Value of the Tuberculin Skin Test in Screening for Tuberculosis in Dialysis Patients

M.A. Habesoglu, D. Torun, Y.Z. Demiroglu, M. Karataslı, N. Sen, H. Ermis, Nurhan Ozdemir,
and F.O. Eyuboglu
ABSTRACT
Background. Hemodialysis patients are at high risk for tuberculosis, and a tuberculin
skin test (TST) is not usually helpful in detecting tuberculosis infection because of anergic
reactions. Prophylactic therapy against tuberculosis in dialysis patients is important to
enhance transplantation success. Herein we evaluated the value of TST in screening for
tuberculosis and analyzed any compounding factors that might affect the results of the test
in hemodialysis patients in an endemic area of Turkey.
Methods. A total of 187 (96 female, 91 male) patients were screened using a 2-step TST.
Test results were compared with clinical, radiologic, and laboratory data.
Results. None of the patients had active tuberculosis during the study and 55% had been
vaccinated against tuberculosis. After the first purified protein derivative (PPD) test,
55.1% of the patients showed a positive reaction, ultimately reaching a total of 68.4%
following the second test. Cumulative positive TST results were significantly correlated
with male gender (P .001, r .352), previous tuberculosis history (P .013, r .183)
positively, whereas with the ferritin level (P .001, r .233) negatively; but there were
no significant relationships between TST results and other data.
Conclusions. Impairment of delayed-type hypersensitivity reaction is frequent in dialysis
patients, but we observed high rates of positivity with the two-step TST which could be
attributed to tuberculosis being endemic in Turkey. Further comparative studies with more
specific diagnostic methods will be helpful to evalute the importance of TST positivity in
identifying tuberculosis-infected HD patients.

Screening for pulmonary tuberculosis using chest radiography in new employees in an industrial park in Taiwan

Shih-Bin Su, MD, MS,a,b Chien-Fang Chiu, MD,a Cheng-Ta Chang, MD,c Kow-Tong Chen, MD, PhD,d
Ching-Yih Lin, MD,e and How-Ran Guo, MD, MPH, ScDb,f
Tainan, Taiwan
Background: Pulmonary tuberculosis (TB) is prevalent in Taiwan, but it is suspected that its occurrence has been underestimated
by the National TB Surveillance Program. A pre-employment health examination is mandated by law in Taiwan, providing a mechanism
to assess the occurrence of TB more accurately.
Methods: A pre-employment TB screening program of an industrial park was used to evaluate the performance of the National TB
Surveillance Program in Taiwan. The yields of the pre-employment TB screening, using chest radiography from July 2004 to June
2005, were compared with corresponding results of the National TB Surveillance Program.
Results: A total of 17,105 new employees with an even gender distribution (men:women ratio, 50.2%:49.8%) underwent screening
during the study period. Among the participants, 22 (128.6 per 100,000) new patients with pulmonary TB were diagnosed, and
7 (31.8%) of the patients had positive bacteriology findings. Compared with the results of the National TB Surveillance Program,
the pre-employment screening had a much higher yield (128 vs. 47 per 100,000, P , .001).
Conclusion: The yield of the active surveillance program through mandatory screening was much higher than that of the National
TB Surveillance Program, which is a passive reporting system. The results of this study highlight the need for more active TB surveillance
efforts in endemic areas like Taiwan. (Am J Infect Control 2007;35:254-9.)

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