Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda.
One principle of tuberculosis control is to prevent the development of tuberculosis disease by treating individuals with latent tuberculosis infection. The diagnosis of latent infection using the tuberculin skin test is not straightforward because of concerns about immunologic cross reactivity with...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0245328&type=printable |
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| author | Henok G Woldu Sarah Zalwango Leonardo Martinez María Eugenia Castellanos Robert Kakaire Juliet N Sekandi Noah Kiwanuka Christopher C Whalen |
| author_facet | Henok G Woldu Sarah Zalwango Leonardo Martinez María Eugenia Castellanos Robert Kakaire Juliet N Sekandi Noah Kiwanuka Christopher C Whalen |
| author_sort | Henok G Woldu |
| collection | DOAJ |
| description | One principle of tuberculosis control is to prevent the development of tuberculosis disease by treating individuals with latent tuberculosis infection. The diagnosis of latent infection using the tuberculin skin test is not straightforward because of concerns about immunologic cross reactivity with the Bacille Calmette-Guerin (BCG) vaccine and environmental mycobacteria. To parse the effects of BCG vaccine and environmental mycobacteria on the tuberculin skin test, we estimated the frequency distribution of skin test results in two divisions of Kampala, Uganda, ten years apart. We then used mixture models to estimate parameters for underlying distributions and defined clinically meaningful criteria for latent infection, including an indeterminate category. Using percentiles of two underlying normal distributions, we defined two skin test readings to demarcate three ranges. Values of 10 mm or greater contained 90% of individuals with latent infection; values less than 7.2 mm contained 80% of individuals without infection. Contacts with values between 7.2 and 10 mm fell into an indeterminate zone where it was not possible to assign infection. We conclude that systematic tuberculin skin test surveys within populations at risk, combined with mixture model analysis, may be a reproducible, evidence-based approach to define meaningful criteria for latent tuberculosis infection. |
| format | Article |
| id | doaj-art-52c4e5fb12cf46c1b803b5ef9a1c1339 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-52c4e5fb12cf46c1b803b5ef9a1c13392025-08-20T03:44:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01161e024532810.1371/journal.pone.0245328Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda.Henok G WolduSarah ZalwangoLeonardo MartinezMaría Eugenia CastellanosRobert KakaireJuliet N SekandiNoah KiwanukaChristopher C WhalenOne principle of tuberculosis control is to prevent the development of tuberculosis disease by treating individuals with latent tuberculosis infection. The diagnosis of latent infection using the tuberculin skin test is not straightforward because of concerns about immunologic cross reactivity with the Bacille Calmette-Guerin (BCG) vaccine and environmental mycobacteria. To parse the effects of BCG vaccine and environmental mycobacteria on the tuberculin skin test, we estimated the frequency distribution of skin test results in two divisions of Kampala, Uganda, ten years apart. We then used mixture models to estimate parameters for underlying distributions and defined clinically meaningful criteria for latent infection, including an indeterminate category. Using percentiles of two underlying normal distributions, we defined two skin test readings to demarcate three ranges. Values of 10 mm or greater contained 90% of individuals with latent infection; values less than 7.2 mm contained 80% of individuals without infection. Contacts with values between 7.2 and 10 mm fell into an indeterminate zone where it was not possible to assign infection. We conclude that systematic tuberculin skin test surveys within populations at risk, combined with mixture model analysis, may be a reproducible, evidence-based approach to define meaningful criteria for latent tuberculosis infection.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0245328&type=printable |
| spellingShingle | Henok G Woldu Sarah Zalwango Leonardo Martinez María Eugenia Castellanos Robert Kakaire Juliet N Sekandi Noah Kiwanuka Christopher C Whalen Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda. PLoS ONE |
| title | Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda. |
| title_full | Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda. |
| title_fullStr | Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda. |
| title_full_unstemmed | Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda. |
| title_short | Defining an intermediate category of tuberculin skin test: A mixture model analysis of two high-risk populations from Kampala, Uganda. |
| title_sort | defining an intermediate category of tuberculin skin test a mixture model analysis of two high risk populations from kampala uganda |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0245328&type=printable |
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