Teste tuberculínico. Como optimizar?

 

Raquel Duarte 1

 

 

Resumo

Os testes utilizados no diagnóstico de infecção latente pelo Mycobacterium tuberculosis, o teste tuberculínico e o doseamento do interferão gama (IGRA) identificam a existência de uma resposta imunológica adaptativa de memória contra os antigénios micobacterianos. Considerando as limitações dos dois testes, a melhor solução passa por tirar proveito das melhores características de cada um. A maior parte dos autores concorda com a utilização dos dois testes, utilizando os IGRA sobretudo na confirmação da positividade do teste tuberculínico (tirando proveito da sua maior especificidade).

As características operativas do teste tuberculínico dependem da prevalência da doença na comunidade e dos objectivos da sua realização (as suas características são superiores quando utilizada no âmbito de rastreio ou como teste diagnóstico). Para interpretar correctamente um teste tuberculínico, o clínico deve conhecer a epidemiologia da tuberculose na comunidade e definir correctamente as indicações para a sua realização.

Palavras-chave: Tuberculose, teste tuberculínico, Mantoux.

 

 

Tuberculin skin test. How to optimise?

Abstract

The tests used in the diagnosis of tuberculosis latent infection, the tuberculin skin test (TST) and the interferon -gamma assays (IGRA), identify the existence of an adaptive immune response towards mycobacterial antigens. Considering the limitations of the two tests, the best solution is to take advantage of the best characteristics of each one. Most of the authors agree to the use of the two tests, using the IGRAS in the confirmation of a positive TST (because of its higher specificity). The operative characteristics of TST depend on the prevalence of the illness in the community and the aim of its use (its operative characteristics are higher when used in the tracing scope or as a diagnostic test). To interpret correctly a TST, the physician must know the epidemiology of tuberculosis in the community and correctly define the indications for its use.

Key-words: Tuberculosis, tuberculin skin test, Mantoux.

 

 

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1 Assistente Hospitalar de Pneumologia

 

Recebido para publicação/received for publication: 08.09.29

Aceite para publicação/accepted for publication: 08.11.10