结节病Kveim试验反应

本文报告使用自制Kveim抗原对12例结节病、5例纵隔或肺门淋巴结结核、5例肺癌纵隔或肺门淋巴结转移者行Kveim试验,结果结节病Kveim试验阳性率为8/12(66.7％),结核和肺癌淋巴结转移者均呈阴性反应。显示Kveim试验仍然为结节病简单和相对非损伤性的有用诊断方法。     

A case of sarcoidosis in a Chinese woman

A case of sarcoidosis in a Chinese woman presenting with hilar lymphadenopathy is described. In addition, there were neurological features, a depressed tuberculin test and a positive Kveim test. The condition is rare in the Chinese.     

An appraisal of the bentonite flocculation test in the detection of bovine tuberculosis

In this further study, an exhaustive investigation into the value of the bentonite flocculation test in detecting tuberculosis in cattle was made on a group of 358 cattle, with known intradermal (ID) tuberculin reactions and with or without tuberculosis lesions. Bentonite sensitized with human old tuberculin (OT) and a purified BCG carbohydrate fraction (BCG-F1) were used.In the group of 126 cows with tuberculosis lesions, 113 were positive to the tuberculin ID test and there were also 113 positive reactions to the flocculation test using OT sensitized bentonite. Only 62 were positive using the BCG-F1 sensitized bentonite.Out of the 232 animals with no visible lesions, 114 reacted positively to the tuberculin ID test, 148 had a titer to the flocculation test using OT sensitized bentonite and 70 were positive when using BCG-F1 sensitized bentonite.     

Clinical significance of Mantoux test in Malaysian patients

The value of tuberculin skin testing in the diagnosis of active tuberculosis remains uncertain. Interpretation of tuberculin tests would be easier if the tuberculin test profiles in different communities were accurately known. We reviewed 468 Mantoux test reactions in patients coming to Hospital Universiti Sains Malaysia with suspected tuberculosis. Eighty six percent of patients with active tuberculosis had a positive Mantoux test. Forty two percent of the cases of positive Mantoux test did not have evidence of active tuberculosis. Most of these cases had evidence of past infection with tuberculosis. We conclude that Mantoux test is a sensitive but a non-specific test in the diagnosis of active tuberculosis.     

In vitro study of macrophages from patients with sarcoidosis

Cultures of leukocytes from patients with sarcoidosis were stimulated with Kveim antigen or PPD-S and the macrophage reactions were compared with those obtained under similar conditions with leukocyte cultures from healthy tuberculin reactors. The non-stimulated control cultures of Kveim-positive sarcoid patients showed signs of macrophage activation, namely an increase in cytoplasmic pyroninophilia in small and enlarged macrophages, together with a higher than normal rate of lymphoblast transformation. In the presence of Kveim antigen this activation was more marked, even in cases where the blast response to the antigen was of low magnitude. Stimulation with tuberculoproteins produced a slight activation of macrophages only in cultures from Kveim reactors who had also shown positive tuberculin reactions.

These observations suggest that the study of lymphocyte transformation together with that of macrophage activation will improve the immunocytological assessment of sarcoidosis.

     

吸毒肺结核患者PPD皮试与结核抗体的临床意义

目的探讨吸毒肺结核患者PPD皮试及血清中结核抗体的临床意义.方法对比两组结核病类型分布、结核抗体及PPD皮试结果,统计学处理用SPSS11.0软件,P＜0.05为差异有显著性.结果吸毒组PPD皮试阳性率低于对照组,两者有显著性差异（P＜0.05）.而结核病类型分布和结核抗体阳性率无显著性差异（P＞0.05）.结论检测血清的结核抗体在吸毒肺结核患者的诊断中和非吸毒者具有同样的临床意义.当普查时吸毒者皮试PPD阴性,建议常规行胸透及痰涂片检查.     

Significance of the tuberculin test in Singapore

The standard tuberculin test used by all Singapore government hospitals and institutions is the intradermal Mantoux test using 1 TU of PPD RT23 with Tween 80, and read 72 hours later. There is almost 100% BCG coverage in Singapore children for many years, and therefore the tuberculin skin reaction must be interpreted with special consideration. Taking 8 mm and above as positive, six month old infants vaccinated at birth gave a positive rate of 42% and a mean reaction size of 5.89 mm. The reaction appeared to wane rapidly and among 6 year old school children the positive rate dropped to 12% and the mean size to 2.38 mm. By the age of 11 years, the children showed a positive rate of 36% and a mean size of 6.27 mm. A further increase is observed in 15 year old children, the positive rate being 88% and mean size 13.28 mm. Among tuberculosis contacts, the positive rate and mean size of the tuberculin reaction are generally higher, especially in the younger age groups. Tuberculosis patients above 15 years old were observed to be practically all positive reactors with a mean size of at least 16 mm.     

