Calmette-Guérin (BCG) TB Vaccine
BCG vaccine is given to prevent TB; it also causes a reaction in TB-infected
individuals, aiding test interpretation.

## Boosted Reactions and Two-Step Testing
Two-step testing involves a booster injection 2 weeks later if initial result is ≤5mm.
This reduces false positives.

## Vaccinations
Live virus vaccines (like MMR) can affect TBST results, necessitating consideration in test interpretation.

## Administering the TB Skin Test
Proper technique ensures correct placement and depth of injection to avoid errors.

## Interpreting Test Results
Classify reactions into positive or negative based on induration size: ≥5mm considered positive for latent TB.

## Classification of TB Skin Test Reactions
– Induration of 5+ mm: Positive.
– 10+ mm: Strongly positive, indicating active TB.

– 15+ mm: Indicates high exposure risk.

## Test Accuracy
False positives occur with other infections; false negatives may result from insufficient antigen exposure.

## What to Do with Test Results
Positive results require further investigation; negatives may need booster tests
if exposure is suspected.

## Reminder
Proper follow-up and patient education are crucial after testing.

## Resources
For more information, visit CDC resources or official health guidelines.

## On This Page
– Tuberculosis (TB)
– For Everyone
– Health Care Providers
– Public Health

This structured approach ensures comprehensive coverage of TBST guidance, aiding healthcare providers in effective TB management.

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