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Delayed Tuberculin Reactivity in Indochinese Persons
- Miguel A. Muniain, MD;
- Jesus Rodriguez-Bano, MD; and
- Jose L. Corral, MD
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TO THE EDITOR:
The study by Robertson and colleagues [1] evaluated the utility of a variant of delayed tuberculin reactivity for the evaluation of patients with suspected tuberculous infection in a high-risk population. The approach is ingenious, but we would like to make some comments.
The appropriate criterion for defining a positive skin-test reaction depends on the population being tested. In a recent report by the Ad Hoc Committee of the Scientific Assembly on Microbiology, Tuberculosis, and Pulmonary Infections [2], a reaction of 5 mm was considered positive in close contacts of infectious cases and in patients who had fibrotic lesions on chest radiography. In a group of patients in which 26% of chest radiographs suggested tuberculosis, it would be unusual to have only 29% of tuberculin purified protein derivative (PPD) test results identified as positive. A possible explanation is that the authors considered the positivity of PPD to be 10 mm.
We would like to know how many patients had induration greater than 5 mm in the PPD readings and whether including the results of these patients as positives would substantially change the results. If that is the case, the paper would support the concept that in populations with a high prevalence of tuberculosis, 5 mm of induration after PPD testing should be considered positive. Second PPD tests would then be limited to patients with induration less than 5 mm.
Miguel A. Muniain, MD
Jesus Rodriguez-Bano, MD
Jose L. Corral, MD
Macarena University Hospital; Seville, Spain 41007
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
