• These guidelines include the recommendation that all persons who are known to be infected with HIV, or are at increased risk of HIV infection, receive a tuberculin skin test (Mantoux test with tuberculin units 5 {TU} of purified protein derivative {PPD}-tuberculin). (cdc.gov)
  • In contrast, responses to antigens administered by a Mantoux-type procedure, in which a known quantity of a known concentration of a standardized antigen is deposited in the skin, may be more accurate indicators of a waning or increasing cellular hypersensitivity. (cdc.gov)
  • the Mantoux test is now used instead. (wikipedia.org)
  • Table 3 Heaf Test grading, reaction, and equivalent Mantoux positive levels. (wikipedia.org)
  • This image depicts the left forearm of a person who had received a Mantoux skin test, or PPD test (purified protein derivative), having been inoculated with an extract of the tubercle bacillus, administered intradermally. (cdc.gov)
  • TB test is a single-visit blood test for TB screening and is one of only two recommended alternatives to the tuberculin skin test (TST) - otherwise known as purified protein derivative (PPD) test, or the Mantoux test. (oxfordimmunotec.com)
  • The most accurate method of tuberculin skin testing is the Mantoux test, when a small amount of PPD is injected into the skin (intradermally). (childhealthcare.co.za)
  • The Tine test is also used but is not as accurate as a Mantoux test. (childhealthcare.co.za)
  • The Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with M. tuberculosis. (cancertherapyadvisor.com)
  • American Thoracic Society (ATS) has recommended 5 Tuberculin Units (0.1 ml) as a standard regimen for the Mantoux Test. (medicallabscientist.org)
  • A positive Mantoux test indicates a previous exposure to M. tuberculosis but not necessarily an active disease. (medicallabscientist.org)
  • The Mantoux test causes a booster effect to produce a positive result in an individual who has been already exposed previously. (medicallabscientist.org)
  • The Mantoux test usually becomes positive 4-6 weeks after infection. (medicallabscientist.org)
  • Together, these tests are the only means for detecting latent M. tuberculosis infection, and they contribute to diagnosing tuberculosis (TB) disease. (cdc.gov)
  • A negative TST or IGRA result does not exclude the possibility of TB infection because some persons can have a compromised ability to react to tests for TB infection. (cdc.gov)
  • The Division of Tuberculosis Elimination (DTBE) in CDC's Center for Prevention Services has considered requests for information regarding screening for anergy among persons infected with HIV who are at increased risk of tuberculous infection but do not react to a tuberculin skin test. (cdc.gov)
  • Thus, the guidelines presented below are intended for the evaluation and management of persons who may have tuberculous infection and HIV-induced anergy to delayed-type hypersen- sitivity (DTH) skin test antigens, including PPD-tuberculin. (cdc.gov)
  • The PPD skin test is a method used to diagnose silent (latent) tuberculosis (TB) infection. (medlineplus.gov)
  • The Heaf test, a diagnostic skin test, was long performed to determine whether or not children had been exposed to tuberculosis infection. (wikipedia.org)
  • Testing of donated blood has essentially eliminated blood transfusions as a source of infection. (medscape.com)
  • Revaccination can considerably alter the tuberculin skin test response and the diagnosis of tuberculous infection. (nih.gov)
  • 4 ]. Yet a number of groups, including a change from past practice, which sug- health care workers, continue to show ris- gested no skin testing after the receipt of ing rates of TB infection [ 4,5 ]. (who.int)
  • Positive tests sis is a recognized risk in health care facili- indicate past TB exposure or infection and ties. (who.int)
  • TB skin testing was added to the NHANES 2011-2012 to provide comprehensive data about the extent of tuberculosis infection in the United States. (cdc.gov)
  • To determine the prevalence of TB infection, NHANES participants aged 6 years and older, who consented to this component, were skin tested with a tuberculin-purified protein derivative (PPD) product, Tubersol, a commercially available antigen. (cdc.gov)
  • Additionally, NHANES participants were secondarily screened with an FDA-approved blood test, QuantiFERON®-TB Gold In Tube test (QFT-GIT), for TB infection. (cdc.gov)
  • Additional evaluation and testing is necessary to distinguish between latent TB infection and TB disease, and to determine the correct treatment (1). (cdc.gov)