Reactivity of allergy skin test in healthy volunteers

INTRODUCTION

Healthy individuals may be exposed and sensitised to allergens, and have a positive response to a skin prick test despite being asymptomatic. The objectives of this study were to evaluate the prevalence of atopic sensitisation and identify the reactivity of healthy volunteers to common aeroallergens.

METHODS

Healthy volunteers with no known allergic symptoms were recruited in this study. All volunteers were scheduled to undergo a skin prick test with 16 common aeroallergens that were previously identified among atopic patients.

RESULTS

A total of 100 volunteers (mean age 28 years) were enrolled in this study. 42 volunteers had positive skin prick tests for at least one allergen. The median number of sensitised allergen was 2 (range 1–7). Volunteers with positive skin tests (n = 42) were younger than those with negative skin tests (n = 58) (mean age 25.5 vs. 29.2 years; p < 0.05). The group with positive skin tests also had a higher proportion of males (57.1% vs. 31.0%; p < 0.01) and first-degree relatives with a history of atopic diseases (31.0% vs. 10.3%; p < 0.05). The most common sensitised allergens in these healthy asymptomatic volunteers were mite (n = 33), house dust (n = 23) and American cockroach (n = 20).

CONCLUSION

In this study, up to 42% of healthy volunteers, particularly those with a family history of atopy, were sensitised to allergens. Reactivity of the skin test without allergic symptoms, however, does not indicate allergic disease. Therefore, the skin test should only be indicated in atopic symptomatic individuals.     

Evaluation of the clinical and histological features of paratracheal and hilar gland enlargement

Sixty-nine patients with a chest radiograph showing enlargement of the hilar and/or paratracheal lymph nodes were analysed. Ten of these, mainly Asian, were found to be suffering from tuberculosis. Of the remaining fifty-nine, who had sarcoidosis, 12% were tuberculin-positive. All the cases diagnosed as sarcoidosis had either a positive Kveim test and/or mediastinal lymph node histology compatible with sarcoidosis. 10% of cases with sarcoidosis showed evidence of uveitis and 10% showed bone cysts and there was also a high proportion of other extrathoracic lesions.     

7299名中学生结核菌素反应性情况分析

目的了解当地中学生结核菌素反应性状况。方法选医院驻地怀来县4所中学7299名初高中一年级学生进行标准化PPD试验调查,并对学生年龄、性别、居住来源及结核病流行特点进行调查分析。结果初一年级学生多集中在13～14岁组(80.2%),高一年级学生多集中在16～17岁组(74.8%),性别女稍多于男,来源于农村的学生占59.3%,≥5mm总阳性率24.7%,≥15mm为7.9%。3149名无卡痕学生PPD反应≥5mm、≥10mm、≥15mm和≥20mm分别为17.3%、11.2%、6.1%和2.9%,有卡痕有结核既往史和接触史学生的结素反应均明显高于无卡痕无结核既往史和接触史者。结论把初高中新入学学生作为当地结素试验对象,应将≥15mm结素反应者列为预防性治疗对象,以减少结核发病。     

The Kveim test in Crohn's disease

Kveim tests were done in forty-eight patients with Crohn''s disease. Of forty-five with definite or probable Crohn''s disease, twenty-three had a positive Kveim test. This finding could be explained:     

Assessing the risk of tuberculosis infection among healthcare workers: the Melbourne Mantoux Study. Melbourne Mantoux Study Group.

