Summary Despite a variety of therapeutic options that is available, treatment of warts remains challenging and rate of recurrence is high. Intralesional immunotherapy is an emerging therapy for warts. Tuberculin purified protein derivative (PPD) is one of the immunotherapeutic antigens used for the treatment of warts. Here we report a case of recalcitrant periungual wart successfully treated with tuberculin immunotherapy.
Tuberculin--therapeutic use ; Wart--therapy

Background: Verruca vulgaris ranked 10th in the top 10 diseases in 2019 seen among the Philippine Dermatological Society training institutions. The efficacy of immunotherapy, such as intralesional zinc sulfate (ZS), for warts were reported. Considering the limited studies with promising results on verruca, a study on the efficacy and safety of intralesional zinc in the treatment of verruca was considered. Objective: This study aims to determine the efficacy and safety of intralesional 2% ZS in comparison to intralesional purified protein derivative (PPD) among adult patients with verruca vulgaris. Methods: This is a double-blind, randomized, controlled trial involving 44 patients allocated to group ZS (n=22) and PPD (n=22). Intralesional injections of ZS or PPD to the largest wart were done at weeks 0, 2, 4, 6, 8, 10. Clearance and size reduction of the target and distant wart at 12th week and recurrence at 14th week were assessed. Adverse effects were checked. Results: At the 12th week of treatment, higher proportion in group ZS patients achieved total resolution of the target lesion compared to PPD, but results were not statistically significant (29% vs. 19%). Both groups showed decline in the target lesion size. The median size reduction between the two groups showed no significant differences. Three patients from group ZS showed clearance of distant warts while none in group PPD. There was no recurrence of all previously resolved warts. Adverse reactions were pain, edema, and erythema. Conclusion Intralesional 2% zinc sulfate (29%) was efficacious and safe compared to Intralesional PPD (19%) but the difference was not statistically significant. There was clearance of distant warts in 5% of group ZS patients. The mild adverse events did not warrant discontinuation of treatment.
Zinc Sulfate ; Tuberculin

OBJECTIVE: To study the clinical features of METHODS: A retrospective analysis was performed on the medical data of children with immunodeficiency and RESULTS: The onset age in the PID group was significantly lower than those in the control and SID groups ( CONCLUSIONS Children with immunodeficiency and
Age of Onset ; Child ; Humans ; Immunologic Deficiency Syndromes/diagnosis* ; Male ; Retrospective Studies ; Tuberculin Test ; Tuberculosis/epidemiology*

Introduction: Intralesional purified protein derivative (PPD) is an affordable therapeutic option that has been studied for cutaneous warts. However, the lack of good evidence precludes its widespread use. Objective: To determine the efficacy and safety of intralesional PPD in the treatment of cutaneous warts. Methods: A systematic search for controlled clinical trials comparing intralesional PPD and placebo or any conventional therapy was conducted using electronic databases. The included studies were assessed for risk of bias, and data such as clearance rate of target and distant lesions, recurrence rate, and adverse events were extracted. Analysis was done through RevMan v5.3. Results: Four controlled clinical trials composed of 205 patients were included. All of the studies compared intralesional PPD to placebo as comparator. Intralesional PPD had a significantly higher clearance rate of target wart (RR=0.43[0.22,0.84], P=0.01) and a significantly higher clearance rate of distant lesions (RR=0.59[0.41,0.85], P=0.005) as compared to placebo. However, there was no significant difference in the recurrence rate (RR=0 [-0.07,0.07], P=0.98). Adverse events reported were only considered minor. Conclusion Intralesional PPD is an effective and safe treatment option for cutaneous warts. However, more well-structured RCTs with longer follow-up period and those comparing it with conventional treatment are needed to further support its use.
Warts ; Meta-Analysis ; Tuberculin

