RESUMO
INTRODUCTION: Management of latent tuberculosis infection (LTBI) was introduced as a national policy in Sri Lanka in 2022, targeting high-risk groups, including health-care workers (HCWs). This study aimed to identify the potential risk factors for LTBI among HCWs in government hospitals. METHODS: A case-control study was conducted. Cases and controls were identified by a screening survey conducted among those tested by the tuberculin skin test (TST). The survey was conducted among HCWs of eight government hospitals in Colombo in 2022. LTBI cases were defined as TST positives (≥10 mm) without a history of pulmonary tuberculosis (TB) and controls were those rated as negative. The cases-to-control ratio was 1:1, with a sample size of 128 cases and 128 controls. Multiple logistic regression analysis was conducted to identify the risk factors. RESULTS: The significant risk factors identified included age ≥40 years (adjusted odds ratio [AOR] - 2.4, 95% confidence interval [CI]: 1.28-4.47) having a service duration of ≥6 years (AOR - 2.92, CI: 1.469-5.82), not maintaining distance (AOR - 2.83, CI: 1.43-5.58) and not wearing face masks when dealing with suspected or diagnosed TB patients (AOR - 3.55, CI: 1.80-7.00), and settings with inadequate TB infection control practices (AOR - 3.47, CI: 1.85-6.47). CONCLUSION: Improving infection control measures, training HCWs on TB prevention, providing adequate personal protective equipment, and initiating screening for LTBI among HCWs are recommended.
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Pessoal de Saúde , Tuberculose Latente , Humanos , Sri Lanka/epidemiologia , Fatores de Risco , Masculino , Feminino , Estudos de Casos e Controles , Adulto , Tuberculose Latente/epidemiologia , Tuberculose Latente/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Teste Tuberculínico , Adulto JovemRESUMO
Bovine tuberculosis (bTB), caused by Mycobacterium bovis (M. bovis), represents a significant problem for the agriculture industry as well as posing a risk for human health. Current diagnostic tests for bTB target the cell-mediated immune (CMI) response to infection with M. bovis, primarily through screening of animals with the tuberculin skin test. Epigenetic modifications have been shown to alter the course of the immune response and differentially methylated regions (DMRs) might also influence the outcome of the skin test in cattle. Whole Genome Bisulphite Sequencing (WGBS) was used to profile DNA methylation levels from peripheral blood of a group of cattle identified as test positive for M. bovis (positive for the single intradermal comparative tuberculin test (SICTT) and/or the interferon-γ release assay compared to a test negative control group [n = 8/group, total of 16 WGBS libraries]. Although global methylation profiles were similar for both groups across the genome, 223 DMRs and 159 Differentially Promoter Methylated Genes (DPMGs) were identified between groups with an excess of hypermethylated sites in SICTT positive cattle (threshold > 15% differential methylation). Genes located within these DMRs included the Interleukin 1 receptor (IL1R1) and MHC related genes (BOLA and BOLA-DQB). KEGG pathway analysis identified enrichment of genes involved in Calcium and MAPK signalling, as well as metabolism pathways. Analysis of DMRs in a subset of SICTT negative cattle that were IFN-γ positive showed differential methylation of genes including Interleukin 10 Receptor, alpha (IL10RA), Interleukin 17 F (IL17F) and host defence peptides (DEFB and BDEF109). This study has identified a number of immune gene loci at which differential methylation is associated with SICTT test results and the degree of methylation could influence effective host immune responses.
