The effects of BCG immunization and human immunodeficiency virus infection on dual skin test reactions to purified protein derivative and Mycobacterium avium sensitin among adults in Zambia.
METHODS
University hospital in Lusaka, Zambia.


OBJECTIVE
To determine the effects of childhood bacille Calmette-Guerin (BCG) immunization and human immunodeficiency virus (HIV) infection on dual skin test reactions to purified protein derivative (PPD) and Mycobacterium avium sensitin (MAS) in a developing country.


METHODS
Descriptive cross-sectional study.


RESULTS
Dual skin testing was performed on 112 adults, 58 HIV-positive and 54 HIV-negative. Forty-seven (42%) of 112 had PPD reactions > or =10 mm and 52 (46%) had MAS reactions > or =10 mm. PPD reactions > or =10 mm were present in 30 (63%) of 48 BCG-positive subjects compared to 17 (27%) of 64 BCG-negative subjects (P<0.001). Nineteen (33%) of 58 PPD or MAS skin test positive subjects were PPD dominant, 15 (26%) were MAS dominant, and 24 (41%) were non-dominant. MAS dominant and non-dominant reactions were significantly reduced in HIV-positive subjects, and non-dominant reactions were increased in BCG-positive subjects.


CONCLUSIONS
Childhood BCG immunization is associated with PPD reactions > or =10 mm among adults. Reduced PPD reaction rates in HIV-positive adults appear to be due to a loss of BCG-induced PPD reactivity. Prior infection with M. avium complex is detectable in a significant proportion of adults in a developing country.
Waddell
R D
RD
Infectious Disease Section, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, New Hamshire 03756, USA.
von Reyn
C F
CF
Baboo
K S
KS
Mwinga
A
A
Chintu
C
C
Zumla
A
A
D000328:Adult; D000941:Antigens; D000942:Antigens, Bacterial; D001500:BCG Vaccine; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis*; D015024:Zambia
D000941:Antigens; D000942:Antigens, Bacterial; D001500:BCG Vaccine; C012031:sensitin