Association between tuberculin skin test result and clinical presentation of tuberculosis disease

Background: The tuberculin skin test (TST) is used to test for latent tuberculosis (TB) infection and support the diagnosis of active TB. However, little is known about the relationship between the TST result and the clinical presentation of TB disease. Methods: We analyzed US TB surveillance data, 1993-2010, and used multinomial logistic regression to calculate the association between TST result (0-4 mm [negative], 5-9 mm, 10-14 mm, and >= 15 mm) and clinical presentation of disease (miliary, combined pulmonary and extrapulmonary, extrapulmonary only, non-cavitary pulmonary, and cavitary pulmonary). For persons with pulmonary disease, multivariate logistic regression was used to calculate the odds of having acid-fast bacilli (AFB) positive sputum. Results: There were 64,238 persons with culture-confirmed TB included in the analysis, which was stratified by HIV status and birthplace (US-vs. foreign-born). Persons with a TST >= 15 mm were less likely to have miliary or combined pulmonary and extrapulmonary disease, but more likely to have cavitary pulmonary disease than noncavitary pulmonary disease. Persons with non-cavitary pulmonary disease with a negative TST were significantly more likely to have AFB positive sputum. Conclusions: Clinical presentation of TB disease differed according to TST result and persons with a negative TST were more likely to have disseminated disease (i.e., miliary or combined pulmonary and extrapulmonary). Further study of the TST result may improve our understanding of the host-pathogen relationship in TB disease.