Unreliability of the Mantoux test using 1 TU PPD in excluding childhood tuberculosis in Papua New Guinea.

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Abstract
Children (139) with bacteriological or histological proof of active tuberculosis (Mycobacterium tuberculosis) were given the Mantoux tuberculin test while they were inpatients. Only half (70) of the children had positive results (induration of at least 5 mm). Of the 35 children under 2 yr, 25 (71%) showed no reaction. Malnutrition, assessed by weight for age, did not appear to influence the response although nearly all children under 5 weighed less than the Harvard mean. Previous BCG immunization had no significant effect on the reaction to tuberculin. General debility, recent measles, treatment with corticosteroids, or early stage of illness may account for some negative reactions, but whatever the cause, the high proportion of negative results means that the tuberculin test as currently practiced in Papua New Guinea cannot be relied on to exclude active tuberculosis in children.