Perspectives
The tuberculin skin test: a hundred, not out?
Great Ormond Street Hospital, London, UK
Correspondence to:
Dr Delane Shingadia, Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; shingd@gosh.nhs.uk
| The first 150 words of the full text of this article appear below. |
In 1890, at a World Congress of Medicine in Berlin, Robert Koch announced a substance that he claimed would both cure and prevent tuberculosis. Although this substance, a glycerin extract of tubercle bacilli, subsequently failed as a therapy, it has become an important diagnostic tool for tuberculosis. Referred to eventually as "old tuberculin", this tubercle protein soup was later refined to create the current diagnostic material we now know as purified protein derivative or PPD.
Over the last century, the tuberculin skin test (TST) has become the established screening method for diagnosing latent TB infection (LTBI) in adults and children. The TST exploits the fact that LTBI induces a strong cell-mediated immune response to intradermal inoculation of tuberculin PPD, a crude mixture of >200 Mycobacterium tuberculosis proteins. However, the TST suffers from poor specificity (false positive tests due to prior BCG vaccination or previous exposure to environmental mycobacteria) and poor
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