OBJECTIVE: To determine the potential prevalence of nosocomial infection with Mycobacterium tuberculosis among hospital employees in teaching hospitals in Melbourne. DESIGN: Cross-sectional survey of positive tuberculin skin test (Mantoux) responses among employees in 14 public hospitals in Melbourne, January 1996 to April 1999. PARTICIPANTS: All consenting employees in participating hospitals (4,070 healthcare and 4,298 non-healthcare workers; participation rates, 13%-66%). OUTCOME MEASURES: Prevalence of positive responses to tuberculin skin tests among healthcare and non-healthcare workers and association with employee and hospital characteristics. RESULTS: Healthcare workers were significantly more likely to have a positive tuberculin response than non-healthcare workers (19.3% versus 13.7%; odds ratio, 1.5; 95% CI, 1.3-1.7; P<0.001). Multivariable analysis revealed that age, country of birth (high versus low tuberculosis [TB] prevalence), history of BCG (bacille Calmette-Guérin) vaccination, years since last BCG, occupation (healthcare versus non-healthcare worker) and years of hospital employment were all significantly associated with a positive response. Rates of positive responses among employees varied greatly between hospitals (6%-35%). These differences were not explained by employee characteristics, hospital TB patient load (number of admissions or bed-days) or percentage of hospital patients from countries with high TB prevalence. The hospital with the highest rate of positive responses was notable for its lack of negative-pressure isolation rooms for TB patients. CONCLUSIONS: Positive tuberculin responses are relatively common among hospital employees in Melbourne, with rates varying between hospitals and being higher among healthcare than non-healthcare workers. Employee characteristics, such as age, country of birth and past BCG status, explain little of this variation. More emphasis on TB infection control measures and regular staff screening may be needed.     

Interpretation of the PPD skin test in BCG-vaccinated children.

Skin testing with 5 tuberculin units (TU) of purified protein derivative (PPD) of tuberculin stabilized with polysorbate (Tween) 80 was done 3 months and 1 year after immunization with bacille Calmette-Guérin (BCG) vaccine in two groups of children: one group vaccinated at birth and another group at age 6 years. Interpretation of the PPD skin test with 5 TU is possible in children 1 year and older vaccinated with BCG at birth: if the diameter of induration is more than 10 to 12 mm the reaction cannot be ascribed to BCG vaccination and is highly suggestive of supervening infection with Mycobacterium tuberculosis or occasionally atypical mycobacteria. In contrast, the interpretation of a PPD test in children vaccinated at age 6 years is extremely difficult.     

Prevalence of Mycobacterium tuberculosis infection among injection drug users in Toronto

BACKGROUND: Injection drug users are at increased risk of Mycobacterium tuberculosis infection and active tuberculosis (TB). The primary objective of this study was to determine the prevalence of M. tuberculosis infection among injection drug users in Toronto, as indicated by a positive tuberculin skin test result. An additional objective was to identify predictors of a positive skin test result in this population. METHODS: A cross-sectional study was carried out involving self-selected injection drug users in the city of Toronto. A total of 171 participants were recruited through a downtown Toronto needle-exchange program from June 1 to Oct. 31, 1996. RESULTS: Of 167 subjects tested, 155 (92.8%) returned for interpretation of their skin test result within the designated timeframe (48 to 72 hours). Using a 5-mm cut-off, the prevalence rate of positive tuberculin skin test results was 31.0% (95% confidence interval 23.8% to 38.9%). Birth outside of Canada and increasing age were both predictive of a positive result. INTERPRETATION: There is a high burden of M. tuberculosis infection in this population of injection drug users. The compliance observed with returning for interpretation of skin test results indicates that successful TB screening is possible among injection drug users.     

Ocular sarcoidosis

In 5529 new patients attending eye clinics 0·8% of patients were found to have endogenous uveitis. None had radiographic evidence of sarcoidosis. Of thirty-four who had a Mantoux test 56% were negative. A Kveim test done on twenty-four of the cases revealed that 12·5% were positive, and in two of these histological evidence of sarcoidosis was found.     

结核分枝杆菌感染T细胞斑点试验对淋巴结结核的诊断价值

目的 探讨结核分枝杆菌感染T细胞斑点试验(T-SPOT.TB)对淋巴结结核的诊断价值。方法 将2012年7月至2015年10月安徽省胸科医院收治的134例淋巴结肿大患者分为结核组(95例)和非结核组(39例),另取健康对照组28例,采外周血行T-SPOT.TB检测,对比分析3组T-SPOT.TB的阳性率,敏感度及特异度。结果 结核组、非结核组和健康对照组T-SPOT.TB阳性率分别为85.26%、15.38%和3.57%,结核组患者T-SPOT.TB阳性检测率显著高于其他两组。T-SPOT.TB诊断淋巴结结核的敏感度、特异度、阳性预测值和阴性预测值分别为85.26%、89.55%、92.05%和81.08%。结论 T-SPOT.TB试验可作为淋巴结结核的重要诊断手段。     

Sarcoidosis: the clinical problem

This paper reviews the clinical manifestations of acute and chronic sarcoidosis. The indications for measuring serum angiotensin converting enzyme and for performing pulmonary function tests, bronchiolo-alveolar lavage and gallium scans are discussed and the modern indications for performing a Kveim Siltzbach test are also considered. The main treatment available for patients with sarcoidosis is systemic steroids and the indications in the various systems for using these drugs are discussed.     

