How does mantoux appear in an adult male. What should be the Mantoux reaction in an adult? What to do with a positive test

Mantoux reaction in adults - the norm and indications for conduction should be evaluated by a doctor. Typically, the Mantoux test is used to diagnose the early stages of tuberculosis in children. For adults, fluorography, laboratory blood and sputum tests are more often used. However, in some cases, for example, if there has been contact with a carrier of an open form of tuberculosis, a Mantoux test can be performed on an adult.

Why are tuberculin tests rarely done for adults? This is due to the fact that this method is not reliable enough. It allows only to assess the risk of the presence of the causative agent of tuberculosis in the body. But as an express diagnostic method, the Mantoux test can be recommended to a patient of any age. Moreover, if the result of the test causes concern to the doctor, more serious tests are carried out.

Many people mistakenly believe that a tuberculin test is a tuberculosis vaccination. Sometimes you can even hear someone say "Mantoux vaccination." However, this is not the case: the test has nothing to do with vaccination and does not affect the body's resistance to Koch's wand.

The essence of the procedure is quite simple: during a diagnostic tuberculin test, tuberculin, which is an extract of tuberculosis pathogens, is injected under the patient's skin. You should not be afraid of infection: there are no living pathogens in the preparation.

The human immune system immediately reacts to tuberculin: T-lymphocytes accumulate at the injection site. In this case, the reaction of the immune system will be expressed if the body already has the "experience" of fighting Koch's wand. And this happens only when a person is infected with tuberculosis or has ever had this dangerous disease. Thus, if there is a causative agent of tuberculosis in the body, the injection site will become inflamed and redden: in this case, they say that the Mantoux reaction gave a positive result.

It is important to note that the test may give false results if the person has recently received any vaccinations.

In order for the doctor to receive accurate data regarding the presence or absence of the causative agent of tuberculosis in the body, it is necessary to follow a number of recommendations:

• the injection site of tuberculin should not be sealed with adhesive tape;
• the sample may itch slightly. It should not be combed: if you injure the injection site of tuberculin, there is a high risk of a false positive reaction;
• it is forbidden to treat the skin at the injection site with antiseptic solutions;
• There is a myth that water should not get on the sample. Do not give up hygiene procedures. True, it is not worth it to wet the sample strongly and rub it with a hard washcloth or towel, as this can distort the result.

Sample evaluation

Three days after the introduction of tuberculin under the skin, the doctor evaluates the reaction of the body. In this case, the dimensions of the so-called papule formed at the site of the sample are measured.

If there is no redness on the skin, there is no slight swelling and no traces of the injection of the drug, the reaction to Mantoux is considered negative. This means that a person is not infected with tuberculosis and there are no pathogens of this dangerous disease in his body. If there is a trace, it must be evaluated. The norm of the Mantoux reaction in adults differs from the "children's" standards.

Mantoux reaction - the norm in adults:

1. If the redness has a small diameter, and the swelling rises above the skin to a height not exceeding one millimeter, the reaction is considered negative.
2. If the redness has a diameter of 1 to 4 mm, the result of the test is doubtful. This result is often interpreted as normal, but if the risk of infection is too high, additional examinations will be prescribed, such as fluorography or chest X-ray.
3. A swelling ranging in size from 4 to 17 mm indicates that the person is infected with Koch's wand.
4. If the size of the swelling exceeds 21 mm, and an inflammatory process or even the appearance of abscesses is noted in the tuberculin area, we can talk about a hyperergic reaction, that is, the highest degree of probability of contracting tuberculosis. In this case, doctors say that the Mantoux test in adults gave a positive result.

It is worth noting that the presence of a seal indicates the presence of infection, but not the duration of the disease. In this regard, such a parameter as the “turn” of the Mantoux test, that is, an increase in the size of the sample compared to the sample made last year, is very important.

False positive reaction

It is important to remember that an enlarged Mantoux test in an adult is not considered an indicator that a patient has tuberculosis. A tendency to allergies or a recent infectious disease can lead to a hyperergic reaction. Therefore, do not panic if the papule is too large: additional examinations prescribed by the doctor will help to find out the cause of the body's pronounced reaction to the causative agent of tuberculosis.

The following factors can distort the result of the survey:

• advanced age of a person;
• the presence of a chronic disease or inflammatory process;
• phase of the menstrual cycle (never done during menstruation: the result will be highly distorted and unreliable);
• skin hypersensitivity;
• individual intolerance to tuberculin;
• incorrect sample setting;
• unfavorable environmental conditions in the place where the patient lives.

To avoid a false positive result, before taking the test, you should warn the doctor about the tendency to allergic reactions or the presence of a chronic disease. Children and adults do not make Mantoux in the presence of epilepsy, as well as during seasonal epidemics.

