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TB Screening Tests

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Also known as: Purified Protein Derivative; PPD; Mantoux; Latent Tuberculosis Infection Test; Interferon-gamma Release Assays; IGRA; T-Spot®.TB; QuantiFERON®-TB Gold (QFT-G); QuantiFERON®-TB Gold In-Tube (QFT-GIT)
Formal name: Tuberculin Skin Test; Interferon Gamma Release Assays

The Test Sample

What is being tested?

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. TB primarily targets the lungs but may affect any area of the body such as the urinary tract, central nervous system, bones, joints, and/or other organs. TB screening tests help to determine whether a person has become infected with Mycobacterium tuberculosis bacteria. The screening tests measure the body's immune response to antigens derived from these bacteria, either directly as a skin reaction to a tuberculin skin test (TST) or indirectly with an interferon gamma release assay (IGRA) blood test.

TB may cause an inactive (latent) infection or an active, progressive disease. The immune system of about 90% of people who become infected with TB manages to control its growth and confine the TB infection to a few cells in the body. The bacteria in these cells are inactive but still alive. The person does not have any symptoms and is not infectious but does have a "latent TB infection."

If, after some time, the immune system of an individual with an inactive infection becomes weakened (compromised), the mycobacteria may begin to grow again, leading to an active case of tuberculosis disease. Active TB does cause illness and can be passed to others through respiratory secretions such as sputum or aerosols released by coughing, sneezing, laughing, talking, singing, or breathing.

Both the tuberculin skin test and the IGRA blood test can detect M. tuberculosis infections, but neither can distinguish between latent and active infections. Additional tests, such as AFB testing, are required to help establish a diagnosis of an active TB infection.

How is the sample collected for testing?

For the tuberculin skin test, no sample is required. The test is performed on a person's skin. A purified protein derivative (PPD) solution that contains M. tuberculosis antigens, but not live bacteria, is used to provoke a hypersensitivity skin reaction (a red, raised bump) in those who have been infected by TB.

A health practitioner will wipe the inner forearm with alcohol and let the skin dry. Using a 1cc syringe and a tiny needle, the health practitioner will then inject a small amount of PPD solution just under the first layer of the skin. When done correctly, the injection forms a small bubble of fluid that looks like a blister. The site should be left uncovered and undisturbed. The site must be examined by a health practitioner at 48 and/or 72 hours to see if a local skin reaction has occurred.

For an interferon gamma release assay, a blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.