  • Clinicians should assess test results based on the person's likelihood of infection and risk of progression to TB disease, if infected (1). (cdc.gov)
  • We did blood tests for tuberculosis infection on the 12 firefighters with positive skin tests. (cdc.gov)
  • Many firefighters missed appointments for skin test result infection on their reading, which contributed to program discrepancies. (cdc.gov)
  • 12 firefighters tested positive for latent tuberculosis infection from 2005-2006. (cdc.gov)
  • Adding to CDC's current recommendations for administering isoniazid preventive therapy to HIV-infected persons with positive tuberculin skin tests and to HIV-infected persons who were exposed to patients with infectious TB, this report also describes in detail the use of new short-course (i.e., 2 months) multidrug regimens (e.g., a rifamycin, such as rifampin or rifabutin, combined with pyrazinamide) to prevent TB in persons with HIV infection. (cdc.gov)
  • Despite these uncertainties, the CD4 + cell count has remained the predicting parameter for the occurrence of specific ocular infection in patients who are HIV positive, at least until antigen-specific tests of T-lymphocyte function become widely available. (medscape.com)
  • TB test in the GDF's diagnostics catalog for the detection of tuberculosis (TB) infection. (oxfordimmunotec.com)
  • TB test, is used for diagnosing infection with Tuberculosis, the world's largest cause of death from infectious disease. (oxfordimmunotec.com)
  • The induration at the site of the skin test is due to delayed sensitivity to the PPD, which develops at the time of the primary infection or the BCG immunisation. (childhealthcare.co.za)
  • The only sign of TB infection is a positive reaction to the tuberculin skin test or special TB blood test. (cancertherapyadvisor.com)
  • Most people with a positive TB skin test have latent TB infection. (dochub.com)
  • Considering the inverse relationship between cell-mediated and humoral responses to M. bovis , the intradermal test and the serological tests are designed to measure different immunological responses, which develop during different stages of infection. (johnes.org)
  • For employees who are otherwise at low risk for TB and who are tested as part of an infection control screening program at the start of employment, a reaction of 15 mm is considered positive. (whatisflike.com)
  • The degree of suppression may be reflected in a patient's inability to mount a DTH response to one or several skin-test antigens. (cdc.gov)
  • However, none of these products are licensed for use as DTH skin-test antigens, and none are certified for lot-to-lot reproducibility for this purpose. (cdc.gov)
  • APLISOL® is one of two purified-protein derivative (PPD) tuberculin antigens that are licensed by the United States Food and Drug Administration (FDA) for use in performing tuberculin skin tests. (cdc.gov)
  • It has been used as a preservative in vaccines, immunoglobulin preparations, skin test antigens, antivenins, ophthalmic and nasal products, and tattoo inks. (fishersci.com)
  • negative results when tested by a ligase chain reaction commer- cial assay specific for MTB. (cdc.gov)
  • M. celatum type 1 differs by one nucleotide from the probe all specimens were negative when tested by the MTB ligase used in the Accuprobe assay, type 2 differs by four nucleotides chain reaction assay. (cdc.gov)
  • An alternative to the PPD test is an Interferon-Gamma Release Assay (IGRA). (health2me.com)
  • TOKYO, July 27, 2022 - FUJIFILM Corporation (President and CEO, Representative Director: Teiichi Goto) announces that Amino acid Derivative Reactivity Assay (ADRA), an alternative method for skin sensitization, has been adopted in the OECD (Organization of Economic Cooperation and Development) Test Guidelines *1 as an internationally reliable test method for mixtures *2 . (fujifilm.com)
  • BQ and BQD skin allerginicity was evaluated in the murine local lymph node assay (LLNA). (cdc.gov)
  • According to this guidance "the skin sensitisation potential of a chemical is related to its ability to react with skin proteins to form covalently linked conjugates and recognition of these by the immune system. (europa.eu)
  • TB test does not cross react with the BCG vaccine[1]. (oxfordimmunotec.com)
  • 1. Substitute IGRA blood tests for TSTs. (cdc.gov)
  • Prochlorperazine is a propylpiperazine derivative of phenothiazine. (drugs.com)
  • While BQ, an extreme skin sensitizer, is an electrophile known to covalently modify proteins via Michael Addition (MA) reaction whilst halogen substituted BQD undergo nucleophilic vinylic substitution (SNV) mechanism onto amine and thiol moieties on proteins, the allergenic effects of adding substituents on BQ have not been reported. (cdc.gov)