The Mantoux reaction can be not only false positive, but also false negative. The latter often occurs if the patient has a deficiency of vitamins of group E. Sometimes, the use of low-quality or expired tuberculin for a sample leads to a false negative result. Therefore, if the test turned out to be negative, and the risk of infection is high enough, it is recommended to undergo additional diagnostic tests.

Russia is one of the most unfavorable countries in terms of the incidence of tuberculosis.

Therefore, it is very important to know what the reaction to the Mantoux test should be and regularly undergo fluorography: this will help diagnose tuberculosis at an early stage and promptly begin treatment.

When the baby turns one year old, at the next appointment, pediatricians give a referral for a Mantoux test.

Of course, almost every resident of the Russian Federation (and not only) has come across this procedure.

However, new parents, constantly wary of everything related to their child's health, vaccinations and medical events, often panic when doctors send them to the treatment room.

What is a tuberculin test? Does it apply to vaccinations? Are there any contraindications? You can find out about this in this article.

What is the Mantoux reaction?

The test, named after the French physician Charles Mantoux, has been carried out for more than seventy years in many countries of the world, and is very important in the diagnosis of tuberculosis.

All children still in the maternity hospital a few days after birth or at discharge are given BCG vaccination(if there are no contraindications), which allows you to protect the baby from a terrible disease. And after the baby is one year old, it is supposed to check the response of the immune system to the introduction of tuberculin.

Tuberculin is a combination of antigen proteins derived from Mycobacterium tuberculosis and used for intradermal or skin tests.

When the baby is done BCG vaccination, his body was "infected" with tuberculosis, which manifested itself as a skin form - a tubercle.

Hence, by the way, the name of the disease: tuberculum "bump".

Of course, the BCG vaccination does not pose any danger if it was done correctly, and the newborn had no contraindications to it.

Mothers who oppose vaccinations should be aware that an unvaccinated child is at enormous risk of getting an infection - after all, in recent years, the incidence of tuberculosis has doubled. A small organism is the most vulnerable to various diseases.

The TB vaccine, injected into the body, causes localized TB, which forces the baby's immune system to fight the causative agent of the deadly disease.

The trace of induration is a scar on the outer surface of the shoulder.

Mantoux reaction, carried out a year after the BCG vaccination (and later - until the child reaches 15 years of age)- this is a kind of allergic reaction that occurs in response to the introduction of tuberculin.

There is a pronounced imitation of tuberculosis infection (with intradermal administration of the drug), and the cells of the immune response cooperate at the site of the pathogen to protect the body from infection.

How many of these cells approach the site of tuberculin injection, so large will be the size of the Mantoux reaction spot. And its size will depend on the doctor's verdict: a positive or negative Mantoux test, normal or pathological ...

Why do a Mantoux test?

The procedure is carried out from the age of 1 to the sixteenth birthday of the child. If necessary, the Mantoux test is also carried out for adults.

This is necessary for:

• identification of children of the first years of life who are indicated for BCG revaccination;
• identifying the primary infected organism;
• detection of the disease when there are no clinical signs yet;
• determination of tuberculosis at an early age (screening), when fluorography is undesirable.

mantoux do to the child once a year, but if there is evidence, the number of samples may increase up to three within 12 months:

• if the test for the introduction of tuberculin is positive;
• if the child lives in a region where the percentage of cases of tuberculosis is increased.

Pirque test or Mantoux reaction?

On the Internet, when searching for information about the Mantoux reaction, patients come across articles in which Mantoux is mistakenly equated with the concept of Pirquet test or Diaskintest.

What is their difference?

Pirk test, named after the name of the scientist who proposed it, is also a method of tuberculin diagnosis. As well as for the Mantoux reaction, an extract of mycobacteria is used in the Pirquet test.

Only the methods of the procedure are different.

The Pirquet test is performed by making notches on the middle third of the forearm with a scarifier and then infusing them with tuberculin.

The drug is aged on the "wounds" for about five minutes, after which it is removed with a napkin.

The interpretation of the result is carried out similarly to the Mantoux reaction.

What is Diaskintest?

Diaskintest is carried out in the same way as well as the Mantoux test (intradermal).

Here, the differences are already in the composition of the drug for administration. Diaskintest is the introduction into the body of synthetic proteins similar to those contained in the causative agent of tuberculosis.

The test is more selective: the reaction occurs only if the organism is infected with tuberculosis or with an already active process.

Which is better: Mantoux test or Diaskintest?

These tests have many differences, but their goal is the same: the detection of a disease in humans. The advantage of diaskintest is that it is more specific: it will not react to microorganisms, proteins that are similar to Mycobacterium tuberculosis, and therefore will not give a false reaction, as the Mantoux test can.

Therefore, Diaskintest is prescribed in case of deviations from the norm of the Mantoux reaction or to confirm the correct treatment of tuberculosis.