BACKGROUND: Tuberculosis (TB) is increasing in immigrants. We aimed to investigate the current status of latent tuberculosis infection (LTBI) treatment for North Korean Refugees (NKR) compared to South Koreans Contacts (SKC). METHODS: TB close contacts in a closed facility of SKC and NKR who underwent LTBI screening in a settlement support center for NKR were analyzed retrospectively. RESULTS: Among tuberculin skin test (TST) ≥10 mm (n=298) reactors, the males accounted for 72.2% in SKC (n=126) and 19.5% in NKR (n=172) (p<0.01). The mean age was higher in South Korea (42.8±9.9 years vs. 35.4±10.0 years, p<0.01). Additionally, the mean TST size was significantly bigger in NKR (17.39±3.9 mm vs. 16.57±4.2 mm, p=0.03). The LTBI treatments were initiated for all screened NKR, and LTBI completion rate was only 68.0%. However, in NKR, LTBI treatment completion rate was significantly increased by shorter 4R regimen (odds ratio [OR], 9.296; 95% confidence interval [CI], 4.159–20.774; p<0.01) and male (OR, 3.447; 95% CI, 1.191–9.974; p=0.02). CONCLUSION: LTBI treatment compliance must be improved in NKR with a shorter regimen. In addition, a larger study regarding a focus on LTBI with easy access to related data for NKR should be conducted.
Asian Continental Ancestry Group ; Compliance ; Emigrants and Immigrants ; Humans ; Interferon-gamma Release Tests ; Korea ; Latent Tuberculosis ; Male ; Mass Screening ; Refugees ; Retrospective Studies ; Skin Tests ; Tuberculin ; Tuberculin Test ; Tuberculosis

BACKGROUND: Tuberculosis (TB) causes substantial health burden to the Korean military. This study aims to assess the impact of infectious TB cases on close and casual contacts in the Korean Army settings based on contact investigation data. METHODS: Six Army units with infectious TB cases from September 2012 to May 2013 were enrolled in the study. We analyzed the clinical data from close and casual contacts screened using the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube to identify latent tuberculosis infection (LTBI) cases. For the control group, 286 military conscripts with no reported TB exposure were tested by TST only. RESULTS: Of the 667 contacts of index cases, LTBI cases identified were as follows: 21.8% of close contacts of smear-positive cases (71/326), 8.5% of casual contacts of smear-positive cases (26/305), and 2.8% of close contacts of smear-negative cases (1/36). In the control group, 16.8% showed positivity in TST. In a multivariate analysis, having stayed in the same room or next room with TB patients was identified as a risk factor of LTBI. CONCLUSION: Using the data from TB contact investigations in the Korean Army units, we found an overall LTBI rate of 14.7% among the contacts screened. This study demonstrates that contacts living in the same building, especially the same room or next room, with TB patients are at a high risk of acquiring LTBI, serving as additional evidence for defining close and casual contacts of a TB patient with regard to Army barrack settings.
Asian Continental Ancestry Group ; Disease Outbreaks ; Humans ; Korea ; Latent Tuberculosis ; Military Personnel ; Multivariate Analysis ; Risk Factors ; Skin Tests ; Tuberculin ; Tuberculosis ; Tuberculosis, Pulmonary

The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette–Guérin vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.
Bacillus ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Korea ; Latent Tuberculosis ; Mass Screening ; Mycobacterium tuberculosis ; Parents ; Sensitivity and Specificity ; Skin Tests ; Tuberculin ; Tuberculin Test ; Tuberculosis ; Vaccination

In order to eliminate tuberculosis worldwide by 2050, effective management of latent tuberculosis infection is essential, and policy-makers have begun to recognize the importance of scaling up preventive therapy. The current guideline recommends targeted latent tuberculosis infection testing that identifies high-risk groups based on risk stratification for progression from latent infection to active disease. Both the tuberculin skin test and interferon-gamma releasing assay have a similar diagnostic efficacy for predicting progression to active tuberculosis. The Korean guideline recommends 9-month isoniazid monotherapy as the standard treatment; however, more evidence supports that short course rifampicin-based regimen is both more effective and tolerable than isoniazid monotherapy.
Diagnosis ; Interferon-gamma ; Interferon-gamma Release Tests ; Isoniazid ; Latent Tuberculosis ; Skin Tests ; Tuberculin ; Tuberculosis