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Metilação de DNA , Teste Tuberculínico , Tuberculose Bovina , Bovinos , Animais , Tuberculose Bovina/genética , Tuberculose Bovina/diagnóstico , Tuberculose Bovina/imunologia , Teste Tuberculínico/veterinária , Mycobacterium bovis/imunologia , Epigênese Genética , Regiões Promotoras GenéticasRESUMO
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Tuberculose Miliar , Humanos , Criança , Adolescente , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Teste Tuberculínico , Pré-Escolar , Antituberculosos/administração & dosagem , Vacina BCG/administração & dosagemRESUMO
BACKGROUND: A novel skin test-called Diaskintest (DT)-containing specific M. tuberculosis antigens is in clinical use in the Russian Federation (RF). This test may improve diagnosis of tuberculosis (TB) infection. The use and performance of the DT was described and compared to the tuberculin skin test (TST). METHODS: Data on children <18 years referred to a TB reference centre (Jan/2018- Dec/2019) with ≥1 DT and TST result available were analysed. An immune correlate of TB infection was defined as a positive TST (≥10 mm induration) or a positive DT (any induration). RESULTS: Of 2710 included cases, the median age was 9.0 (IQR 5.7-13.1) years and 97.5% were BCG immunised. Overall, 1976 (79.9%) were TB uninfected, 724 (26.7%) had an immune correlate of TB infection and 10 (0.4%) TB disease. Reasons for referral were: positive or increasing skin test results in routine screening (992, 36.6%), screening before admission to a health care institution (501, 18.5%) and TB contact (457, 16.9%). DT was positive in 11.7% (308/2625) and TST in 63.1% (467/740) (Kappa 0.08, 95% CI:0.013-0.14). A positive DT was associated with older age (OR 1.16 (95% CI: 1.13-1.19) per year). Among TB contacts DT positivity was associated with contagiousness: highest proportion of positivity of 12.0% was observed when the index case was smear positive. CONCLUSION: In a setting with universal BCG vaccination and regular screening with TST, DT was used to rule out TB infection as TST was commonly positive. We found an association of DT positivity and contagiousness of the index case in children contacts. These observations may suggest improved specificity and sensitivity of DT compared to TST.
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Teste Tuberculínico , Tuberculose , Humanos , Criança , Teste Tuberculínico/métodos , Masculino , Feminino , Pré-Escolar , Adolescente , Tuberculose/diagnóstico , Mycobacterium tuberculosis/imunologia , Testes Cutâneos/métodos , Vacina BCG/imunologia , Lactente , Antígenos de Bactérias/imunologia , Antígenos de Bactérias/análiseRESUMO
INTRODUCTION: The large reservoir of tuberculosis (TB) infections is one of the main reasons for the persistent incidence of TB. Accurate diagnostic tests are crucial to correctly identify and treat people with TB infection, which is vital to eliminate TB globally. The rdESAT-6 and rCFP-10 (Cy-Tb) injection ('Cy-Tb'), a TB-specific antigen skin test and STANDARD F TB-Feron FIA ('Standard F TB') measuring interferon-gamma by fluorescence immunoassay assay are two novel tools for the diagnosis of TB infection which offer advantages compared with current tests in low-resource settings and reduced costs to both health systems and TB-affected people. The proposed study aims to evaluate the diagnostic accuracy of these two new tests for TB infection diagnosis. METHODS AND ANALYSIS: This cross-sectional study aims to assess the diagnostic accuracy for TB infection of the Cy-Tb skin test and Standard F TB assay (investigational tests) compared with the QuantiFERON-TB Gold Plus (QFT-Plus) assay as the immunological reference standard. Three different cohorts of study participants will be recruited at the Vietnam National Lung Hospital: adults with bacteriologically confirmed pulmonary TB (n=100), household contacts of people with TB (n=200) and people without TB infection (n=50). All consenting participants will undergo simultaneous testing with Cy-Tb, Standard F TB and QFT-Plus. The primary endpoint is the diagnostic accuracy of the Cy-Tb skin test and Standard F TB assay, expressed as sensitivity and specificity against the reference standard. ETHICS AND DISSEMINATION: Ethical approval was granted by the Vietnam National Lung Hospital Institutional Review Board (65/23/CN-HDDD-BVPTU) and the Swedish Ethical Review Authority (Dnr 2023-04271-01). Study results will be disseminated to the scientific community and policymakers through scientific publications. TRIAL REGISTRATION NUMBER: NCT06221735.