Clinical diagnosis of tuberculosis.

Tuberculosis is currently a socially significant disease, the fight against it has been going on all over the world for many years.

Despite the fact that most people are vaccinated with the BCG vaccine, "consumption" still affects hundreds of thousands of people, leaving them no chance of salvation.

That is why the annual audit of the working and non-working population, children and adults is so important.

Clinical diagnosis of tuberculosis is carried out in various ways:

• Mantoux reaction (more often in children under 16 years old), Pirque test, Diaskintest;
• Fluorography;
• X-ray examination;
• Physical examination (examination of the patient, palpation, auscultation);
• Collection of anamnesis and identification of risk factors for tuberculosis (immunodeficiency, smoking, drug addiction, alcoholism, unfavorable living conditions);
• Collection of sputum and its analysis for the presence of Mycobacterium tuberculosis;
• Clinical and biochemical blood tests;
• Computed tomography in difficult cases.

Let us analyze in more detail how the Mantoux test is carried out, because it is what is done to children.

Preparation for the Mantoux reaction.

No special preparation is required.

The procedure is safe for the child (in the absence of contraindications) and does not apply to vaccinations.

Mantoux reaction: contraindications.

1. Any disease in the acute stage. This applies even to SARS. Therefore, before carrying out the Mantoux reaction, you should be completely cured.
2. Epilepsy (an injection can cause another seizure);
3. Skin diseases in the acute stage;
4. allergic conditions.
5. Oncological diseases

All these reasons contribute both to the distortion of the result of the Mantoux test, and to the negative impact on the body itself.

How is tuberculin diagnosis performed in children.

For children not younger than 1 year old, 0.1 ml of the drug is injected into the forearm area with a special syringe. The injection is made intradermally (in no case should the needle get under the skin, and even more so into the muscle!), This forms a colorless tubercle.

Tuberculin is administered in the amount of 2 tuberculosis units and does not harm the health of even an infant. After 3 days, the result of the test is evaluated by a pediatrician.

FAQ.

Is it possible to do Manto...

• - with a runny nose? Rhinorrhea is an early symptom of SARS. "Button" with a viral disease can give a false positive result.
• - when coughing? No, it is better to wait for the child to recover.
• - Is it possible to do Mantoux if there is no BCG? Even necessary! In this case, the test must be negative.
• - Is it possible to do Mantoux with other vaccinations? No, because any vaccines distort the final result of the test.
• - Diet with Mantoux? It is advisable to exclude all known allergenic foods and not introduce new ones into complementary foods.

Is it possible to wet Mantoux?

Distortion of the sample upon contact with a liquid is more typical for the Pirquet test, in which the drug injected into the skin can be diluted with water, and the result will be unreliable.

However, for safety reasons, Mantoux should still not be wetted: the water may contain various microorganisms that the introduced tuberculin may react to.

How not to wet Mantoux in a child?

1. Wear blouses that cover the forearm;
2. do not let play with a bottle or cup;
3. while washing, cover the injection site with a dry, waterproof cloth fixed with a bandage or elastic mesh.

What to do if you wet Mantoux?

Try to quickly blot the injection site with a cotton swab or soft towel, but in no case rub it, do not wipe it with alcohol-containing solutions and soap.

Mantoux itches: what to do?

Non-intense itching at the tuberculin injection site is normal - this is how the skin reacts to tuberculin, which is essentially an allergen. However, if the itching is unbearable, and the child is worried and crying, you should seek help from a doctor.

Mantoux test results.

The test result may be:

• negative: when only an injection mark is visible;
• doubtful when there is a spot, redness, but the skin is not raised above the surface of the "uninfected" area of ​​​​the forearm;
• positive when there is a papule.
• In addition, there is a hyperergic reaction when the size of the papule exceeds fifteen millimeters or there are pathological changes in the skin.

Mantoux reaction: the norm per year.

With any size of the scar on the left shoulder, the length of the papule should be in a one-year-old baby should be 5-10 mm.

The Mantoux test should be evaluated taking into account the BCG scar:

• In a two-year-old child, immunity to tuberculosis is maximum, so the size of the papule can reach up to 15-16 mm.
• Then the intensity of immunity weakens, and at 3-6 years the diameter of the trace from the Mantoux reaction should not exceed 10 mm.
• At the age of seven, in children, anti-tuberculosis immunity fades, as evidenced by a negative or dubious Mantoux reaction. Therefore, at the age of 7, BCG revaccination is carried out.

After that, the cycle repeats:

• For 7-10 years, the characteristic size of the papule is 11-16mm.
• For 10-12 years old: 5-6mm;
• For 13-16 years: 0-4mm.

Mantoux in adults: the norm is:

1. redness of the skin, without the formation of papule;
2. the absence of any reaction;
3. minimum papule size.

Mantoux positive: what to do?

