Tuberculin
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| Trade names | Aplisol, Mantoux, PPD, others |
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intradermal |
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Tuberculin, also known as purified protein derivative is a combination of proteins that are used in the diagnosis of tuberculosis. This use is referred to as the tuberculin skin test and is recommended only for those at high risk. Injection is done into the skin. After 48 to 72 hours if there is more than a five to ten millimeter area of swelling the test is considered positive.
Common side effects include redness, itchiness, and pain at the site of injection. Allergic reactions may occasionally occur. The test may be falsely positive in those who have been previously vaccinated with BCG or have been infected by other types of mycobacteria. The test may be falsely negative within 10 weeks of infection, in those less than 6 months old, and in those who have been infected for many years. Use is safe in pregnancy. Tuberculin is made out of an extract of Mycobacterium tuberculosis.
Tuberculin was discovered in 1890 by Robert Koch. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is about 0.22 USD per dose. In the United States testing costs less than 25 USD.
The test used in the United States at present is referred to as the Mantoux test. An alternative test called the Heaf test was used in the United Kingdom until 2005, although the UK now uses the Mantoux test in line with the rest of the world. Both of these tests use the tuberculin derivative PPD (purified protein derivative).
Tuberculin was discovered by German scientist and physician Robert Koch in 1890. The original tuberculin discovered by Koch was a glycerine extract of the tubercle bacilli and was developed as a remedy for tuberculosis, but it was ineffective in this role. Clemens von Pirquet, an Austrian physician, discovered that patients who had previously received injections of horse serum or smallpox vaccine had quicker, more severe reactions to a second injection, and he coined the word allergy to describe this hypersensitivity reaction. Soon thereafter von Pirquet discovered the same type of reaction took place in those infected with tuberculosis, and he thus found the utility of what would become the tuberculin skin test. Individuals with active tuberculosis were usually tuberculin positive, but many of those with disseminated and rapidly progressive of disease were negative. This led to the widespread but erroneous belief that tuberculin reactivity is an indicator of immunity to tuberculosis.
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