Tuberculin purified protein derivative (RT 23) 100 tuberculin units/ml solution for injection 1.5ml vials

BackgroundCutaneous warts are exophytic, benign proliferative lesions caused by human papillomavirus infection of basal keratinocytes. Many intralesional immunomodulatory agents are used by dermatologists these days including Bacillus Calmette-Guerin vaccine, measles-mumps-rubella vaccine, purified protein derivative (PPD), Candida extract, vitamin D3, interferon alpha, zinc sulphate, and hepatitis B vaccine. Intralesional acyclovir is considered a novel intralesional therapy for warts as it directly destroys the viral cells. The objectives of this study are to provide the latest comparison among different intralesional therapies and to specifically compare acyclovir with PPD.MethodsA comprehensive search strategy was implemented to identify relevant randomized controlled trials, and those with single-arm studies were excluded. After this, 5 studies were finally included in the review. Statistical analysis was done using a frequentist random-effects model. Dichotomous outcomes were analyzed using odds ratio and 95% confidence interval with statistical significance set as P-value ResultsUse of saline had the highest probability of being the best treatment for achieving a complete response (probability to be the best 96%, P-score = .96) and partial response (98% probability, P-score = .98) when compared with other modalities. The forest plot shows no statistically significant differences among the treatment arms except for saline (P ConclusionThis network's meta-analysis concludes the superiority of intralesional saline in achieving response to treatment when compared with other modalities such as cryotherapy and vaccines. A higher risk of adverse events was noted on use of vaccines. Future research is needed to strengthen these findings.

Abstract licence: CC BY-NC

Background: The world health goal of eliminating tuberculosis (TB) is heavily hinged on timely and efficient diagnosis and treatment. The interferon-γ release assays (I.G.R.A.s) can diagnose Mycobacterium tuberculosis infection and offer an alternative to the centuries-old tuberculin skin test (T.S.T.). Yet there is disagreement over replacing the T.S.T. with I.G.R.A.s as a standard tool. Objective: We aim to assess the diagnostic ability of I.G.R.A.s compared with T.S.T. for detecting active TB cases. Methods: A systematic review identified relevant studies from four databases. In the diagnostic meta-analysis conducted with OpenMeta Analyst software, we calculated the sensitivity (SN) and specificity (SP) for active TB detection via I.G.R.A. and T.S.T. methods compared to TB culture. Results included pooled estimates for SN and SP with 95% confidence intervals (CI), stratified by age, immunity, I.G.R.A. type, and T.S.T. cut-off. Results: Our meta-analysis revealed that TB diagnosis using T.S.T. showed an SN of 72.4% and SP of 79.3%, while I.G.R.A. demonstrated higher accuracy with an SN of 78.9% and SP of 85.7%. Subgroup analysis by age indicated that I.G.R.A. consistently outperformed T.S.T. in both adult and pediatric populations. Among immunocompromised individuals, T.S.T. had low SN (23%) but high SP (91.2%), whereas I.G.R.A. had higher SN (65.6%) but lower SP (81.9%). Immunocompetent subjects showed that T.S.T. had SN of 72% and SP of 87.3%, while I.G.R.A. had higher SN (82.9%) and SP (89.1%). Evaluation by I.G.R.A. type revealed that T-SPOT.GIT demonstrated a higher SN but lower SP compared to QFT-GIT. Assessing T.S.T. cut-offs, SP was highest (88.8%) at ≥15 mm, while SN peaked (71.6%) at ≥5 mm. Conclusions: I.G.R.A. consistently showed higher diagnostic accuracy than T.S.T. across most studied subgroups, indicating its potential superiority in active TB diagnosis.

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BackgroundWe aimed to estimate the sensitivity of skin and blood-based tuberculosis (TB) infection tests and assess variation in sensitivity by test type and population characteristics.MethodsWe conducted a meta-analysis of studies involving individuals with microbiologically confirmed TB disease (surrogate reference standard) who underwent TB infection testing. Searches were performed across databases up to February 24, 2025. Data were extracted using a standardized form and pooled using random-effects meta-analysis. Primary analyses focused on tests performed before or during TB disease treatment.ResultsFrom 103 031 records, 307 studies were included: 110 evaluated tuberculin skin testing (TST), 185 QuantiFERON (QFT), 107 T-SPOT.TB, 10 antigen-based skin tests, and 5 TB-IGRA. Sensitivity was consistently lower among people with HIV. Among populations without vs with HIV, respectively, TST ≥5 mm sensitivity was 80.3% (95% CI, 73.7%-85.5%) and 53.6% (95% CI, 41.5%-65.4%), TST ≥10 mm sensitivity was 75.1% (95% CI, 68.8%-80.5%) and 64.5% (95% CI, 36.8%-85.0%), antigen-based skin test sensitivity was 77.7% (95% CI, 69.7%-84%) and 61.3% (95% CI, 39.6%-79.3%), QFT sensitivity was 82.6% (95% CI, 80.7%-84.3%) and 66.5% (95% CI, 59.8%-72.6%), and T-SPOT.TB sensitivity was 88.2% (95% CI, 86.2%-90.0%) and 69% (95% CI, 56.6%-79.2%). TB-IGRA was only evaluated in populations without HIV (sensitivity, 85.4%; 95% CI, 81.3%-88.7%). Sensitivity in other populations targeted for TB infection testing generally fell between estimates among people with and without HIV. In comparative analyses, TST ≥5 mm and TST ≥10 mm had comparable sensitivity to QFT; however, T-SPOT.TB had superior sensitivity to both TST ≥5 mm and QFT.ConclusionsTB infection test sensitivity varies by test type and population. All tests showed reduced sensitivity in people with HIV. T-SPOT.TB demonstrated the highest sensitivity across populations.

