Tuberculin Skin Test

A tuberculin skin test is done to see if you have ever had tuberculosis (TB). The test is done
by putting a small amount of TB protein (antigens) under the top layer of skin on your inner
forearm. If you have ever been exposed to the TB bacteria (Mycobacterium tuberculosis),
your skin will react to the antigens by developing a firm red bump at the site within 2 days.
The TB antigens used in a tuberculin skin test are called purified protein derivative (PPD). A
measured amount of PPD in a shot is put under the top layer of skin on your forearm. This is
a good test for finding a TB infection. It is often used when symptoms, screening, or testing,
such as a chest X-ray, show that a person may have TB.
A tuberculin skin test cannot tell how long you have been infected with TB. It also cannot tell
if the infection is latent (inactive) or is active and can be passed to others.
Why It Is Done
A tuberculin skin test is done to find people with tuberculosis (TB), including:

• People who have been in close contact with someone known to have TB.
• Health care workers who are likely to be exposed to TB.
• People with TB symptoms, such as an ongoing cough, night sweats, and weight loss
for no reason.
• People who have had an abnormal chest X-ray.
• People who have had a recent organ transplant or with impaired immune systems,
such as those with human immunodeficiency virus (HIV).

A tuberculin skin test should not be done for people:

• With a known TB infection.

• Who have had a previous severe reaction to the TB antigens.
• With a skin rash that would make it hard to read the skin test.

How To Prepare
Before having a tuberculin skin test, tell your doctor if you:

• Have symptoms of tuberculosis (TB), such as an ongoing cough, night sweats, or weight
loss for no reason.
• Have had a severe reaction to a tuberculin skin test in the past.
• Have had TB in the past.
• Have risk factors for TB. Risk factors include:
- Contact with a person who has TB.
- A job as a health care worker that may cause you to be exposed to people with TB.
- Having lived or traveled in a country where TB is common.
• Have been given a TB vaccination. The vaccine contains a bacteria called BCG (bacille
Calmette-Guérin) that is closely related to the bacteria that cause TB.
• Have been treated with medicines, such as corticosteroids, that can affect your immune
system.
• Are infected with the human immunodeficiency virus (HIV).
• Have a skin rash that may make it hard to read the skin test.

How is the tuberculosis skin test administered?

The standard recommended tuberculin test, known as the Mantoux test, is administered by
injecting a 0.1 mL volume containing 5 TU (tuberculin units) PPD into the top layers of skin
(intradermally, immediately under the surface of the skin) of the forearm. The use of a skin
area that is free of abnormalities and away from veins is recommended. The injection is
typically made using a ¼- to ½-inch, 27-gauge needle and a tuberculin syringe. The
tuberculin PPD is injected just beneath the surface of the skin. A discrete, pale elevation of
the skin (a wheal) 6 mm-10 mm in diameter should be produced when the injection is done
correctly. This wheal or "bleb" is generally quickly absorbed. If it is recognized that the first
test was improperly administered, another test can be given at once, selecting a site several
centimeters away from the original injection.

After the test

Some redness at the skin test site is expected. The site may itch, but it is important that you
do not scratch it, since this may cause redness or swelling that could make it hard to read the
skin test. If itching is a problem, put a cold washcloth on the site and then dry it.
A strong positive reaction may cause mild pain. Talk to your doctor if you have:

• A fever.
• Swelling in your arm.
• Swollen lymph nodes in your armpit.

Results
A tuberculin skin test is done to see if you have ever had tuberculosis (TB) (infection with
Mycobacterium tuberculosis).
Redness alone at the skin test site usually means you have not been infected with TB
bacteria. A firm red bump may mean you have been infected with TB bacteria at some time.
The size of the firm bump (not the red area) is measured 2 to 3 days after the test to
determine the result. Your doctor will consider your chance of having TB when looking at the
skin test site. See a picture of the measurement of a tuberculin skin test result .
Three levels of risk have been defined:

• High-risk group includes people who have human immunodeficiency

virus (HIV), those who have had close recent contact with a person who
has an active TB infection, and those who have symptoms or a chest X-ray
that shows TB. Other people at high risk for tuberculosis include those who
take medicines that contain corticosteroids for a long time or people taking
tumor necrosis factor-alpha antagonists (used to treat rheumatoid arthritis
and Crohn's disease).
• Moderate-risk group includes people who have recently moved from or
traveled in a country with a high rate of TB; those who use illegal drugs by
injection (intravenous drug users); people who live in nursing homes;
workers in hospitals, nursing homes, schools, and prisons; children younger
than 4 years old; children (ages 4 to 18) who are exposed to high-risk
adults; and homeless people. Others at moderate risk for having
tuberculosis include people who are 10% or more below their ideal body
weight and people who have kidney failure, diabetes, leukemia, cancer, or
those who have had part of their stomach removed (gastrectomy).
• Low-risk group includes people who do not have any possible
exposure to TB listed in the other risk groups.