Evaluation of a risk assessment questionnaire used to target tuberculin skin testing in children

CONTEXT: Universal tuberculin skin testing of children has been shown to be costly and inefficient. In response, several authorities have recommended targeted screening based on epidemiological risk. In 1996, the New York City Department of Health (NYCDOH) developed questions to identify children who require a tuberculin skin test. OBJECTIVE: To determine the sensitivity, specificity, and predictive validity of the NYCDOH tuberculosis risk assessment questionnaire. DESIGN: Prospective criterion standard study in which tuberculin skin tests and the NYCDOH questionnaire were administered simultaneously between August 1996 and January 1998. Specific questions asked about contact with a tuberculosis case, birth in or travel to endemic areas, regular contact with high-risk adults, and human immunodeficiency virus infection in the child. SETTING: Ambulatory clinic in South Bronx, New York, NY. PARTICIPANTS: Consecutive sample of 2920 children aged 1 to 18 years. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values of the questionnaire, and odds ratio (OR) of reactive skin test results. RESULTS: The NYCDOH questionnaire identified 413 children (14%) as having at least 1 risk factor. Of these, 23 (5.6%) had a positive skin test result; 4 (0.16%) of the 2507 without risk factors had a positive result. Results for the full NYCDOH questionnaire were sensitivity, 85.2%; specificity, 86.0%; negative predictive value, 99.8%; positive predictive value, 5.4%; and OR, 35.2 (95% confidence interval, 12.1-102.4). CONCLUSION: The NYCDOH questionnaire is a valid instrument for identifying children for tuberculin skin testing.     

Pleural effusion in 100 Malaysian patients.

In a retrospective study of 100 patients with pleural effusion the final diagnosis was tuberculosis in 49, malignancy in 43, malignancy with tuberculosis, bacterial infection, hydrothorax with cirrhosis, reaction to pneumothorax in one each, and unknown in 4. Most of the effusions analysed were exudates (94%). Pleural biopsy was diagnostic in 46% of tuberculous effusions (13/28) and 67% of malignant effusions (20/30). Tuberculosis accounted for 87% of cases in patients aged 40 years and under. In this age group, patients with exudative pleural effusion and a positive tuberculin test are likely to have tuberculosis and early therapeutic trial is justified.     

Astograph乙酰甲胆碱激发试验对支气管哮喘的诊断价值

目的 评价Astograph乙酰甲胆碱激发试验对支气管哮喘(简称哮喘)患者的诊断价值.方法 采用Astograph J-21气道反应性测定仪对2010年11月至2012年7月于河北联合大学附属开滦总医院呼吸内科就诊的262例哮喘患者行Astograph乙酰甲胆碱激发试验,同时105例正常体检者作为健康对照组,分析哮喘患者气道高反应性特点,计算Astograph乙酰甲胆碱激发试验诊断哮喘的敏感度、特异性、阳性预测值、阴性预测值、诊断准确性及Yunden指数.结果 支气管哮喘组所有肺功能指标均低于健康对照组,差异均有统计学意义(P<0.05),哮喘组Rrs cont (初期阻力)高于健康对照组,而GRs cont (初期反应)、Dmin (最小诱发累积剂量)、Cmin (乙酰甲胆碱的最小浓度)、PD35 (使Grs升高到基础水平的135%所需乙酰甲胆碱的最小浓度)均低于健康对照组,差异均有统计学意义(P<0.05).Astograph乙酰甲胆碱激发试验诊断哮喘的敏感度、特异性、阳性预测值、阴性预测值、诊断准确性及Yunden指数分别为80.15%、72.12%、87.87%、59.06%、92.59%及0.5227.结论 Astograph乙酰甲胆碱激发试验对支气管哮喘有较高的诊断价值,值得临床推广.