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Background: Cutaneous warts, caused by HPV, are common, and conventional destructive treatments often fail to prevent recurrence. Intralesional immunotherapy offers a promising alternative. Specifically, purified protein derivative (PPD) and vitamin D have demonstrated efficacy; however, a direct comparison of their therapeutic value and safety profiles is needed. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of intralesional PPD versus intralesional Vitamin D for cutaneous warts. Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Google Scholar was conducted for RCTs up to November 2025. Primary outcomes were the complete and partial clinical response rates of warts. Secondary outcomes included recurrence and adverse events. Risk ratios (RRs) with 95% confidence intervals (CIs) and p-values were pooled using STATA 19.5. Results: Seven RCTs involving 520 patients were included. The analysis found no significant difference in the rate of complete clinical response (RR: 1.07, 95% CI [0.95, 1.21]; p = 0.24) or partial clinical response (RR: 0.90, 95% CI [0.56, 1.46]; p = 0.68) between the two groups. Also, the two groups showed no significant difference in recurrence rate (RR: 1.14, 95% CI [0.48, 2.68]; p = 0.77). Regarding safety, PPD was associated with a significantly higher risk of injection site erythema (RR: 4.76, 95% CI [2.08, 10.93]; p p = 0.01). Still, no significant differences were found for injection site pain (p = 0.12) or swelling (p = 0.68). Conclusions: With uncertain evidence, intralesional PPD and vitamin D demonstrate comparable overall efficacy in clearing cutaneous warts. However, PPD carries a higher risk of systemic adverse events (fever) and injection site erythema, with a more effective potential to clear distant warts. The choice between the two agents should be based on the clinical profile and patient preference.

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BackgroundThe World Health Organization has recommended three new tuberculosis (TB) antigen-based skin tests (TBST) (Diaskintest®, C-TST®, Cy-TB®) for the diagnosis of tuberculosis infection (TBI). Household contacts (HHC) of people with pulmonary TB are at increased risk for TBI. We evaluated the cost-effectiveness of the use of TBST and of QuantiFERON-TB Plus® (QFT-Plus®) compared to the tuberculin skin test (TST) in Brazil.MethodsA state-transition Markov model simulating four distinct hypothetical cohorts of 10,000 HIV-negative contacts of different ages (3 months-4 years, 5-9 years, 10-14 years, and 15 or older) was built over five annual cycles for TBI testing and tuberculosis preventive treatment (TPT) under the Brazilian public health system perspective. Effectiveness was estimated from systematic reviews and costs were raised from the Brazilian government (TST and QFT-Plus®) and from the manufacturers (TBST). Incremental cost-effectiveness per TB case averted was calculated.FindingsTBST has similar accuracy to QFT-Plus®, and all are more specific than TST. TBST are less costly compared with TST or QFT-Plus®. All TBST were cost-saving regardless of the age group compared to TST or QFT-Plus®. Cy-Tb® was the most cost-saving, followed by Diaskintest® and C-TST®.InterpretationThe incorporation of the new TBST for screening in the Brazilian public health system would be a cost-saving alternative for contacts. Because these tests require the same infrastructure and human resources skills as TST, the tests could be readily implemented.FundingCNPq and Stop TB Partnership.

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Delayed-type hypersensitivity (DTH) to Mycobacterium tuberculosis (MTb) antigens is a crucial component of the cellular immune response presented during tuberculosis infection. This reaction is driven primarily by T lymphocytes, which recognize mycobacterial antigens and trigger a focused inflammatory cascade. Cytokines produced by T lymphocytes stimulate the formation of granulomas, organized structures that help contain the bacteria and prevent their spread. DTH is essential for controlling the infection and forms the basis of diagnostic tools, including the still widely practiced tuberculin skin test despite its limitations. This immunological mechanism is also used as an important therapeutic target in the treatment of tuberculosis by modulating the cellular response. These approaches include immunomodulatory agents, therapeutic vaccines and host-directed treatment. Ongoing research offers promising opportunities for future interventions aimed at decreasing the global mortality associated with tuberculosis.

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