  • Bovine tuberculosis control programs are based on a standard diagnostic method, the intradermal test with purified protein derivatives, which is used to identify and eliminate diseased animals. (johnes.org)
  • Animals considered positive by TB ELISA that were not positive in the intradermal test does not mischaracterize the clinical picture of the disease. (johnes.org)
  • Although it is the official test for the control of TB in different countries, the intradermal test with PPD has presented limitations, primarily related to specificity. (johnes.org)
  • Paratuberculosis is considered the main cause of false positive reactions in the intradermal test. (johnes.org)
  • It requires an intradermal injection of a small amount of purified protein derivative (PPD), a TB antigen, into the skin. (tspot.asia)
  • In the vast majority of cases, this is dependent on electrophilic reactivity of the skin sensitizer or a derivative produced (usually by oxidation) in vivo or abiotically (Barratt et al. (europa.eu)
  • This might require deferment of testing some persons. (cdc.gov)
  • Tubersol is one of two purified-protein derivative (PPD) tuberculin products licensed by the Food and Drug Administration (FDA). (cdc.gov)
  • 3. Substitute Aplisol for Tubersol for skin testing. (cdc.gov)
  • Samples of lung and lymph nodes (retropharyngeal, submandibular, cervical and mediastinal) of the animals testing positive by CCT were evaluated using qPRC for M. bovis , and intestinal and mesenteric lymph nodes using PCR for PTB. (johnes.org)
  • Of the 334 serum samples evaluated, the M. bovis ELISA Antibody Test (IDEXX®) identified 17 positive animals. (johnes.org)
  • The Brazilian study illustrates the interaction of MAP and M. bovis , the cause of bovine tuberculosis (bTB), as a confounder when trying to use standard immune-diagnostic tests for bTB. (johnes.org)
  • the development of skin test responses in m bovis-infected cattle was determined for international standard ppd-s, m bovis ppd-2, and m bovis ppd-5 at 24, 48, and 72 hours. (liverpool.ac.uk)
  • When findings such as chest radiography, nucleic acid amplification test of sputum, and/or mycobacterial cultures are sufficient for confirming or excluding TB, the results from a TST or an IGRA blood test might not be needed ( 2 ). (cdc.gov)
  • Diagnosis is most often by sputum smear and culture and, when available, by nucleic acid amplification tests. (merckmanuals.com)
  • The PPD bacterial extract is a complex mixture of proteins, lipids, sugars and nucleic acids, and many of these components are also shared by numerous species of mycobacteria (tuberculous or not). (johnes.org)
  • TB test, the QuantiFERON ® -TB Gold Plus test (QFT ® -Plus), and LIAISON ® QuantiFERON-TB Gold Plus (LIAISON QFT-Plus). (tspot.asia)
  • The steps involved in the workup of a patient include naming, meshing, office testing, specific and nonspecific laboratory tests, specialty consultations, therapeutic tests, and diagnosis and treatment. (medscape.com)
  • Inclusion in the GDF's diagnostic catalog makes our test more accessible to countries that are most in need of an accurate, reliable TB test that works in challenging patient populations, including children and those with immunosuppression, who are likely the first targets for new latent TB testing programs. (oxfordimmunotec.com)
  • Tuberculin skin test [TST] was investigated and proven to be a simple, cheap and efficacious in diagnosing Latent TB infections. (immunopaedia.org.za)
  • If a large area of swelling (induration) develops after 2 to 3 days at the injection site, the test is said to be positive. (childhealthcare.co.za)
  • When placed correctly, the injection should produce a pale elevation of the skin (a wheal) 6-10 mm in diameter. (cancertherapyadvisor.com)
  • What type of injection is a PPD test? (dochub.com)
  • If the area of skin where you received the PPD injection isn't swollen or is only slightly swollen 48 to 72 hours after the injection, the test results are negative. (whatisflike.com)
  • If a papule does not appear after the injection, the test should be repeated on other arm as the solution has been injected too deeply. (medicallabscientist.org)
  • In this study to assess the relationship between the number of BCG vaccinations and tuberculin skin reactions, 3548 children (ages 6 to 12 years) from 7 elementary schools were given 5 tuberculin units of purified protein derivative, and results were compared taking vaccination status into account. (nih.gov)
  • The prevalence of positive tuberculin skin reactions at King Abdulaziz University Hospital, Saudi Arabia, was investigated by testing 298 health care workers. (who.int)
