Validity of a self-reported history of a positive tuberculin skin test: A prospective study of drug users

Hillary V. Kunins, Andrea A. Howard, Robert S. Klein, Julia H. Arnsten, Alain H. Litwin, Ellie E. Schoenbaum, Marc N. Gourevitch

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To define the prevalence of and factors associated with having a negative purified protein derivative (PPD) among persons who self-report a prior positive PPD and to define the safety of repeat testing in such persons. DESIGN: Observational cohort study. SETTING: Methadone maintenance program with onsite primary care. PATIENTS/PARTICIPANTS: Current or former drug users enrolled in methadone maintenance treatment. INTERVENTIONS: Structured interview, tuberculin skin testing regardless of self-reported PPD status, and anergy testing. MEASUREMENTS AND MAIN RESULTS: Nearly one third (31%) of participants who self-reported a prior positive PPD had a negative measured PPD, despite receipt of a "booster" PPD. A single participant (0.5%) blistered in response to the PPD without lasting ill effect. Participants with PPD results discordant from their history were more likely to be HIV-seropositive and nonreactive to the anergy panel. The discordance rate among HIV-infected participants was 43%, and was largely attributable to immune dysfunction. Among HIV-seronegative participants, the discordance rate was 27%. Recent crack-cocaine use was independently associated with discordance in the absence of HIV infection. CONCLUSIONS: We confirmed that planting a PPD in patients who self-report a positive PPD history confers minimal risk. Substantial rates of discordance exist between self-reported history of a positive PPD and measured PPD status. Further research is needed to define the optimal management of PPD-negative patients who self-report a prior positive PPD and who have not received prior treatment for latent tuberculosis.

Original languageEnglish (US)
Pages (from-to)1039-1044
Number of pages6
JournalJournal of general internal medicine
Volume19
Issue number10
DOIs
StatePublished - Oct 2004

Keywords

  • Drug users
  • PPD
  • Tuberculin skin testing
  • Tuberculosis screening

ASJC Scopus subject areas

  • Internal Medicine

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