Tuberculin skin test reaction depends on type of purified protein derivative: implications for cut-off values

SETTING: Due to purified protein derivative (PPD) RT23 stock-outs in 2014, PPD-Tubersol and PPD-Bulbio have been used for latent tuberculosis infection (LTBI) testing in the Netherlands.OBJECTIVE: To determine whether PPD-RT23, PPD-Tubersol and PPD-Bulbio were associated with differential indurations and confirmation using interferon-gamma release assays (IGRAs).DESIGN: LTBI surveillance data from 2013 to 2016 were extracted. Regression analyses were used to determine whether IGRA confirmation of TST-positive indurations depended on PPD, controlling for sex, age, incidence in country of origin, and bacille Calmette-Guérin (BCG) status.RESULTS: A total of 20 956 individuals were tested with PPD-RT23: 10 382 with PPD-Tubersol and 18 562 with PPD-Bulbio. Overall, 21% with PPD-Bulbio had an induration of ≥5 mm compared to 12% of those tested with PPD-RT23 and PPD-Tubersol. Compared to PPD-RT23, PPD-Bulbio indurations ≥5 mm were significantly less often IGRA-confirmed among contacts (aOR 1.3, 95% CI 1.1–1.6) and BCG-vaccinated immigrants (PPD-RT23, aOR 2.4, 95% CI 1.4–4.1). Increasing the PPD-Bulbio cut-off from ≥5 to ≥10 mm would save respectively 26%, 42%, and 35% of IGRAs among contacts, health care workers (HCWs) and BCG-vaccinated immigrants, with small absolute numbers of positive IGRAs missed (range 0–55 annually).CONCLUSION: PPD-Bulbio shows larger TST indurations than other PPDs, but is less often IGRA-confirmed. Increasing the TST cut-off from 5 to 10 mm prior to testing with an IGRA in HCWs and immigrants is recommended.

Immune response interaction of Klebsiella pneumoniae and Eimeria tenella

This study aimed to investigate the immune responses (Cellular and humoral) to Klebsiella pneumoniae and Eimeria tenella by using Delayed Type Hypersensitivity Test (Skin Test) and Tube Agglutination Test in sixteen local breed rabbits. Animals were divided into four equal groups; First group was immunized subcutaneously with 1 ml (1000 µg/ml) of sonicated Eimeria tenella oocysts –SETO-ET), second group was immunized subcutaneously with 1 ml (1000 µg/ml) of sonicated Whole Cells Klebsiella pneumoniae antigen –SKWC-KP), third group was immunized subcutaneously with 1 ml (500 µg/ml of sonicated Eimeria tenella –SETO-ET and 500 µg/ml SKWC-KP). The fourth control group was injected subcutaneously by 1 ml of phosphate buffer saline. After 14 days all groups were given a booster dose at the same dose above. Results of Delayed type hypersensitivity showed that the third group had a high significant (P≤ 0.05) skin test reaction of Erythema and induration compared to the first and second groups after 24, 48 and 72 hours. Also, that was synchronized with the increased titers of antibodies, which increase to peak (720 ± 201.32) compared with the first group (200 ± 40.00) and second group (360 ± 100.66) after 35 days. This is the first study about the synergistic immune response interaction between Klebsiella pneumoniae and Eimeria tenella antigens in Iraq.

The clinical role of purified protein derivative skin test reaction in patients with non-muscle invasive bladder cancer treated with bacillus-Calmette Guerin.

4545 Background: We investigated the association between purified protein derivative (PPD) skin test reaction prior to BCG therapy and clinical outcomes, both oncological outcomes and occurrence of side effects, in BCG-naïve non-muscle invasive bladder cancer (NMIBC) patients. Methods: A total of 288 NMIBC patients who received PPD skin test prior to BCG therapy were included. The PPD skin test reaction was categorized into three groups: positive, slightly positive, and negative. The presence of an induration was positive. If an induration was absent, an erythema 10 mm or more and less than 10 mm corresponds to slightly positive and negative, respectively. Results: Sixty-six (22.9%), 149 (51.7%), and 73 (25.3%) patients had positive, slightly positive, and negative PPD skin test results, respectively. The 5-year recurrence-free survival rate of patients with a positive PPD skin test was 89.4±4.1%, which was significantly higher than that of patients with slightly positive (65.5±4.2%, p = 0.001) and negative (56.4±6.6%, p < 0.001) results. Multivariate Cox regression analysis demonstrated that a positive PPD skin test was independently associated with tumor recurrence (Hazard ratio of 0.213, p < 0.001) but not with stage progression. The occurrence rate of major side effects in patients with a positive BCG skin test (33.3%) was significantly higher than that in patients with slightly positive (26.8%) and negative PPD skin tests (13.7%). The incidence rate of fever persisting beyond 2 days or fever of ≥38°C in patients with a positive PPD skin test (18.2%) was significantly higher than that in patients with slightly positive (8.7%) and negative PPD skin tests (4.1%). Conclusions: NMIBC patients with a positive PPD skin test and who were treated with BCG therapy had a significantly lower tumor recurrence rate and higher incidence of major side effects such as fever persisting beyond 2 days or fever of ≥38°C. Our findings suggest that PPD skin test prior to BCG therapy can predict clinical outcomes following BCG therapy and provide useful information regarding who would experience a strong therapeutic effect for BCG therapy and BCG-related major side effects.