Tuberculin test variability: using the Norwegian Adrenaline-Pirquet method.

SETTING: Chest Unit, Bergen, Norway. OBJECTIVES: To study the agreement between two Adrenaline-Pirquet tuberculin tests and compare reactivity in groups read after 2, 3 and 4 days. DESIGN: Responders from a random sample of 1200 men and women 20-44 years of age in 1991 were tested with dual Adrenaline-Pirquet skin scratch tests with Norwegian-produced synthetic medium tuberculin and read after 2-7 days. RESULTS: Of 588 subjects dually tuberculin tested, complete agreement existed in 220 (37.4%). A difference of 1 mm one way or the other was observed in 239 (40.6%), whereas a difference of less than 3 mm was found in 567 (96.5%). Using the larger of the two reactions increased the rate of tuberculin positivity (> or =4 mm) by up to 8.4% compared with reading only one of the tests. No statistically significant differences were observed between subjects whose reactions were read after 2, 3 and 4 days. CONCLUSION: Under the non-blinded conditions of this study the dual Adrenaline-Pirquet tuberculin tests demonstrated reproducibility equivalent to the internationally recommended Mantoux test, and appeared to be independent of time of reading within four days.

Tuberculin reactivity: prevalence and predictors in BCG-vaccinated young Norwegian adults.

We studied tuberculin reactivity in young Norwegian adults and its possible dependency on age, gender, previous BCG vaccination, smoking habits, occupational exposure, diet as well as years of education as a measure of socio-economic status. Responders of a random sample of men and women aged 20-44 years living in Bergen, Norway were interviewed and tested withthe adrenaline-Pirquettest with Norwegian-produced synthetic mediumtuberculin at the out-patient chest clinic in the city of Bergen in 1992-1993. Nine hundred and three subjects out of 1200 met for the clinical examination (75%). Five hundred and eighty-eight subjects were tuberculin-tested and read, whereof 95% were BCG vaccinated by age 14. Mean tuberculin reactivity was 4.8 mm (SD: 3.0 mm). A positive reaction (> or = 4 mm) was found in 64%, whereof 7% had a strongly positive reaction (>10 mm). A negative reaction (<4 mm) occurred in 36%, whereof 10% had no reaction (0 mm). Only 30% ofthe females and 36% of the males aged 21--25 years were tuberculin positive 7-12 years after BCG vaccination. Linear regression analysis demonstrated tuberculin reactivity to increase with increasing age, male gender with an increasing sex effect by age, and current smoking. Occupational dust or gas exposure, a diet rich in vitamin C or years of education did not influence tuberculin reactivity significantly.

Comparing the adrenaline-Pirquet test with international PPD tuberculin tests.

Several tuberculins, strengths and setting methods are in everyday use. We wanted to compare the Norwegian reference adrenaline Pirquet test with the internationally recommended Mantoux PPD test and Rhoditest. In responders of a random sample of young adults, with randomization of test subjects, we intra-individually compared the adrenaline-Pirquet (aP) test with Norwegian-produced synthetic medium tuberculin (SMT) with either the Mantoux test with PPD 2 tuberculin units (TU) (M2), the Mantoux-PPD 5 TU (M5) or the PPD 2 TU-Rhoditest (Rh). The criteria for a positive reaction were > or = 4mm for the aP test, > or = 10 mm for the M2 test, > or = 6 mm for the M5 test and > or = 2 mm for the Rh test. Strongly positive reactions were defined as aP test > or = 10 mm and M2/M5 test > or = 15 mm. One of the tuberculin tests was positive while the comparison test was negative in 14% of the M2 test group (n = 236), 15% in the M5 test group (n = 162) and 20% in the Rh test group (n = 187). The three PPD tests had positive reactions 3-10 times as often, with a simultaneous negative aP test, than vice versa. Strongly positive reactions occurred in 7% of the aP tests (> or = 10 mm), 32% of the M2 tests (> or = 15 mm) and in 41% of the M5 tests (> or = 15 mm). Receiver operating characteristic (ROC) curves gave the best agreement, with aP test >3mm compared with the M2 and the Rh tests. Regression equations are presented for transformations of the Norwegian reference method of adrenaline-Pirquet results to internationally recommended PPD tests. The international recommendations, globalization in general and the skill of Norwegian public health nurses in performing intra-dermal BCG suggest a future shift to the PPD 2 TU Mantoux test in Norway. Due to the lack of sensitivity and specificity of all tuberculin tests they might be used in targeted tuberculin testing and not as a general screening procedure in a low-incidence tuberculosis area with BCG-vaccinated inhabitants.

Absence of relationship between tuberculin reactivity and asthmatic symptoms, level of FEV1 and bronchial hyperresponsiveness in BCG vaccinated young adults.

