Booster Phenomenon of 3-Step Tuberculin Skin Testing in Hemodialysis Patients

Document Type : Original Article(s)

Authors

1 Assistant Professor, Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Isfahan Kidney Diseases Research Center, Assistant Professor, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The risk of increasing active tuberculosis is a significant health problem among patients receiving hemodialysis. Also prophylactic therapy against tuberculin in these patients is important to have a successful transplantation. The tuberculin skin test (TST) is used to detect tuberculosis infection, but uremia in these patients may lead to coetaneous anergy that decrease the accuracy of the test. The aim of study was to identify the TST reactivity and frequency of booster phenomenon in 3-step TST in under hemodialysis patients.Methods: A total of 74 patients in Alzahra and Zahraye Marziye hemodialysis center in Isfahan were prospectively tested. To determine the frequency of booster effect, patients with less than 10 mm indurations were given additional TST one and four weeks after the initial test.Finding: Totally, 12 (16.2%) of 74 patients showed a positive tuberculin reaction (≥ 10 mm) on the initial test. Positive TST in 8 patients (10.8%) was added after the second test and in 6 patients (8.1%) after the third test. The booster phenomenon was detected in 18.9% of the patients. There was a significant correlation between TST positivity and anemia. There was no influence of age, gender, serum albumin level, urea reduction ratio and KT/V (P > 0.05).Conclusion: According to the results and the necessity of diagnosis of tuberculin in hemodialysis patients, our study support 3-step tuberculin skin testing in hemodialysis patients. As TST is easy and inexpensive, it seems to be useful for kidney transplant candidates.Keywords: Hemodialysis, Booster effect, Tuberculin skin test, Tuberculosis.

Keywords

References

  1. Sherman RA, Shimoda KJ. Tuberculosis track-ing: determining the frequency of the booster effect in patients and staff. Am J Infect Control 2001; 29(1): 7-12.
  2. Barnes PF, Barrows SA. Tuberculosis in the 1990s. Ann Intern Med 1993; 119(5): 400-10.
  3. Sagheb MM, Goodarzi M, Roozbeh J. The booster phenomenon of tuberculin skin testing in patients receiving hemodialysis. Iran J Immunol 2008; 5(4): 212-6.
  4. Woeltje KF, Mathew A, Rothstein M, Seiler S, Fraser VJ. Tuberculosis infection and anergy in hemodialysis patients. Am J Kidney Dis 1998; 31(5): 848-52.
  5. Habesoglu MA, Torun D, Demiroglu YZ, Kara-tasli M, Sen N, Ermis H, et al. Value of the tu-berculin skin test in screening for tuberculosis in dialysis patients. Transplant Proc 2007; 39(4): 883-6.
  6. Hussein MM, Mooij JM, Roujouleh H. Tuberculosis and Chronic Renal Disease. Seminars in Dialysis 2003; 19(1): 34-8.
  7. Fang HC, Chou KJ, Chen CL, Lee PT, Chiou YH, Hung SY, et al. Tuberculin skin test and anergy in dialysis patients of a tuberculosis-endemic area. Nephron 2002; 91(4): 682-7.
  8. Akcay A, Erdem Y, Altun B, Usalan C, Agca E, Yasavul U, et al. The booster phenomenon in 2-step tuberculin skin testing of patients receiving long-term hemodialysis. Am J Infect Control 2003; 31(6): 371-4.
  9. Cohen G, Haag-Weber M, Horl WH. Immune dysfunction in uremia. Kidney Int Suppl 1997; 62: S79-S82.
  10. Wauters A, Peetermans WE, Van den BP, De Moor B, Evenepoel P, Keuleers H, et al. The value of tuberculin skin testing in haemodialysis patients. Nephrol Dial Transplant 2004; 19(2): 433-8.
  11. Simon TA, Paul S, Wartenberg D, Tokars JI. Tuberculosis in hemodialysis patients in New Jersey: a statewide study. Infect Control Hosp Epidemiol 1999; 20(9): 607-9.
  12. Rutsky EA, Rostand SG. Mycobacteriosis in pa
  13. tients with chronic renal failure. Arch Intern Med 1980; 140(1): 57-61.
  14. Counsell SR, Tan JS, Dittus RS. Unsuspected pulmonary tuberculosis in a community teaching hospital. Arch Intern Med 1989; 149(6): 1274-8.
  15. Rao VK, Iademarco EP, Fraser VJ, Kollef MH. Delays in the suspicion and treatment of tuberculosis among hospitalized patients. Ann Intern Med 1999; 130(5): 404-11.
  16. Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005; 54(RR-17): 1-141.
  17. DeCastro MG, Denys GA, Fauerbach LL, Fer-ranti JK, Hawkins K, Masters LC, et al. APIC position paper: responsibility for interpretation of the PPD tuberculin skin test. Association for Professionals in Infection Control and Epidemiology, Inc. Am J Infect Control 1999; 27(1): 56-8.
  18. Murthy BV, Pereira BJ. A 1990s perspective of hepatitis C, human immunodeficiency virus, and tuberculosis infections in dialysis patients. Semin Nephrol 1997; 17(4): 346-63.
  19. Korzets A, Gafter U. Tuberculosis prophylaxis for the chronically dialysed patient-yes or no? Nephrol Dial Transplant 1999; 14(12): 2857-9.
  20. Cengiz K, Seker A. Boosted tuberculin skin testing in hemodialysis patients. Am J Infect Control 2006; 34(6): 383-7.
  21. Reichman LB. A scandalous incompe-tence.continued. Chest 1998; 113(5): 1153-4.
  22. Andrew OT, Schoenfeld PY, Hopewell PC, Humphreys MH. Tuberculosis in patients with end-stage renal disease. Am J Med 1980; 68(1): 59-65.
  23. Ferebee SH, Mount FW. Evidence of booster effect in serial tuberculin testing. AM Rev Respir Dis 1963; 88: 118-9.
  24. Bemanian M. Effect of heparin in the prevention of infections in patients un-dergoing hemodialysis access Zahra Hospital in Isfahan in 2008. [Thesis] Isfahan: Isfahan University of Medical Science; 2009.
Journal of Isfahan Medical School
Volume 28, Issue 116 - Serial Number 116
September and October 2011
Pages 1049-1055

Files

History

  • Receive Date: 07 March 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics