Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Mar 19;7:38.
doi: 10.1186/1471-2458-7-38.

The Presence of a Booster Phenomenon Among Contacts of Active Pulmonary Tuberculosis Cases: A Retrospective Cohort

Affiliations
Free PMC article

The Presence of a Booster Phenomenon Among Contacts of Active Pulmonary Tuberculosis Cases: A Retrospective Cohort

Cristiane G Salles et al. BMC Public Health. .
Free PMC article

Abstract

Background: Assuming a higher risk of latent tuberculosis (TB) infection in the population of Rio de Janeiro, Brazil, in October of 1998 the TB Control Program of Clementino Fraga Filho Hospital (CFFH) routinely started to recommend a two-step tuberculin skin test (TST) in contacts of pulmonary TB cases in order to distinguish a boosting reaction due to a recall of delayed hypersensitivity previously established by infection with Mycobacterium tuberculosis (M.tb) or BCG vaccination from a tuberculin conversion. The aim of this study was to assess the prevalence of boosted tuberculin skin tests among contacts of individuals with active pulmonary tuberculosis (TB).

Methods: Retrospective cohort of TB contacts > or = 12 years old who were evaluated between October 1st, 1998 and October 31st 2001. Contacts with an initial TST < or = 4 mm were considered negative and had a second TST applied after 7-14 days. Boosting reaction was defined as a second TST > or = 10 mm with an increase in induration > or = 6 mm related to the first TST. All contacts with either a positive initial or repeat TST had a chest x-ray to rule out active TB disease, and initially positive contacts were offered isoniazid preventive therapy. Contacts that boosted did not receive treatment for latent TB infection and were followed for 24 months to monitor the development of TB. Statistical analysis of dichotomous variables was performed using Chi-square test. Differences were considered significant at a p < 0.05.

Results: Fifty four percent (572/1060) of contacts had an initial negative TST and 79% of them (455/572) had a second TST. Boosting was identified in 6% (28/455). The mean age of contacts with a boosting reaction was 42.3 +/- 21.1 and with no boosting was 28.7 +/- 21.7 (p = 0.01). Fifty percent (14/28) of individuals whose test boosted met criteria for TST conversion on the second TST (increase in induration > or = 10 mm). None of the 28 contacts whose reaction boosted developed TB disease within two years following the TST.

Conclusion: The low number of contacts with boosting and the difficulty in distinguishing boosting from TST conversion in the second TST suggests that the strategy of two-step TST testing among contacts of active TB cases may not be useful. However, this conclusion must be taken with caution because of the small number of subjects followed.

Figures

Figure 1
Figure 1
Prevalence of boosting among contacts of active pulmonary tuberculosis cases.

Similar articles

See all similar articles

Cited by 5 articles

References

    1. Jasmer RM, Nahid P, Hopewell PC. Latent tuberculosis infection. N Eng J Med. 2002;347:1860–1866. doi: 10.1056/NEJMcp021045. - DOI - PubMed
    1. Menzies D. Interpretation of repeated tuberculin tests. Am J Respir Crit Care Med. 1999;159:15–21. - PubMed
    1. Cauthen GMD, Snider DE, Onorato IM. Boosting of tuberculin sensitivity among Southeast Asian refugees. Am J Respir Crit Care Med. 1994;149:1597–1600. - PubMed
    1. Ferebee SH. Controlled chemoprophylaxis trials in tuberculosis. Adv Tuberc Res. 1970;17:28–106. - PubMed
    1. Boletim informativo 2005

Publication types

LinkOut - more resources

Feedback