Assuntos
Testes de Liberação de Interferon-gama , Teste Tuberculínico , Tuberculose , Adulto , Humanos , Antígenos de Bactérias/análise , Estudos Transversais , Testes de Liberação de Interferon-gama/métodos , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/imunologia , Sensibilidade e Especificidade , Teste Tuberculínico/métodos , Tuberculose/diagnóstico , Tuberculose Pulmonar/diagnóstico , Vietnã , Projetos de PesquisaRESUMO
Despite widespread adoption and maturity, paper persistence endures in many Electronic Health Record (EHR) systems, particularly for complex workflows involving multiple steps from different stakeholders separated in time. In our health system, Latent Tuberculosis Infection (LTBI) testing was one such workflow where a Tuberculin Skin Test (TST) must be administered and then correctly read 48-72 hours later and documented. This paper discusses a low-resource workflow analysis and clinical decision support approach to replace a paper workflow and garner the benefits of the EHR for clearer documentation and retrieval of LTBI results. Our approach resulted in a significant increase in completed TST documentation, 57% (24/42) to 95% (18/19), P < 0.003. Human-centered design practices such as work system analysis and formative usability testing are feasible with limited resources and improve the likelihood of success of electronic workflows by designing solutions that fit existing clinical workflows and automating processes wherever possible.
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Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Teste Tuberculínico , Fluxo de Trabalho , Humanos , Tuberculose Latente/diagnóstico , Papel , DocumentaçãoRESUMO
Currently, interferon-gamma release assay (IGRA) is costly and not included as latent tuberculosis infection (LTBI) screening test strategy in Thailand's Universal Coverage Scheme (UCS) benefit package. The objective of this study was to assess the cost-utility of LTBI screening strategies among tuberculosis (TB) contacts in Thailand. A hybrid decision tree and Markov model was developed to compare the lifetime costs and health outcomes of tuberculin skin test (TST) and IGRA, in comparison to no screening, based on a societal perspective. Health outcomes were the total number of TB cases averted and quality-adjusted life years (QALYs), with results presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to explore uncertainties in all parameters. The ICER of TST compared with no screening was 27,645 baht per QALY gained, while that of IGRA compared to TST was 851,030 baht per QALY gained. In a cohort of 1000 TB contacts, both TST and IGRA strategies could avert 282 and 283 TB cases, respectively. At the Thai societal willingness-to-pay threshold of 160,000 baht per QALY gained, TST was deemed cost-effective, whereas IGRA would not be cost-effective, unless the cost of IGRA was reduced to 1,434 baht per test.
Assuntos
Análise Custo-Benefício , Testes de Liberação de Interferon-gama , Tuberculose Latente , Teste Tuberculínico , Tuberculose Pulmonar , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Tuberculose Latente/economia , Tailândia/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/economia , Teste Tuberculínico/economia , Testes de Liberação de Interferon-gama/economia , Masculino , Feminino , Anos de Vida Ajustados por Qualidade de Vida , Adulto , Pessoa de Meia-Idade , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Cadeias de MarkovRESUMO
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Consumo de Bebidas Alcoólicas , Antituberculosos , Infecções por HIV , Isoniazida , Tuberculose Latente , Humanos , Isoniazida/administração & dosagem , Antituberculosos/administração & dosagem , Antituberculosos/efeitos adversos , Uganda/epidemiologia , Tuberculose Latente/tratamento farmacológico , Masculino , Infecções por HIV/tratamento farmacológico , Feminino , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Adulto , Cadeias de Markov , Teste Tuberculínico , Tuberculose/prevenção & controle , Tuberculose/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Adulto Jovem , Pessoa de Meia-IdadeRESUMO
Tuberculosis (TB) is caused by Mycobacterium tuberculosis (Mtb). Following infection, immune responses to Mtb antigens can be measured using the tuberculin skin test or an interferon-γ release assay. The gain of Mtb immunoreactivity, a change from a negative to a positive tuberculin skin test or interferon-γ release assay result, is called conversion and has long been used as a measure of Mtb exposure. However, the loss of immunoreactivity (reversion; a positive followed by a negative result) has often been overlooked. Instead, in clinical and epidemiological circles, Mtb immunoreactivity is commonly considered to persist lifelong and confer a lifetime of disease risk. We present a critical review, describing the evidence for reversion from cohort studies, ecological studies and studies of TB progression risk. We outline the inconsistent reasons why reversion has been dismissed from common understanding and present evidence demonstrating that, just as conversion predominantly indicates prior exposure to Mtb antigens, so its opposite, reversion, suggests the reduction or absence of exposure (endogenous or exogenous). Mtb immunoreactivity is dynamic in both individuals and populations and this is why it is useful for stratifying short-term TB progression risk. The neglect of reversion has shaped TB research and policy at all levels, influencing clinical management and skewing Mtb infection risk estimation and transmission modelling, leading to an underestimation of the contribution of re-exposure to the burden of TB, a serious oversight for an infectious disease. More than a century after it was first demonstrated, it is time to incorporate reversion into our understanding of the natural history of TB.
