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Definitions of positive tuberculin skin test (TST) in children


Induration 5 mm
Children or adolescents in close contact with a known or suspected infectious case of TB Children or adolescents with suspected TB disease: - Finding on chest radiograph consistent with active or previously active TB - Clinical evidence of TB disease Children or adolescents who are immunosuppressed (eg, receiving immunosuppressive therapy or with immunosuppressive conditions, eg, HIV infection)

Induration 10 mm
Children or adolescents at increased risk of disseminated disease: - Children <4 yrs - Children with concomitant medical conditions (eg, Hodgkin's disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition) Children or adolescents with increased risk of exposure to cases of TB disease: - Children born in a country with a high prevalence of TB - Children who travel to a country with a high prevalence of TB - Children whose parents were born in a country with a high prevalence of TB cases - Children frequently exposed to adults with risk factors for TB disease (eg, adults who are HIVinfected or homeless, users of illicit drugs, those who are incarcerated, or migrant farm workers)

Induration 15 mm
Children 4 y old with no known risk factors * TSTs should be read at 48 to 72 hours after placement. These definitions apply regardless of previous Bacille Calmette-Guérin immunization. Modified with permission from: American Academy of Pediatrics. Tuberculosis. In: Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed, Pickering, LK, Baker, CJ, Kimberlin, DW, Long, SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2009.

or chemical denaturation Administration: Injection of too little tuberculin. leprosy. typhus. pertussis) HIV infection (especially if CD4 count <200) Other viral infection (measles. burns) Diseases of lymphoid organs: (lymphoma. mumps. varicella) Fungal infection (South American blastomycosis) Live virus vaccination: (measles. mumps. brucellosis. stress (surgery. sarcoidosis) Age: infants <6 months. polio) Immunosuppressive drugs: (corticosteroids. and others) Metabolic disease: chronic renal failure. TNF inhibitors. or too deeply (should be intradermal) Administration more than 20 minutes after drawing up into the syringe Reading: Inexperienced or biased reader Error in recording Biologic (not correctable) Infections: Active TB (especially if advanced) Other bacterial infection (typhoid fever. improper dilution. chronic lymphocytic leukemia. severe malnutrition.Potential causes of false negative tuberculin te sts Technical (potentially correctable) Tuberculin material: Improper storage (exposure to light or heat) Contamination. elderly .