Tuberculin test using Indian indigenous purified-protein derivative (PPD) shows only moderate agreement with international standard PPD

Devasahayam J. Christopher, N. Priya, Deepa Shankar, Barney Isaac, Andrea DeLuca, Sonali Sarkar, Senbagavalli Prakash Babu, Prasanna Samuel, Adithya Cattamanchi, Amita Gupta, Jerrold Ellner, Sudha Srinivasan, Samyra Cox, Balamugesh Thangakunam

Research output: Contribution to journalArticlepeer-review


Background: In India, the prevalence of Latent TB infection (LTBI) is estimated to be around 40%. Various formulations of PPD(Purified protein derivative) are available, for diagnosis of LTBI, which may give variable responses. The commercially available PPD in India is by Arkray Healthcare (TST-Arkray). It is unclear if this product may have a similar sensitivity compared to other internationally accepted tuberculins (TST-Tubersol). Objectives: To assess the performance of the two TSTs compared to Quantiferon-Gold Plus (QFT-Plus). Methodology: A blood sample was collected for the QFT-Plus test. Both the TSTs were placed in the right and the left volar aspect of the forearms and 48 hrs later, the subjects came back to the study site for reading. Results: Among the 512 participants who were recruited, 326 subjects were healthcare professionals and 186 subjects were household contacts of patients with tuberculosis. They were tested with both TST-Tubersol and TST-Arkray, 139(27 %) participants tested positive for TST-Tubersol (≥10 mm), whereas 203 participants (40.1 %)tested positive for TST-Arkray. There was moderate agreement between the two tests with k = 0.58. Also, there was only poor agreement between both the TSTs with QFT Plus(kappa = 0.19 for Tubersol and 0.17 for Arkray). With QFT-Plus as gold standard, the sensitivity, specificity, PPV and NPV of TST-Tubersol, ast an induration cut-off of 10 mm was 46.8 %,76.3 %,31.8 % and 85.8 %. respectively and TST- Arkray; 60.6 %, 64 %, 28.5 % and 87.2 % respectively. Conclusion: The Indian TST (Arkray Diagnostics) has shown moderate agreement with the internationally accepted Tubersol. Additionally, there was poor agreement between the TSTs and QFT plus test.

Original languageEnglish (US)
Article number100404
JournalJournal of Clinical Tuberculosis and Other Mycobacterial Diseases
StatePublished - Feb 2024


  • Health Care workers
  • Latent Tuberculosis infection
  • Purified protein derivative
  • QuantiFERON-TB Gold Plus
  • Tuberculin skin test

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pulmonary and Respiratory Medicine


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