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Testes de Liberação de Interferon-gama , Mycobacterium tuberculosis , Valor Preditivo dos Testes , Teste Tuberculínico , Tuberculose , Humanos , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Tuberculose/microbiologia , Tuberculose/epidemiologia , Tuberculose/diagnóstico , Fatores de Risco , Interações Hospedeiro-Patógeno , Antígenos de Bactérias/imunologia , Medição de Risco , Progressão da Doença , Prognóstico , Biomarcadores/sangue , Fatores de TempoRESUMO
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Teste Tuberculínico , Tuberculose , Humanos , Incidência , Masculino , Uganda/epidemiologia , Adulto , Feminino , Estudos Prospectivos , Tuberculose/epidemiologia , Adulto Jovem , Pessoa de Meia-Idade , Adolescente , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Doenças Endêmicas , Estudos de CoortesRESUMO
Bovine tuberculosis (bTB) represents a threat to livestock production. Mycobacterium bovis is the main causative agent of bTB and a pathogen capable of infecting wildlife and humans. Eradication programs based on surveillance in slaughterhouses with mandatory testing and culling of reactive cattle have failed to eradicate bTB in many regions worldwide. Therefore, developing effective tools to control this disease is crucial. Using a computational tool, we identified proteins in the M. bovis proteome that carry predictive binding peptides to BoLADRB3.2 and selected Mb0309, Mb1090, Mb1810 and Mb3810 from all the identified proteins. The expression of these proteins in a baculovirus-insect cell expression system was successful only for Mb0309 and Mb3810. In parallel, we expressed the ESAT-6 family proteins EsxG and EsxH in this system. Among the recombinant proteins, Mb0309 and EsxG exhibited moderate performance in distinguishing between cattle that test positive and negative to bTB using the official test, the intradermal tuberculin test (IDT), when used to stimulate interferon-gamma production in blood samples from cattle. However, when combined as a protein cocktail, Mb0309 and EsxG were reactive in 50â¯% of positive cattle. Further assessments in cattle that evade the IDT (false negative) and cattle infected with Mycobacterium avium paratuberculosis are necessary to determine the potential utility of this cocktail as an additional tool to assist the accurate diagnosis of bTB.
