Comparison of mantoux and tine tuberculin skin tests in BCG-vaccinated children investigated for tuberculosis.
BACKGROUND
Tuberculin skin tests (TSTs) are long-established screening methods for tuberculosis (TB). We aimed to compare agreement between the intradermal Mantoux and multipuncture percutaneous Tine methods and to quantify risk factors for a positive test result.


RESULTS
1512 South African children younger than 5 years of age who were investigated for tuberculosis (TB) during a Bacille Calmette Guerin (BCG) trial were included in this analysis. Children underwent both Mantoux and Tine tests. A positive test was defined as Mantoux >or=15 mm or Tine >or= Grade 3 for the binary comparison. Agreement was evaluated using kappa (binary) and weighted kappa (hierarchical). Multivariate regression models identified independent risk factors for TST positivity. The Mantoux test was positive in 430 children (28.4%) and the Tine test in 496 children (32.8%, p<0.0001), with observed binary agreement 87.3% (kappa 0.70) and hierarchical agreement 85.0% (weighted kappa 0.66). Among 173 children culture-positive for Mycobacterium tuberculosis, Mantoux was positive in 49.1% and Tine in 54.9%, p<0.0001 (kappa 0.70). Evidence of digit preference was noted for Mantoux readings at 5 mm threshold intervals. After adjustment for confounders, a positive culture, suggestive chest radiograph, and proximity of TB contact were risk factors for a positive test using both TST methods. There were no independent associations between ethnicity, gender, age, or over-crowding, and TST result.


CONCLUSIONS
The Tine test demonstrated a higher positive test rate than the Mantoux, with substantial agreement between TST methods among young BCG-vaccinated children. TB disease and exposure factors, but not demographic variables, were independent risk factors for a positive result using either test method. These findings suggest that the Tine might be a useful screening tool for childhood TB in resource-limited countries.
Pan
Wenli
W
Department of Health, Haikou, Hainan Province, China.
Matizirofa
Lyness
L
Workman
Lesley
L
Hawkridge
Tony
T
Hanekom
Willem
W
Mahomed
Hassan
H
Hussey
Gregory
G
Hatherill
Mark
M
D001500:BCG Vaccine / Q000378:metabolism*; D002675:Child, Preschool; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000378:metabolism; D012044:Regression Analysis; D015203:Reproducibility of Results; D012867:Skin / Q000473:pathology; D014374:Tuberculin Test / Q000295:instrumentation* / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000517:prevention & control*
D001500:BCG Vaccine