Herf test tine test
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tine test tuberculosis TB skin test overview 2024
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Here is a comprehensive overview of Tuberculosis (TB) and its key diagnostic tests, including the tine test you mentioned:
Tuberculosis (TB)
Causative Organism & Transmission
Tuberculosis is caused by Mycobacterium tuberculosis, transmitted by airborne droplets from close contact with infected individuals. The lungs are the most common site, but hematogenous spread can cause extrapulmonary TB in 10-25% of patients worldwide (meningitis, peritonitis, renal TB, Pott's disease/spinal TB, adrenal TB, and others). - Textbook of Family Medicine 9e
Clinical Presentation
Pulmonary TB typically includes:
- Fever and night sweats
- Productive cough, hemoptysis
- Anorexia and weight loss
- Imaging: upper lobe cavitary lesions (reactivation TB), or consolidation in lower lobe apex (primary TB)
Extrapulmonary TB includes:
- Miliary (disseminated) TB - more common in children and immunosuppressed
- Serosal TB - pleurisy, meningitis (most dangerous), pericarditis, peritonitis, arthritis
- Solid organ TB - osteomyelitis (Pott's disease), adrenal TB
Diagnostic Tests for TB
1. Tine Test (Multipuncture Test)
The tine test is an older, multiple-puncture tuberculin skin test where a device with 4 tines (small prongs) coated with tuberculin is pressed into the skin of the forearm. It was historically used for TB screening but is no longer recommended by the CDC because:
- Results are less reliable and harder to standardize than the Mantoux test
- It has been largely replaced by the Mantoux TST and IGRA blood tests
2. Mantoux Tuberculin Skin Test (TST / PPD Test) - Current Standard
- 0.1 mL of purified protein derivative (PPD) is injected intradermally into the forearm (Mantoux method)
- Read at 48-72 hours by measuring the induration (hardness), NOT just redness
- Interpretation of induration size:
- ≥5 mm = positive in HIV+ patients, close contacts of active TB, immunosuppressed
- ≥10 mm = positive in high-risk groups (recent immigrants, healthcare workers, prisoners, IV drug users)
- ≥15 mm = positive in low-risk individuals
- Per the CDC Mantoux guidelines, this is the standard skin test currently in use
3. Interferon-Gamma Release Assays (IGRAs) - Blood Tests
Two FDA-approved blood tests:
- QuantiFERON-TB Gold (QFT) - measures interferon-gamma release from sensitized T-cells; a result >15 on the QFT is moderately correlated with a positive skin test
- T-SPOT.TB Test - another IGRA option
Advantages of IGRAs over TST:
- One-time blood sample (no second visit needed)
- Greater specificity for M. tuberculosis (not cross-reactive with BCG vaccine)
- No anamnestic (booster) response on repeat testing
4. Latent TB
Latent TB = positive TST or IGRA without evidence of active disease. Positive results should prompt consultation with guidelines for preventive therapy with isoniazid (INH). - Textbook of Family Medicine 9e
Treatment of Active TB
The standard US regimen uses 4 drugs (RIPE therapy):
| Drug | Abbreviation |
|---|---|
| Isoniazid | INH |
| Rifampin | RIF |
| Pyrazinamide | PZA |
| Ethambutol | EMB |
- Duration: 6 months total for pulmonary TB (regardless of HIV status)
- Patients are generally non-contagious after 2 weeks of effective therapy
- Treatment should be supervised by local/state health department
Summary: Tine Test vs. Mantoux vs. IGRA
| Feature | Tine Test | Mantoux TST | IGRA (QFT/T-SPOT) |
|---|---|---|---|
| Method | Skin prick | Intradermal injection | Blood test |
| Visits needed | 2 | 2 | 1 |
| Standardization | Poor | Good | Excellent |
| BCG cross-reactivity | Yes | Yes | No |
| Current use | Obsolete | Standard | Preferred in many settings |
The tine test has been phased out of clinical practice. The Mantoux TST and IGRAs (especially QuantiFERON) are the current standard of care per CDC TB testing guidelines.
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