title: 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.
abstract: 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.
authors: Infectious Disease Section, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, New Hamshire 03756, USA.
authors: R D
authors: RD
authors: Waddell
authors: C F
authors: CF
authors: von Reyn
authors: K S
authors: KS
authors: Baboo
authors: A
authors: A
authors: Mwinga
authors: C
authors: C
authors: Chintu
authors: A
authors: A
authors: Zumla
mesh_terms: 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
chemical_list: D000941:Antigens; D000942:Antigens, Bacterial; D001500:BCG Vaccine; C012031:sensitin