Technical (potentially correctable) |
Tuberculin material: |
Improper storage (exposure to light or heat) |
Contamination, improper dilution, or chemical denaturation |
Administration: |
Injection of too little tuberculin or too deeply (should be intradermal) |
Administration more than 20 minutes after drawing up into the syringe |
Reading: |
Inexperienced or biased reader |
Error in recording |
Biologic (not correctable) |
Infections: |
Active tuberculosis (especially if advanced) |
Other bacterial infection (typhoid fever, brucellosis, typhus, leprosy, pertussis) |
HIV infection (especially if CD4 count <200) |
Other viral infection (measles, mumps, varicella) |
Fungal infection (South American blastomycosis) |
Recent live-virus vaccination (measles, mumps, polio) |
Immunosuppressive drugs (corticosteroids, tumor necrosis factor inhibitors, and others) |
Metabolic disease (chronic renal failure, severe malnutrition, stress [surgery, burns]) |
Diseases of lymphoid organs (lymphoma, chronic lymphocytic leukemia, sarcoidosis) |
Age (infants <6 months, older adults) |
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