Test with recombinant tuberculosis allergen (Diaskintest®) in the diagnosis of pulmonary tuberculosis in pulmonological practice

Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia remains an urgent problem in primary health care despite the improvement of radiological and laboratory diagnostic methods.

The aim of study was to evaluate the possibility of using a skin test with recombinant tuberculosis allergen (Diaskintest^®, Generium, Russia) for the differential diagnosis of pulmonary tuberculosis and pneumonia.

Methods. 119 cases of pulmonary tuberculosis first detected in the pulmonology department during differential diagnosis were analyzed. The diagnosis was verified by a liquid media culture in the BACTEC MGIT 960 system (BD, USA). All patients with suspected tuberculosis had a skin test with recombinant tuberculosis allergen upon admission. Statistical analysis was carried out using the statistical software package IBM SPSS Statistics 22.0. The differences were considered statistically significant at p < 0.05.

Results. Most patients were of working age and had aggravating social risk factors 49 (41.2%), HIV-infection 75 (63.0%), drug addiction 44 (36.9%), or viral hepatitis C 33 (24.2%). As for the clinical forms, infiltrative and disseminated tuberculosis prevailed. Evaluation of the results of the «fast» methods of the diagnostic minimum showed that a positive result of the test with Diaskintest^® was almost three times more likely than the positive result of bacterioscopy of a sputum smear with Ziehl–Neelsen staining. Mycobacterium tuberculosis DNA was detected in sputum using the GeneXpert MTB/RIF cartridge technology in 92.6% patients with a positive result of Diaskintest^® skin test and a negative sputum bacterioscopy analysis.

Conclusion. Is advisable to use Diaskintest^® skin test in patients of a pulmonological hospital in the early stages and confirm the positive result with GeneXpert MTB/RIF to reduce the time for diagnosing tuberculosis and the patient’s bed-days in a non-specialized medical institution.

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