The results of a tuberculin skin test alone
cannot confirm an active TB infection. Other tests, such as a chest X-ray, sputum cytology, and
sputum culture, may be done to confirm an active TB
infection when a skin test is positive. A person who has a positive skin test
or chest X-ray, but no TB symptoms, is usually thought to have a TB infection
that cannot be passed to others (latent TB).
Among hospital workers or
others who have periodic skin tests, a second test done within a few weeks of a
negative test may be positive, even though the person was not infected between
the two tests. These results (called the booster effect) may indicate a TB infection that occurred a long time ago or a
previous BCG vaccination.
About 5% to 10% of people (1 to 2 people out of 20) who
have inactive (latent) TB will develop active TB at some time in their lives.1 The chance of developing
active TB is higher in children, older adults, and people with an
impaired immune system.
No more tests are
needed for a person with a negative tuberculin skin test who has no symptoms of
active infection and no history of being exposed to TB.
do not react to a tuberculin skin test even if they have tuberculosis.
Conditions such as active TB, cancer, or
acquired immunodeficiency syndrome (AIDS) do not always
respond normally to the TB antigens. In these cases, other skin tests may be
done. If there is a skin reaction, then the tuberculin skin test is probably
correct. But if there is no reaction, the person's immune system is likely to
be too weak to respond normally to the tuberculin skin test.
blood tests to diagnose TB have been approved by the U.S. Food and Drug
Administration (FDA). These tests may be used instead of a tuberculin skin
test. A rapid blood test may be able to tell if a person reacted to a skin test
because of an active TB infection or a previous BCG vaccination. Rapid blood tests are also called interferon-gamma release assays (IGRAs).
Rapid sputum tests that can detect TB bacteria in sputum have been approved by the FDA. These tests, called nucleic acid amplification tests (NAAs) can provide results within 24 hours. But they are done only when a person is strongly suspected of having TB.
Pasipanodya J, et al. (2011). Tuberculosis and other mycobacterial diseases. In ET Bope et al., eds., Conn's Current Therapy 2011. pp. 295–301. Philadelphia: Saunders.
Other Works Consulted
American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America (2003). Treatment of tuberculosis. American Journal of Respiratory and Critical Care Medicine, 167(4): 603–662.
Centers for Disease Control and Prevention (2005). Guidelines for using the QuantiFERON®-TB test for diagnosing latent Mycobacterium tuberculosis infection. MMWR, 54(RR-15): 49–55.
Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (2009). Questions and Answers About TB. Available online: http://www.cdc.gov/tb/publications/faqs/default.htm.
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.