The use of topical zinc in tuberculin test
Keywords:
topical zinc, tuberculin test, children, tuberculosis
Abstract
with under-diagnosis or over-diagnosis commonly occurring. The tuberculin test as a supporting examination for tuberculosis infection has a false negative value rate of 10-25%. Also, a majority of children with tuberculosis have lower plasma zinc levels than healthy children. Zinc deficiency may impair the immune response, leading to more false negative skin-test results.Objective To evaluate the effectiveness of topical zinc for augmenting the diameter of tuberculin induration in children with tuberculosis.
Methods This unblinded, clinical trial was performed from October to December 2012 in subjects matched with themselves. Subjects were children with tuberculosis aged 2-18 years at the Department of Child Health at Cipto Mangunkusumo Hospital and Persahabatan Hospital. Every subject was injected tuberculin in volar region of left and right arm. Test sites then were covered with topical zinc cream on the right arm and placebo cream on the left arm. Indurations were measured after 72 hours. The difference of tuberculin diameter of 3 mm was considered as clinically significant. Data analysis was performed with Wilcoxon signed rank test.
Results There were 47 subjects in this study. The majority of subjects were well-nourished (53%). Subjects’ median treatment duration was < 6 months, median age was 72 months and 47% of subjects were under the age of five years. Sixteen subjects had a median 1 mm difference in tuberculin induration diameter between the zinc arm and placebo arm (P<0.001), but this was clinically insignificant. Twenty-two subjects (43%) had Koch reaction after zinc cream application, but the placebo cream did not cause Koch reaction.
Conclusion Application of topical zinc does not increase tuberculin induration compared to placebo.
References
1. Huebner RE, Schein MF, Bass JB.The tuberculin skin test. Clin Infect Dis. 1993;17:968-75.
2. Menon MPS. A new look at the immunology of tuberculosis. Indian J Tub. 1997;44:3-8.
3. American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161:1376-95.
4. Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in human and experimental animals. Int J Tuberc Lung Dis. 2004;8:286-98.
5. R Ray M, Kumar L, Prasad R. Plasma zinc status in Indian childhood tuberculosis: an impact of antituberculosis therapy. Int J Tuberc Lung Dis. 1998;2:719-25.
6. Soegiarto B. Kadar seng plasma pasien tuberkulosis anak: studi pendahuluan [thesis]. [Jakarta]: FKUI; 2008.
7. Rao VB, Pelly TF, Gilman RH, Cabrera L, Delgado J, Soto G, et al. Zinc cream and reliability of tuberculous skin testing. Emerg Infect Dis. 2007;13:1101-4.
8. Kwok T, Fotherby MD, Cookson J, Potter JF, Castleden CM. Can topical zinc accentuate tuberculin reactivity in the elderly? Respir Med. 1994;88:237-8.
9. Supriyatno B, Rahajoe NN, Rahajoe N, Boediman I, Said M, Setyanto DB. Karakteristik tuberkulosis anak dengan biakan positif. Cermin Dunia Kedok. 2002;137:21-4.
10. Gulec SG, Telhan L, Kockaya T, Erdem E, Bayraktar B, Palanduz A. Description of pediatric tuberculosis evaluated in referral center in Istanbul Turkey. Yonsei Med J. 2012;53:1176-82.
11. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68:447S-63S.
12. Chavakis T, May AE, Preissner KT, Kanse SM. Molecular mechanisms of zinc-dependent leukocyte adhesion involving the urokinase receptor and β2-integrins. Blood. 1999;93:2976-83.
13. Rink L, Kirchner H. Zinc-altered immune function and cytokine production. J Nutr. 2000;130:1407S-11S.
14. Prasad AS. Clinical, immunological,anti-inflammatory and antioxidant roles of zinc. Exp Gerontol. 2008;43:370-7.
15. Kenyorini, Suradi, Surjanto E. Uji tuberkulin. J Tuber Indo. 2006;3:1-5.
16. Lin RY, Busher J, Bogden GJ, Schwart RA. Topical zinc sulfate augmentation of human delayed type skin test response. Acta Derm Venereol. 1985;65:190-3.
17. Menzies D. Interpretation of repeated tuberculin tests: boosting, conversion, and reversion. Am J Respir Crit Care Med. 1999;159:15-21.
18. Oliveira HMV, Sant’Anna CC. Tuberculin test in the diagnosis of childhood tuberculosis: analysis of quantitative and qualitative features. Oliveira HMV J Pediatr. 2000;76:115-8.
2. Menon MPS. A new look at the immunology of tuberculosis. Indian J Tub. 1997;44:3-8.
3. American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161:1376-95.
4. Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in human and experimental animals. Int J Tuberc Lung Dis. 2004;8:286-98.
5. R Ray M, Kumar L, Prasad R. Plasma zinc status in Indian childhood tuberculosis: an impact of antituberculosis therapy. Int J Tuberc Lung Dis. 1998;2:719-25.
6. Soegiarto B. Kadar seng plasma pasien tuberkulosis anak: studi pendahuluan [thesis]. [Jakarta]: FKUI; 2008.
7. Rao VB, Pelly TF, Gilman RH, Cabrera L, Delgado J, Soto G, et al. Zinc cream and reliability of tuberculous skin testing. Emerg Infect Dis. 2007;13:1101-4.
8. Kwok T, Fotherby MD, Cookson J, Potter JF, Castleden CM. Can topical zinc accentuate tuberculin reactivity in the elderly? Respir Med. 1994;88:237-8.
9. Supriyatno B, Rahajoe NN, Rahajoe N, Boediman I, Said M, Setyanto DB. Karakteristik tuberkulosis anak dengan biakan positif. Cermin Dunia Kedok. 2002;137:21-4.
10. Gulec SG, Telhan L, Kockaya T, Erdem E, Bayraktar B, Palanduz A. Description of pediatric tuberculosis evaluated in referral center in Istanbul Turkey. Yonsei Med J. 2012;53:1176-82.
11. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68:447S-63S.
12. Chavakis T, May AE, Preissner KT, Kanse SM. Molecular mechanisms of zinc-dependent leukocyte adhesion involving the urokinase receptor and β2-integrins. Blood. 1999;93:2976-83.
13. Rink L, Kirchner H. Zinc-altered immune function and cytokine production. J Nutr. 2000;130:1407S-11S.
14. Prasad AS. Clinical, immunological,anti-inflammatory and antioxidant roles of zinc. Exp Gerontol. 2008;43:370-7.
15. Kenyorini, Suradi, Surjanto E. Uji tuberkulin. J Tuber Indo. 2006;3:1-5.
16. Lin RY, Busher J, Bogden GJ, Schwart RA. Topical zinc sulfate augmentation of human delayed type skin test response. Acta Derm Venereol. 1985;65:190-3.
17. Menzies D. Interpretation of repeated tuberculin tests: boosting, conversion, and reversion. Am J Respir Crit Care Med. 1999;159:15-21.
18. Oliveira HMV, Sant’Anna CC. Tuberculin test in the diagnosis of childhood tuberculosis: analysis of quantitative and qualitative features. Oliveira HMV J Pediatr. 2000;76:115-8.
Published
2013-10-30
How to Cite
1.
Rahmadhany A, Setyanto D, Trihono P. The use of topical zinc in tuberculin test. PI [Internet]. 30Oct.2013 [cited 25Nov.2024];53(5):273-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/305
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Received 2016-08-21
Accepted 2016-08-21
Published 2013-10-30
Accepted 2016-08-21
Published 2013-10-30