  • However, most persons diagnosed with TB in the United States have had a positive TST or IGRA blood test that has contributed to that diagnosis. (cdc.gov)
  • When TB disease is strongly suspected, specific treatment should be started regardless of results of a TST or an IGRA blood test ( 1 , 3 ). (cdc.gov)
  • The agreement between results from a TST and an IGRA blood test or between results from the two commercial IGRA blood tests is lower ( 1 ). (cdc.gov)
  • Clinicians who use the IGRA blood tests should be aware that the criteria for test interpretation are different from criteria for interpreting TSTs ( 1 ). (cdc.gov)
  • Health2me offers the IGRA screening test for TB. (health2me.com)
  • Both PPD and IGRA tests are accepted by the State of Hawaii. (health2me.com)
  • Individuals without a previous positive test for TB may receive TB clearance after receiving a two-step PPD or a single IGRA blood test. (health2me.com)
  • The manufacturer notified CDC that they anticipate a supply interruption of APLISOL® 5 mL (50 tests) beginning in June 2019, followed by a supply interruption of APLISOL® 1 mL (10 tests) in November 2019. (cdc.gov)
  • The expected shortage of APLISOL® 1 mL (10 tests) could occur before November 2019, if demand increases before then. (cdc.gov)
  • These situations may lead to inaccurate test results. (medlineplus.gov)
  • Results of a purified protein derivative (PPD) skin test for tuberculosis are negative. (cdc.gov)
  • Prevention (CDC) recommends that all this disease have increased and more atten- health care workers should be screened tion is now being given to control mea- with yearly tuberculin tests and the results sures. (who.int)
  • Log into MyQuest ® to book or reschedule a lab visit, view test results, and more. (questdiagnostics.com)
  • Most TB cases in the United States are diagnosed with a set of findings including results from one of these tests. (cdc.gov)
  • In cross-sectional studies, the two skin test products give similar results for most patients. (cdc.gov)
  • While overall test concordance is high, switching between PPD skin test products or between TSTs and blood tests in serial testing may cause apparent conversions of results from negative to positive or reversions from positive to negative. (cdc.gov)
  • If the results of these tests aren't clear, doctors may do a TB skin test or a blood test. (msdmanuals.com)
  • Your provider considers your particular risk factors to determine the results of your test. (dochub.com)
  • The main limitations of the tests available are related to diagnostic sensitivity and specificity, which results in false-positive reactions due to the existence of cross infections, and also false-negative, inherent to the state of energy of some animals. (johnes.org)
  • Understanding your PPD skin test results. (whatisflike.com)
  • However, the traditional judgment standard of the PPD test is influenced by subjective factors, which can lead to less accurate and intuitive test results.Objectives:To. (deepdyve.com)
  • The revised method underwent a test to validate the reliability of its assessment results and scored 100% in intra- and inter-facility reproducibility test *11 . (fujifilm.com)
  • For interpretation of the test, see Tuberculosis diagnosis. (wikipedia.org)
  • Complement your expertise with ours to improve test selection and interpretation. (questdiagnostics.com)
  • The skin test interpretation depends on two factors: measurement of the induration (in millimeters) and the person's risk of being infected with TB and, if infected, of progression to disease. (cancertherapyadvisor.com)
  • This test is done to find out if you have ever come in contact with the bacteria that cause TB. (medlineplus.gov)
  • A health care worker injects a little bit of protein from TB bacteria just under the skin of your arm. (msdmanuals.com)
  • How do you test for TB bacteria? (dochub.com)
  • At the first visit, the provider will clean an area of your skin, usually the inside of your forearm. (medlineplus.gov)
  • The gun injected PPD equivalent to 100,000 units per ml to the skin over the flexor surface of the left forearm in a circular pattern of six. (wikipedia.org)
  • The TST is performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. (cancertherapyadvisor.com)
  • For a tuberculin skin test, you sit down and turn the inner side of your forearm up. (dochub.com)
  • Although the sensitivity of these tests may be high, their use as quantitative tools for assessment of anergy is limited. (cdc.gov)
