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PPD skin test

The PPD skin test is a method used to diagnose silent (latent) tuberculosis (TB) infection. PPD stands for purified protein derivative.

Alternative Names

Purified protein derivative standard; TB skin test; Tuberculin skin test; Mantoux test

How the test is performed

You will need two visits to your doctor's office for this test.

At the first visit, the health care provider will clean an area of your skin. You will get a small shot that contains PPD. The needle is gently placed under the top layer of skin, causing a bump (welt) to form. This usually goes away in a few hours.  

After 48-72 hours, you must return to your doctor's office. The doctor or nurse will check the area to see if you have had a strong reaction to the test.

How to prepare for the test

There is no special preparation for this test.

Tell your health care provider if you have ever had a positive PPD skin test. If so, you should not have a repeat PPD test, except under unusual circumstances.

Tell your doctor if you have a medical condition or if you take certain drugs, such as steroids, that can affect your immune system. These situations may lead to inaccurate test results.

How the test will feel

You will feel a brief sting as a needle is inserted just below the skin surface.

Why the test is performed

This test is done to find out if you have ever come in contact with the bacteria that causes TB.

TB is an easily spread (contagious) disease. It most often affects the lungs. The bacteria can remain inactive (dormant) in the lungs for many years. This situation is called latent TB.

Most people in the United States who are infected with the bacteria do not have signs or symptoms of active TB.

You are most likely to need this test if you:

  • May have been around someone with TB
  • Work in health care
  • Have a weakened immune system, due to certain medicines or disease (such as cancer or HIV and AIDS)

Normal Values

A negative reaction usually means you have never been infected with the bacteria that cause TB.

A negative reaction means the skin where you received the PPD test is not swollen, or the swelling is very small. This measurement is different for children, people with HIV, and other high risk groups.

The PPD skin test is not perfect. Up to 1 in 5 people infected with the bacteria that cause TB may not have a reaction. Also, diseases or medicines that weaken the immune system may cause a false-negative result.

What abnormal results mean

An abnormal (positive) result means you have been infected with the bacteria that cause TB. You may need treatment to lower the risk of the disease coming back (reactivation of the disease). 

It is important to note that test results depend on the person being tested.

A small reaction (5 mm of firm swelling at the site) is considered to be positive in people:

  • Who have HIV
  • Who have received an organ transplant
  • Who have a suppressed immune system or are taking steroid therapy (about 15 mg of prednisone per day for 1 month)
  • Who have been in close contact with a person who has active TB
  • Who have changes on a chest x-ray that look like past TB

Larger reactions (greater than or equal to 10 mm) are considered positive in:

  • People with a known negative test in the past 2 years
  • People with diabetes, kidney failure, or other conditions that increase their chance of getting active TB
  • Health care workers
  • Injection drug users
  • Immigrants who have moved from a country with a high TB rate in the past 5 years
  • Children under age 4
  • Infants, children, or adolescents who are exposed to high-risk adults
  • Students and employees of certain group living settings, such as prisons, nursing homes, and homeless shelters

In people with no known risks of TB, 15 mm or more of firm swelling at the site indicates a positive reaction.

What the risks are

There is a very small risk of severe redness and swelling of the arm in people who have had a previous positive PPD test and who have the test again. There have also been a few cases of this reaction in people who have not been tested before.

Special considerations

A positive skin test does not always mean that a person has active TB. More tests must be done to check whether there is active disease.

Many people who were born outside the United States may have had a vaccine called BCG, which can lead to a false-positive test result. Most experts say that a past BCG vaccination should not change the PPD result when the test is done in people with an increased risk of TB infection or disease.

References

Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 332.

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009:chap 250.

Updated: 12/6/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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