Tuberculosis remains a major public health concern and a leading cause of morbidity and mortality worldwide, especially in developing countries. Tuberculosis is a fatal bacterial infection caused by the bacterium Mycobacterium tuberculosis, a highly contagious droplet infection, which primarily affects the lungs. However, it can affect any area of the body, which includes bones, joints, central nervous system, etc. The treatment for tuberculosis is available and is effective. Although the overall incidence and prevalence of tuberculosis have been declining, the incidence of multidrug-resistant tuberculosis is steadily rising. The Asians and Hispanics account for more than half of the new tuberculosis cases, with the highest incidence in India, China, Indonesia, Pakistan, Nigeria, and South Africa. However, in the United States, recent trends show a significant decline in this infection.[1]
Active and Latent TB Infection
 A person with active infection usually presents with symptoms of the part affected and constitutional symptoms such as unexplained weight loss, fever, fatigue, loss of appetite, and night sweats. The latent TB, however, is asymptomatic and non-infectious. Early diagnosis of active TB is crucial to managing the disease in time and prevent its spread. The latent TB infection is non-infectious and asymptomatic, with a significant worldwide prevalence (33%). Since this population carries a risk of reactivation in immunocompromised states and progress to an active TB disease, which is symptomatic and highly contagious, latent TB is an important public health issue. The LTBI progression risk to active disease is maximum in the first two years after exposure. The progression, detection, and treatment of latent TB cases are important for tuberculosis control and reduce the disease burden. The LTBI progression risk declines with age as the immunity increases with age. The risk of progression in infants is 50%, which declines to 1% to 2% by the age of 10 years.[2]
TB Screening Tests
Two screening tests can demonstrate TB infection: PPD Skin test (Mantoux test/tuberculin skin test)[3]. IGRA (interferon-gamma release assay)[4]. Both these tests evaluate cell-mediated immunity, which usually occurs when the person has been exposed to TB bacteria. The skin reaction is the response mediated by T lymphocytes (cell-mediated immunity). The positivity of these tests, however, does not distinguish between latent or active tuberculosis. Therefore, symptom assessment and further testing (chest radiograph, sputum test for acid-fast bacillus, CT scan) and are essential to look for an active infection. There is no definitive test to diagnose LTBI, which is a clinical diagnosis. The diagnosis of LTBI is done based on a history of prior TB infection and ruling out active TB disease.
PPD Skin Test/ Tuberculosis Skin Test
Purified protein derivative test (PPD skin test), administered through the Mantoux technique, is a type IV hypersensitivity skin reaction to ‘tuberculin.’ Therefore, also known as the tuberculin skin test (TST skin test) and Mantoux test. This test was developed by Koch and further developed by Charles Mantoux, who described the intradermal technique in 1912.  Tuberculin protein used in the test is extracted from mycobacterium tuberculosis cultures and is used as a purified protein derivative. However, a standardized PPD-S is used, which is a tuberculous mycobacterium (non-tuberculous Mycobacterium are identified by a letter other than S). The results of this test are interpreted by measuring the hypersensitivity reaction (delayed-type hypersensitivity) to tuberculin purified protein derivative, derived from Mycobacterium tuberculosis. The peak of the induration reaction occurs after 24 hours of the test injection. Induration of the skin at the injection site occurs secondary to cell infiltration.  It takes about 6 to 8 weeks after exposure to the bacteria for the PPD test to be positive. Two visits are required in this test. First visit to get the test administered, and the second visit to get the reading of the test after 48 to 72 hours of test placement.[5]