  • It has been shown to have a sensitivity of 98.8% and a specificity in excess of 99%, and is able to maintain performance even in samples otherwise difficult to test, such as samples from immunosuppressed patients. (oxfordimmunotec.com)
  • Perform a skin sensitivity test 48 hours before each product use, even if you have already used previously a colouring product of this brand or another brand ( see enclosed leaflet ). (natureshealthbox.co.uk)
  • PPD (purified protein derivative) is subcutaneously injected to the patient and individual's sensitivity to tuberculin protein is assessed. (medicallabscientist.org)
  • The ADRA can assess skin sensitization at a high level of accuracy *5 , using a reactive reagent with high detection sensitivity developed by Fujifilm in 2017 with the company's advanced chemical synthesis and molecular design capabilities. (fujifilm.com)
  • The indications for use of these tests are the same, although one or the other method is preferred for certain populations ( 1 ), and this could play a role in setting priorities when one of the methods is unavailable. (cdc.gov)
  • If an individual is infected, a reaction will occur, resulting in reddening and elevation of the skin (induration). (health2me.com)
  • A positive TB skin test will look like a firm, red bump. (dochub.com)
  • Within 48 to 72 hours, a positive TB skin test is marked by an area of reddish induration greater than 10 mm. (whatisflike.com)
  • With a negative reaction, the skin where you received the PPD test is not swollen, or the swelling is very small. (medlineplus.gov)
  • Patients who exhibited a negative reaction to the test were considered for BCG vaccination. (wikipedia.org)
  • Negative ppd skin test. (cdc.gov)
  • Purified protein derivative skin testing for tuberculosis was previously negative. (acpjournals.org)
  • How do you know if a TB test is positive or negative? (whatisflike.com)
  • How does a negative TB test look? (whatisflike.com)
  • The test is "negative" if there is no bump (or only a very small bump) at the spot where the fluid was injected. (whatisflike.com)
  • A negative TB skin test usually means that you don't have TB. (whatisflike.com)
  • U/L), alkaline phosphatase was elevated and lowest TB rates in the provinces of (650 IU/L), tuberculin skin test with puri- the country were 137/100 000 (Sistan va fied protein derivative 5 units giving an in- Baluchestan) and 10/100 000 (Khorasan) duration of 17 mm, HIV test was negative. (who.int)
  • It contains rice proteins with a restructuring and regenerating action similar to keratin, while a willow extract protects your hair from harmful UV rays and discoloration Fruit lipophilic acids protect your scalp during the colour application and Argan oil offers vital hydrating, emollient and protective properties. (natureshealthbox.co.uk)
  • The hair is clipped on two areas of the neck, the skin thickness measured, and bovine PPD injected intradermally at one site and avian PPD at the other site. (dochub.com)
  • Mariana Assunção de Souza and 6 other Brazilian colleagues reported on the occurrence of Johne's disease (paratuberculosis) in cattle that were necropsied based on a positive comparative cervical skin test for bovine tuberculosis (bTB). (johnes.org)
  • comparison of the specificity of human and bovine tuberculin ppd for testing cattle. (liverpool.ac.uk)
  • a tuberculin testing trial was carried out in eight counties of south-eastern england to compare the specificity for bovine tuberculosis of weybridge human ppd with that of rotterdam bovine ppd. (liverpool.ac.uk)
  • Regarding the structure of Benzo- and Acetoguanamine it can be assumed, that both substances show a likely chemical reactivity in the mentioned electrophile-nucleophile reactions and therefore a simaliar skin sensitising effect can be assumed. (europa.eu)
  • Reactivity measurement in estimation of benzoquinone and benzoquinone derivatives' allergenicity. (cdc.gov)
  • A licensed healthcare professional must read the test between 48 and 72 hours after administration. (health2me.com)
  • The diameter of the induration is measured to evaluate the test and is directly proportional to the level of sensitization. (medicallabscientist.org)
  • Blood Test - In this test, a doctor or nurse draws a small amount of blood from your arm, and then send it to a laboratory for analysis. (sanmiguelurgentcare.com)
  • If your blood test is positive, it means you've been infected with TB germs. (whatisflike.com)
  • The PPD test determines if someone has developed an immune response to the bacterium that causes tuberculosis (TB). (dochub.com)
  • IGRAs are blood tests that measure the immune response to TB proteins in whole blood. (health2me.com)