BACKGROUND: Some recent studies have suggested that bacillus Calmette-Guérin (BCG) vaccination or mycobacterial infection early in life is inversely related to asthma. We wondered if an increase in tuberculin reactivity was inversely related to commonly used indices of asthma in a population of young adults who were BCG vaccinated at age 14. METHODS: Men and women aged 20-44 years, randomly selected from the general population, were tuberculin tested with the epinephrine-Pirquet method with Norwegian-produced synthetic medium tuberculin (n = 588). In addition they were interviewed using eight questions on asthma symptoms and medication. Lung function and bronchial responsiveness were also tested. RESULTS: Altogether 95% of those studied had been BCG vaccinated at age 14 (n = 558). In the 386 subjects with complete examinations, there was no relationship between a positive tuberculin reaction (> or = 4 mm) and asthma symptoms or use of asthma medication. Furthermore we did not observe any relationship between a positive tuberculin reaction and the level of forced expiratory volume (FEV1) or a positive bronchial responsiveness test, assessed as the percent of predicted of FEV1 and PD20 < 2 mg methacholine, respectively. In multiple logistic regression analyses neither respiratory symptoms, level of FEV1, nor bronchial hyperresponsiveness were related to tuberculin reactivity after adjustment for age, gender and smoking habits. CONCLUSIONS: In this young adult population who were BCG vaccinated at the age of 14 no significant relationship existed between tuberculin reactivity and asthmatic symptoms, level of FEV1 or bronchial hyperresponsiveness. Our data does not support the hypothesis that BCG immunization is beneficial in reducing asthmatic symptoms and disease in young adults.

Improved haemodynamics but reduced arterial blood oxygenation, at rest and during exercise after long-term oral prazosin therapy in chronic cor pulmonale.

The effect of vasodilator therapy in chronic obstructive lung disease with pulmonary hypertension was evaluated in eight patients during oral prazosin therapy (2-10 mg day-1). After one week, prazosin reduced mean pulmonary artery pressure and pulmonary and systemic vascular resistance, and increased cardiac index both at rest and during exercise. Similarly improved haemodynamics were observed after two months of therapy. Arterial PO2 and oxygen saturation fell significantly after two months both at rest and during exercise, but were not changed after one week. Lung function tests were not altered by prazosin. Thus, although prazosin improves the haemodynamics in patients with chronic obstructive lung disease, caution is advised in long-term therapy since prazosin worsens the arterial blood oxygenation.

Notification of tuberculosis in the south-west health region of Norway: incidence and trends.

A survey of tuberculosis notification from the south-west health region of Norway showed a decrease from 17.7 cases of tuberculosis per 100,000 population during 1969-1973 to 12.3 cases per 100,000 during 1979-1983. The notification rate linearly increased with age from the age of 20 years on a logarithmic scale. The downward trend in notification was less marked in the last 5-year period compared with the first 5-year period probably due to changes in notification procedures in 1976, an epidemic of tuberculosis in the health region and on oil platforms in the North Sea in 1980 and an increased immigration of people from areas with high incidence of tuberculosis. Tuberculosis of the extrathoracic lymph nodes was during 1979-1983 the most frequent location of non-respiratory tuberculosis.

Demonstration and partial characterization of an atypical protein in the urine of a patient with primary amyloidosis.

A paraprotein has been isolated from the urine of a patient with primary amyloidosis. Immunologically it was classified as a free lambda light chain. The molecular weight was 22500 daltons. N-terminal amino acid analysis demonstrated homology with lambda IV variable subgroup in 19 of the first 20 amino acids. Extensive homology with lambda IV chains was demonstrated also in the hypervariable region of the light chain. An antiserum produced against the paraprotein was rendered idiotype-specific by absorption with pooled human light chains. This antiserum stained tissue specimen from the rectum and liver of the patient by the indirect immunofluorescence technique. This strongly indicates that the free lambda light chains that can be isolated from the urine are also deposited in the tissues as amyloid substance.

Absence of relationship between tuberculin reactivity and atopy in BCG vaccinated young adults.

BACKGROUND: An inverse association between tuberculin responses and atopy has been observed in Japanese children, indicating that BCG immunisation, subclinical exposure to Mycobacterium tuberculosis without clinical disease, or host characteristics may influence the T helper (Th) lymphocyte balance with decreased atopy as a result. This study was undertaken to determine whether tuberculin reactivity is inversely related to atopy in young adults vaccinated with BCG at the age of 14. METHODS: Men and women aged 20-44 years were tested using the adrenaline-Pirquet test with Norwegian produced synthetic medium tuberculin (n = 891). In addition, their serum total and specific IgE antibodies against mite, cat, timothy grass, mould and birch were measured. RESULTS: Of the 574 subjects with complete examinations, 64% had a positive adrenaline-Pirquet tuberculin test (> or =4 mm) and 27% exhibited IgE antibodies (> or =0.35 kU/l) to one or more of the five specific allergens. The geometric mean of total serum IgE in the population was 30.2 kU/l. Tuberculin reactivity and log IgE were not correlated (r = 0.043, p = 0.30). The mean tuberculin reactivity was 4.6 mm, 4.9 mm, and 5.0 mm in the lower, middle and upper tertile of IgE distribution (<14 kU/l, 14-61 kU/l, >61 kU/l). The prevalence of atopy, as assessed by either the presence of any of the five specific IgE antibodies or by each specific IgE antibody separately, did not differ between subjects with a positive and those with a negative tuberculin test. These results persisted after adjustment for age, sex, and smoking status in multivariate logistic regression analyses. CONCLUSIONS: In this young adult population, BCG vaccinated at the age of 14, no significant relationship between a positive tuberculin reaction and atopy was observed. If a true relationship had been found, our study suggests that it may be limited to populations immunised in early childhood when a substantial modulation of the immune system can occur.