BACKGROUND: Latent tuberculosis infection is a condition where there is a persistent immune response to Mycobacterium tuberculosis without clinical manifestations of tuberculosis. Currently, there is no gold standard to diagnose latent tuberculosis infection. The tuberculin skin test and interferon-gamma release assay are currently used to diagnose latent tuberculosis infection. However, studies have shown inconsistencies regarding the level of agreement between these tests in different settings. In this study, we aimed to evaluate the agreement between these two tests for diagnosing latent tuberculosis infection in human immunodeficiency virus (HIV)-infected individuals. METHODS: We screened HIV patients with no clinical symptoms of tuberculosis, a normal chest X-ray, and no history of tuberculosis or use of antituberculous drugs. Participants were tested with tuberculin skin test (TST) and T-SPOT.TB (an interferon gamma release assay) simultaneously. Participants' HIV stage was determined by measuring the level of CD4+ T-lymphocytes. Tuberculosis status was confirmed by sputum examination using GeneXpert. The level of agreement between the TST and T-SPOT.TB results was measured using Cohen's κ coefficient. RESULTS: Of the 112 participants, 20 had a positive T-SPOT.TB test result, and 21 had a positive TST result. The TST and T-SPOT.TB test results showed a high level of agreement (κ = 0.648, P < 0.001). Performance of the tests did not vary with CD4+ level. However, in participants with CD4+ < 200 cells/mm³, T-SPOT.TB detected more latent tuberculosis infections than the TST. CONCLUSION: There was good agreement between the TST and T-SPOT.TB results of latent tuberculosis infection in participants. TST is the preferred test for diagnosing latent tuberculosis infection in HIV-infected patients, especially in resource-limited settings, because it is simple and cost-effective. However, T-SPOT.TB may be useful to rule out latent tuberculosis infection in patients with severe immunodeficiency.
HIV ; Humans ; Indonesia ; Interferon-gamma Release Tests ; Interferons ; Latent Tuberculosis ; Mycobacterium tuberculosis ; Skin Tests ; Skin ; Sputum ; T-Lymphocytes ; Thorax ; Tuberculin ; Tuberculosis

BACKGROUND/AIMS: To estimate the level of agreement and positivity rates of latent tuberculosis infection (LTBI) tests prior to the use of tumor necrosis factor (TNF) inhibitors in relation to underlying rheumatic diseases and endemic tuberculosis levels. METHODS: The Ovid-Medline, Embase, and Cochrane Libraries were searched for articles before October 2013 involving LTBI screening in rheumatic patients, including rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis. RESULTS: In pooled analyses, 5,224 rheumatic patients had undergone both a tuberculin skin test (TST) and an interferon-gamma release assay (IGRA) before TNF inhibitors use. The positivity of TST, QuantiFERON-TB Gold In Tube (QFT-GIT), and T-SPOT.TB (T-SPOT) tests were estimated to be 29%, 17%, and 18%, respectively. The agreement percentage between the TST and QFT-GIT, and between the TST and T-SPOT were 73% and 75%. Populations from low-to-moderate endemic TB presented with slightly less agreement (71% between TST and QFT-GIT, and 74% between TST and T-SPOT) than patients from high endemic countries (73% between TST and QFT-GIT, and 81% between TST and T-SPOT). By underlying disease stratification, a lower level of agreement between TST and QFT-GIT was found among AS (64%) than among JIA (77%) and RA patients (73%). CONCLUSIONS: We reaffirm the current evidence for accuracy of LTBI test done by TST and IGRA among rheumatic patients is inconsistent. Our stratified analysis suggests different screening strategies might be needed in clinical settings considering the endemic status in the patient’s country of origin and the precise nature of underlying diseases.
Arthritis, Juvenile ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Humans ; Interferon-gamma Release Tests ; Latent Tuberculosis* ; Mass Screening* ; Rheumatic Diseases* ; Skin Tests ; Spondylitis, Ankylosing ; Tuberculin ; Tuberculin Test ; Tuberculosis ; Tumor Necrosis Factor-alpha