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Tuberculin Skin TestAka: Purified Protein Derivative, Tuberculosis Screening, Mantoux, PPD

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  1. See Also
    1. Tuberculosis
    2. Tuberculosis Risk Factors
    3. Tuberculosis Screening in Children
  2. Epidemiology
    1. Clinicians under-read PPDs
    2. References
      1. Kendig (1998) Chest 113:1175
  3. Indication: Testing for Latent Tuberculosis
    1. See Tuberculosis Risk Factors
    2. Low risk patients
      1. Routine screening not recommended
      2. Screen only if symptoms suggest possible Tuberculosis
    3. High risk patients
      1. Medical risk factors for Tuberculosis
        1. Human Immunodeficiency Virus (HIV)
        2. Alcoholism
        3. Intravenous Drug Abuse
      2. Immigration from regions with high TB Prevalence
        1. Africa
        2. Asia
        3. Latin America
      3. Resident of long-term care facility
        1. Correctional institution
        2. Psychiatric institution
        3. Nursing home
      4. Close contacts of high risk patients
      5. Health care workers
  4. Contraindications
    1. BCG vaccine within 1 year of testing
      1. PPD should otherwise be placed as if BCG not given
  5. Technique
    1. Inject 0.1 ml Purified Protein Derivative Intradermal
      1. Contains 5 tuberculin units
    2. Read in 48 to 72 hours after injection
      1. Reaction is largest at 72 hours
      2. Reading at 72 hours reduces false negative rate
        1. Singh (2002) Chest 122:1299
    3. Measure induration (palpable) across forearm
      1. Perpendicular to long axis
      2. Pen Technique
        1. Draw with pen in from both lateral margins to edge
        2. Pen stops at induration
    4. Record result in millimeters (No induration: 0 mm)
  6. Interpretation: PPD under 5 mm
    1. Negative
    2. Observe Patient
  7. Interpretation: PPD 5 mm or greater
    1. Positive if
      1. HIV Infection
      2. Tuberculosis contact
      3. Immunosuppressed (e.g. HIV, Prednisone >15 mg qd)
      4. Abnormal finding on Chest XRay
    2. Management
      1. Chest XRay and exam for disseminated disease
      2. Refer to Public Health or Infectious Disease
      3. See Tuberculosis Prophylaxis
  8. Interpretation: PPD 10 mm or greater
    1. Positive if
      1. Health care workers
      2. New immigrant within last 5 years
      3. Intravenous Drug Abuse
      4. Homeless
      5. Under 4 years old
      6. Malnutrition
      7. Diabetes Mellitus
      8. Silicosis
      9. Tuberculosis endemic to region
    2. Management
      1. Chest XRay and exam for disseminated disease
      2. Refer to Public Health or Infectious Disease
      3. See Tuberculosis Prophylaxis
  9. Interpretation: PPD 15 mm or greater
    1. Positive in all persons
    2. Management
      1. Chest XRay and exam for disseminated disease
      2. Refer to Public Health or Infectious Disease
      3. Isolate organism for drug susceptibility testing
      4. See multi-drug Tuberculosis treatment regimen
  10. References
    1. Jasmer (2002) N Engl J Med 347:1860

Purified Protein Derivative of Tuberculin (C0034131)

Definition (NCI)A purified protein extract derived from the bacterium Mycobacterium tuberculosis. Intradermally-administered, PPD stimulates preprimed CD4 T cells in immunologically competent subjects previously exposed to the bacterium Mycobacterium tuberculosis; these activated CD4 T cells secrete various cytokines that attract granulocytes, monocytes, and macrophages in an inflammatory response known as delayed hypersensitivity. (NCI04)
ConceptsOrganic Chemical (T109) , Immunologic Factor (T129) , Indicator, Reagent, or Diagnostic Aid (T130)
EnglishPPD, Purified Protein Derivative, Purified Protein Derivative of Tuberculin, Tuberculin, Tuberculin PPD, Tuberculin purified protein derivative
Spanishderivado proteico purificado, derivado proteico purificado de la tuberculina, derivado proteico purificado de tuberculina, PPD tuberculina, reacción de Mantoux, reaccion de Mantoux, tuberculina
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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