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Antígenos de Bactérias , Mycobacterium bovis , Tuberculose Bovina , Mycobacterium bovis/imunologia , Animais , Bovinos , Antígenos de Bactérias/imunologia , Tuberculose Bovina/imunologia , Proteínas de Bactérias/imunologia , Proteínas de Bactérias/genética , Teste Tuberculínico/veterinária , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/genéticaRESUMO
INTRODUCTION: Tuberculosis (TB) is a significant global health concern, particularly in developing countries. Diagnosing latent tuberculosis infection (LTBI) in hemodialysis patients is crucial because of the risk of developing active tuberculosis in this population due to attenuated immune response. Herein, we assessed the prevalence of LTBI in hemodialysis patients. METHODS: In this cross-sectional study, we included all patients referred to hemodialysis centers in Kohgiluyeh and Boyer-Ahmad Province, southwest Iran, in 2018 through census sampling. Tuberculin skin test (TST) was utilized to screen the patients for LTBI. All steps were done by trained physicians. RESULTS: In total, 183 patients (mean age: 59.3, SD= 16.0) were included in the study of which 76 (41.5%) were females, and 107 (58.5%) were males. Neither the patients nor their family members had a history of tuberculosis. Assuming an above 5-millimeter enduration as a positive TST result, 22 patients (12%) had LTBI. None of the demographic or clinical features differed between TST -negative and -positive groups. CONCLUSION: Hemodialysis patients are prone to LTBI due to several immunological and environmental factors. Screening for LTBI may be beneficial to prevent active tuberculosis in this population.
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Tuberculose Latente , Diálise Renal , Teste Tuberculínico , Humanos , Feminino , Masculino , Irã (Geográfico)/epidemiologia , Tuberculose Latente/epidemiologia , Tuberculose Latente/diagnóstico , Diálise Renal/efeitos adversos , Prevalência , Pessoa de Meia-Idade , Fatores de Risco , Estudos Transversais , Adulto , Idoso , Falência Renal Crônica/terapia , Falência Renal Crônica/epidemiologiaRESUMO
BACKGROUND: Tuberculosis (TB) is still the main cause of mortality due to a single transfectant, Mycobacterium tuberculosis (MTB). Latent tuberculosis infection (LTBI) is a condition characterized by the presence of tuberculosis (TB) that is not clinically apparent but nonetheless shows a sustained response to MTB. Presently, tuberculin skin test (TST) and interferon gamma (IFN-γ) release assays (IGRAs) are mainly used to detect LTBI via cell-mediated immunity of T-cells. For people with end-stage renal disease (ESRD), the diagnosis of patients infected with MTB is difficult because of T-cell dysfunction. To get more accurate diagnosis results of LTBI, it must compensate for the deficiency of IGRA tests. METHODS: Sixty-seven hemodialysis (HD) patients and 96 non-HD patients were enrolled in this study and the study population is continuously included. IFN-γ levels were measured by the QuantiFERON-TB Gold In-Tube (QFT-GIT) test. Kidney function indicators, blood urea nitrogen (BUN), serum creatinine (Cr), and estimated glomerular filtration rate (eGFR) were used to compensate for the declined IFN-γ levels in the IGRA test. RESULTS: In individuals who were previously undetected, the results of compensation with serum Cr increased by 10.81%, allowing for about 28% more detection, and compensation with eGFR increased by 5.41%, allowing for approximately 14% more detectable potential among them and employing both of them could enhance the prior shortcomings of IGRA tests. when both are used, the maximum compensation results show a sensitivity increase rate of 8.81%, and approximately 23% of patients who were previously undetectable may be found. CONCLUSION: Therefore, the renal function markers which are routine tests for HD patients to compensate for the deficiency of IGRA tests could increase the accuracy of LTBI diagnosis.
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Testes de Liberação de Interferon-gama , Falência Renal Crônica , Tuberculose Latente , Diálise Renal , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/imunologia , Tuberculose Latente/sangue , Masculino , Feminino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Testes de Liberação de Interferon-gama/métodos , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , Falência Renal Crônica/sangue , Falência Renal Crônica/imunologia , Idoso , Interferon gama/sangue , Adulto , Reações Falso-Negativas , Taxa de Filtração Glomerular , Creatinina/sangue , Mycobacterium tuberculosis/imunologia , Teste Tuberculínico/métodos , Nitrogênio da Ureia SanguíneaRESUMO
Neil J Watt and Keith Cutler argue that Defra's aim of achieving officially bovine tuberculosis (bTB)-free status for England by 2038 is unlikely to be met without a drastic change to testing and policy.