  • In a healthy person whose immune system is normal, induration greater than or equal to 15 mm is considered a positive skin test. (whatisflike.com)
  • People who were born outside the United States who have had a vaccine called BCG may have a false-positive test result. (medlineplus.gov)
  • The whole parasite vaccine plus BCG proved to be immunogenic, but its efficacy was not superior to BCG alone with respect leishmanin skin test (LST) conversion. (immunopaedia.org.za)
  • Skin sensitization refers to the skin inflammation or rashes caused as a result of an allergic reaction induced by a chemical when it comes into contact with the skin. (fujifilm.com)
  • Skin sensitization test is carried out prior to product planning or manufacturing process to assess the safety of a chemical. (fujifilm.com)
  • A method for testing skin sensitization of mixtures was anticipated. (fujifilm.com)
  • In the process of covalent binding to proteins, which is one of the processes *4 for skin sensitization, the ADRA is now the first test method to be adopted in the OECD Test Guidelines. (fujifilm.com)
  • After the ADRA is adopted in the OECD Test Guidelines for single chemical in 2019, Fujifilm has been promoting the use of the ADRA and undergoing improvement work to expand its scope for skin sensitization test of mixtures. (fujifilm.com)
  • In the latest development, Fujifilm has made changes to the conventional measuring method of the ADRA to test skin sensitization of mixtures. (fujifilm.com)
  • These changes resulted in achieving skin sensitization test at a high level of accuracy *10 for wide variety of mixtures. (fujifilm.com)
  • In order to expand the range of use for the ADRA, Fujifilm has been providing the ADRA kit that can easily carry out the ADRA from September 2018 and a contract skin sensitization testing service using the ADRA kit from April 2022 through FUJIFILM Wako Pure Chemical Corporation. (fujifilm.com)
  • Taking advantage of the latest revised method of the ADRA, Fujifilm will proactively propose the use of the ADRA for skin sensitization test of natural extracts, including plant extracts which are widely used in cosmetics, detergents and disinfectants, to the customers such as cosmetics companies, chemical manufacturers and contract testing organizations to expand its range of use. (fujifilm.com)
  • 4 There are three processes for skin sensitization: covalent binding to proteins, keratinocyte activation and activation of dendritic cells. (fujifilm.com)
  • However, mandated reduction/elimination of animals used in cosmetics testing in Europe has led to an increased need for alternatives for the prediction of skin sensitization potential. (cdc.gov)
  • Note and record the presence or absence of other skin reactions such as vesiculation and bullae or ulceration and necrosis anywhere on the volar surface of the arm being examined. (cdc.gov)
  • 1977)." The guidance also states the most frequently encountered types of electrophile-nucleophile reactions in skin sensitisation: "Michael-type reactions, SN2 reactions, SNAr reactions, acylation reactions and Schiff-base formation. (europa.eu)
  • TB test is available in over 60 countries including Europe, China, Japan and the US, and is recognized by the WHO as one the 100 essential diagnostic tests that should be available in every country. (oxfordimmunotec.com)
  • About 11 woredas had no any type of diagnostic tests for COVID-19. (bvsalud.org)
  • Blood tests, including a complete blood count and chemistry panel, are normal, with the exception of a total serum calcium level of 12.7 milligrams per deciliter (mg/dL) (normal range: 9.2 to 11.0 mg/dL). (cdc.gov)
  • Thimerosal is an organic compound and a derivative of thiosalicyclic acid. (fishersci.com)
  • multiple puncture tests, such as the Heaf test and Tine test, are not recommended. (wikipedia.org)
  • Of the 334 cattle evaluated using the comparative cervical test, 16 were considered positive. (johnes.org)
  • Your provider will check the area to see if you have had a strong reaction to the test. (medlineplus.gov)
  • Strategies that selectively target tumour necrosis factor α (TNFα) have shown efficacy when tested in patients with considerable disease activity despite treatment with disease modifying antirheumatic drugs (DMARDs). (bmj.com)
  • If blisters are present (vesiculation), the test is also considered positive. (whatisflike.com)
  • Additional testing and care based on the specialist's assessment and recommended treatment plan may include further testing with additional referral (depending on the findings) to an oncologist, a chest surgeon, or both. (cdc.gov)