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Tuberculin Tests
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Administration
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(too BER kyoo lin tests)

U.S. Brand Names
Aplisol®; Aplitest®; Tine Test PPD; Tubersol®

Generic Available

No


Synonyms
Mantoux; PPD; Tine Test; TST; Tuberculin Purified Protein Derivative; Tuberculin Skin Test

Pharmacological Index

Diagnostic Agent, Skin Test


Use

Skin test in diagnosis of tuberculosis, cell-mediated immunodeficiencies


Pregnancy Risk Factor

C


Contraindications

250 TU strength should not be used for initial testing


Warnings/Precautions

Do not administer I.V. or S.C.; epinephrine (1:1000) should be available to treat possible allergic reactions


Adverse Reactions

1% to 10%:

Local: Pain at injection site


Drug Interactions

Decreased effect: Reaction may be suppressed in patients receiving systemic corticosteroids, aminocaproic acid, or within 4-6 weeks following immunization with live or inactivated viral vaccines


Stability

Refrigerate; Tubersol™ opened vials are stable for up to 24 hours at <75°F


Mechanism of Action

Tuberculosis results in individuals becoming sensitized to certain antigenic components of the M. tuberculosis organism. Culture extracts called tuberculins are contained in tuberculin skin test preparations. Upon intracutaneous injection of these culture extracts, a classic delayed (cellular) hypersensitivity reaction occurs. This reaction is characteristic of a delayed course (peak occurs >24 hours after injection, induration of the skin secondary to cell infiltration, and occasional vesiculation and necrosis). Delayed hypersensitivity reactions to tuberculin may indicate infection with a variety of nontuberculosis mycobacteria, or vaccination with the live attenuated mycobacterial strain of M. bovis vaccine, BCG, in addition to previous natural infection with M. tuberculosis.


Pharmacodynamics/Kinetics

Onset of action: Delayed hypersensitivity reactions to tuberculin usually occur within 5-6 hours following injection

Peak effect: Become maximal at 48-72 hours

Duration: Reactions subside over a few days


Usual Dosage

Children and Adults: Intradermal: 0.1 mL about 4" below elbow; use 1/4 " to 1/2 " or 26- or 27-gauge needle; significant reactions are greater than or equal to 5 mm in diameter

Interpretation of induration of Tine test injections: Positive: >2 mm and vesiculation present; inconclusive: <2 mm (give patient Mantoux test of 5 TU/0.1 mL - base decisions on results of Mantoux test); negative: <2 mm or erythema of any size (no need for retesting unless person is a contact of a patient with tuberculosis or there is clinical evidence suggestive of the disease)


Administration

Select a site without acne or hair


Mental Health: Effects on Mental Status

None reported


Mental Health: Effects on Psychiatric Treatment

None reported


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Return to physician for reaction interpretation at 48-72 hours


Nursing Implications

Test dose: 0.1 mL intracutaneously; store in refrigerator; examine site at 48-72 hours after administration; whenever tuberculin is administered, a record should be made of the administration technique (Mantoux method, disposable multiple-puncture device), tuberculin used (OT or PPD), manufacturer and lot number of tuberculin used, date of administration, date of test reading, and the size of the reaction in millimeters (mm).


Dosage Forms

Injection:

Intermediate test strength: 5 TU/0.1 mL (1 mL, 5 mL, 10 mL)

Second test strength: 250 TU/0.1 mL (1 mL)

Tine: 5 TU each test


References

Dutt AK and Stead WW, "Tuberculosis," Clin Geriatr Med, 1992, 8(4):761-75.


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