Differential avian and human tuberculin skin testing in non-tuberculous mycobacterial infection

Objective-To determine the sensitivity of differential avian and human delayed type hypersensitivity skin testing in the diagnosis of non-tuberculous mycobacterial lymphadenitis. Method-Retrospective review of all patients with culture proved nontuberculous mycobacterial lymph node infections who also had differential avian and human skin testing performed over a 10 year period from 1986 to 1996. Results-One hundred and twenty four patients had non-tuberculous mycobacteria isolated from lymph nodes over this period, 59 of whom had differential skin testing performed. The sensitivity of a response of greater than or equal to 10 mm to the avian precipitin was 58 of 59. No patient had both a negative human and avian Mantoux. The sensitivity of the human Mantoux alone for diagnosing non-tuberculous mycobacterial infection was 81% for a response of greater than or equal to 5 mm and 66% for greater than or equal to 10 mm. Ten patients had a 0 human response. Fifty five of the 59 patients had an avian response at least 2 mm greater than the human response. Conclusion-The avian Mantoux is a very sensitive method of diagnosing nontuberculous mycobacterial infection in children. The human Mantoux is not sensitive enough to be used alone as a surrogate to diagnose non-tuberculous mycobacterial infection.