Tuberculosis

Table 2. Criteria for a Positive Tuberculin Skin Test by Risk Group

Reaction ≥ 5 mm induration Reaction ≥ 10 mm induration (continued)

Fibrotic changes on chest radiography consistent with previous Persons with the following clinical conditions:
tuberculosis Body weight 10 percent or more below the ideal
Persons with human immunodeficiency virus infection Chronic renal failure and end-stage renal disease
Persons with organ transplants, or who are otherwise Diabetes mellitus
immunocompromised (including those who receive 15 mg or more Gastrectomy or intestinal bypass
per day of prednisone or the equivalent for one month or longer, or
Malignancy
who receive other immunosuppressant medications)
Silicosis
Recent contacts of persons with active tuberculosis
Residents and employees of the following high-risk
Reaction ≥ 10 mm induration congregate living facilities:
Children younger than four years or infants, children, and Prisons and jails
adolescents exposed to high-risk adults
Nursing homes for older patients or patients with
High-risk racial and ethnic minorities, as defined locally acquired immunodeficiency syndrome
Immigrants who have arrived within the past five years from Hospitals
high-prevalence countries*
Homeless shelters
Persons who inject illicit drugs or use other locally identified
Some medically underserved, low-income populations
high-risk substances (e.g., crack cocaine)
Mycobacteriology laboratory personnel Reaction ≥ 15 mm induration
Persons with no risk factors for tuberculosis

*—All developing countries.

Adapted from Screening for tuberculosis and tuberculosis infection in high-risk populations. Recommendations of the Advisory Council for the Elimi-
nation of Tuberculosis. MMWR Recomm Rep. 1995;44(RR-11):24, with additional information from references 12 and 14.

diagnostic standard, IGRAs are comparable

Table 3. Causes of False-Negative and False-Positive to TST in detecting LTBI.18
Tuberculin Skin Test Results The QuantiFeron-TB Gold test is the only
IGRA that is approved by the U.S Food and
Causes of false-negatives Causes of false-negatives Drug Administration and commercially
Acquired immunodeficiency (continued)
available in the United States. The CDC
syndrome Systemic viral, bacterial, and
released guidelines in 2005 stating that the
Alcoholism fungal infections
QuantiFeron-TB Gold test may be used
Gastrectomy or intestinal bypass Use of corticosteroids or other
immunosuppressant medications wherever TST is currently used.19 The test is
Hematologic or lymphoreticular
Zinc deficiency commercially available to tuberculosis con-
disorders
trol programs and institutions. Individual
Inaccurate reading of induration Causes of false-positives
physicians should consult their local labora-
Live virus vaccines (measles, Boosting phenomenon†
mumps, and rubella; poliovirus)* tory for availability and cost of the test. If it
Cross-reaction with nontuberculous
Malnutrition mycobacterial antigens
is not available, TST should be continued.
Patient age older than 45 years Error in administering the test
IGRAs avoid the subjective nature of
Renal failure Previous bacille Calmette-Guérin
placing and interpreting TSTs and are less
Sarcoidosis vaccination affected by previous BCG vaccinations.18,20
They also differentiate nontuberculosis
*—When live virus vaccines are administered with the tuberculin skin test, the result reactions and obviate two-step tuberculin
is not affected; if these vaccines are given before the tuberculin skin test, results may
be false negatives for up to two months.
testing associated with boosting effects.18,19
†—Institutions may use a two-step approach (test at baseline and again in one to three IGRAs are labor intensive, however, and
weeks) to detect boosting reactors and avoid misclassifying them as converters. there is a 12-hour time limit from blood
Information from references 16 and 17. draw to receipt in a qualified laboratory and
incubation with the test antigens. Still, the

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