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Política de Saúde , Tuberculose Bovina , Tuberculose Bovina/prevenção & controle , Animais , Bovinos , Inglaterra , Erradicação de Doenças , Reino Unido , Teste Tuberculínico/veterináriaRESUMO
INTRODUCTION: Exposure to Non-tuberculous Mycobacteria (NTM) varies regionally and may partly explain the disparate outcomes of BCG vaccination and tuberculosis (TB) susceptibility. METHODS: We examined NTM sputum colonization, associations with clinical characteristics, and tuberculin skin test (TST) responses in an adolescent TB prevalence survey. RESULTS: Among 5004 adolescents screened, 2281 (45.5 %) were evaluated further. TB and NTM prevalence rates were 0.3 % and 8.0 %, respectively. Among 418 NTM isolates, 103 were unidentifiable, and 315 (75 %) comprised 15 species, the most frequent being M. intracellulare (MAC) (108, 26 %), M. scrofulaceum (96, 23 %) and M. fortuitum (51, 12 %). "NTM colonized" adolescents had less frequent chronic cough and night sweats (adjusted odds ratio [aOR] 0.62, 95 % confidence interval [CI] 0.44-0.87and aOR 0.61, CI 0.42-0.89 respectively), and lower TST induration (median 11 mm (interquartile range [IQR] 0-16) vs 13 mm (IQR 6-17; p = 0.006)) when compared to "NTM not colonized" participants. MAC, but not M. scrofulaceum or M. fortuitum, was associated with decreased TST induration (median 7.5 mm (IQR 0-15) vs 13 mm (IQR 6-17) among "MAC colonized" vs "not colonized", p = 0.001). CONCLUSION: We observed high NTM prevalence rates with species-specific associations with TST induration, consistent with a model of species-dependent heterologous immunity among mycobacteria.
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Complexo Mycobacterium avium , Escarro , Teste Tuberculínico , Humanos , Adolescente , Quênia/epidemiologia , Masculino , Feminino , Prevalência , Escarro/microbiologia , Complexo Mycobacterium avium/imunologia , Complexo Mycobacterium avium/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/imunologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/imunologia , Criança , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecção por Mycobacterium avium-intracellulare/imunologia , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Valor Preditivo dos Testes , Estudos TransversaisRESUMO
BACKGROUND: Neonates are at risk of nosocomial tuberculosis (TB) infection from health care workers (HCWs) in neonatal care facilities, which can progress to severe TB diseases. Tuberculin skin test (TST) is commonly used for TB diagnosis, but its accuracy in neonates is influenced by various factors, including bacilli Calmette-Guérin (BCG) vaccination. This study aimed to identify predictors of positive TSTs in neonates exposed to HCWs with pulmonary TB. METHODS: A retrospective observational study was conducted to compare the frequency of predictors between TST-positive and TST-negative neonates. Demographic, epidemiological, and clinical data of neonates exposed to TB, along with that of HCW and household contacts, were collected retrospectively through contact investigations with the Korean National TB Surveillance System (KNTSS) database. TSTs using 2 tuberculin units of purified protein derivative RT23 were performed on exposed neonates at the end of preventive TB treatment. Firth logistic regression was performed to identify predictors of TST positivity. RESULTS: Contact investigations revealed that 152 neonates and 54 HCWs were exposed to infectious TB index cases in 3 neonatal care facilities. Of 152 exposed neonates, 8 (5.3%) had positive TST results. Age of 6 days or more at the initial exposure is a statistically significant predictor of positive TST (Firth coefficient 2.1, 95% confidence interval 0.3-3.9, P = 0.024); BCG vaccination showed no statistical significance in both univariable and multivariable analysis. Sex, prematurity, exposure duration, duration from initial exposure to contact investigation, and isoniazid preventive treatment duration were not significant predictors. CONCLUSION: Age at the initial exposure is a significant predictor of positive TST in neonates exposed to active pulmonary TB. Given the complexities of TST interpretation, including false positives due to BCG vaccination, careful risk assessment is necessary for appropriate decision-making and resource allocation in the management of neonatal TB exposure.