Since this type of diagnosis is not 100% reliable, the diagnosis should be clarified (or refuted).

Usually, the pediatrician gives a referral to a phthisiatrician, who takes a sputum test, does a fluorography, or conducts a diaskintest.

In addition, a history is taken and a physical examination is performed.

When does the trail from Mantou pass?

Normally, after 1-1.5 weeks, there should be no traces of the test.

If the stain persists for a longer time, it is possible:

• there was a local allergic reaction to tuberculin;
• the child has a hereditary predisposition to such a manifestation of the Mantoux reaction;
• individual feature of the organism;
• or, more seriously, the child is infected.

In any case, all suspicious, in your opinion, phenomena should be reported to the attending physician so as not to endanger the health of the baby.

The Mantoux reaction is a technique for analyzing the severity of immunity to the causative agent of a serious disease - tuberculosis. Hence other names: tuberculin diagnostics, tuberculin test. The diagnostic test is carried out annually in kindergartens, clinics and schools.

For many parents, the study raises many questions. Passions are fueled by stories about the optionality of diagnostics, the fashion for refusing to vaccinate. The material will help parents understand why it is important to conduct a tuberculin test, whether there are contraindications. Learn more about what is the norm and pathology in the Mantoux reaction.

general information

A special test confirms or refutes the presence of tuberculosis bacillus in the body. Tuberculin, administered intradermally, indicates the presence of a causative agent of a serious illness. An analysis of the reaction to the drug gives an answer: is there a Koch stick in the body or not.

The essence of the method:

• extract based on mycobacterium tuberculosis, containing auxiliary components, is injected intradermally;
• after a diagnostic Pirquet test, a papule appears at the injection site - a compacted area of ​​\u200b\u200bthe skin, redness appears;
• in some children, the reaction is weak, the papule is practically absent or hardly noticeable. In some cases, the red swollen spot grows to 15–17 mm or more;
• 72 hours after the tuberculin test, the doctor monitors the reaction of the body. The doctor examines the injection site, checks the thickness of the epidermis at the injection site, and measures the size of the papule with a transparent ruler. In the absence of compaction, the diameter of the reddened area matters;
• according to the results of the diagnostic test, the doctor records the size of the papule, the nature of the reaction in the card of the young patient. In case of violation of the norms, the doctor writes out a referral for examination to an anti-tuberculosis dispensary.

Why is a test necessary?

In countries where tuberculosis is one of the national problems, tuberculin testing is mandatory. The technique allows you to effectively control a dangerous infection, track the dynamics of the spread of the disease.

The Pirke reaction is needed to solve certain problems:

• active detection of primary infected patients;
• diagnosis of tuberculosis in patients who have Koch's bacillus, but there are no visible signs of a serious illness;
• confirmation of the diagnosis in case of suspected tuberculosis;
• identification of patients who were infected a year ago or more. Marked enlarged papule, active redness;
• selection of children aged 6–7, adolescents aged 14–15 for mandatory revaccination against a dangerous disease - tuberculosis.

Mantoux reaction: vaccination or not

Many parents call the tuberculin test a vaccine, but in fact it is not:

• Vaccination produces immunity against a specific pathogen. After vaccination, the child receives protection for a certain period of time. Revaccination is often required to maintain specific immunity for a longer period of time;
• Mantoux reaction is a diagnostic test, with the help of which the reaction of the body to the lysate from Mycobacterium tuberculosis is visible. The more active the redness, the larger the size of the papule, the higher the probability of finding a tubercle bacillus in the body.

Norm and deviations

The nature of the reaction during the diagnostic test:

• negative. There is no infiltration, the injection site is indicated by a dot up to 1 mm;
• doubtful. With this form, the papule grows from 2 to 4 mm. The second option - with redness of any size, there is no seal;
• positive Mantu. The injection site turns into a papule with a diameter of 5 mm or more. Manifestations can be weakly positive - the papule reaches 9 mm, of medium intensity - 14 mm, well pronounced - the diameter is from 15 to 16 mm;
• strongly pronounced- in this case, the infiltrate reaches 17 mm or more;
• dangerous, vesiculo-necrotic. Dead areas appear at the injection site, daughter screenings, pustules appear nearby, nearby lymph nodes increase.

When the child is sent for examination to the TB dispensary

You should not panic if you have a doubtful or mild (moderate) reaction to tuberculin. When evaluating the results, doctors take into account the time elapsed since the last BCG vaccination.

Landmarks:

• one year after BCG vaccination. Permissible values ​​are from 5 to 15 mm. Seal, redness - manifestations of post-vaccination immunity;
• two years after vaccination. The infiltrate during the Mantoux reaction should be smaller or remain at the same level. With an increase in papular formation by more than 5 mm, severe redness requires an additional examination to exclude infection with Koch's wand;
• three to five years after the introduction of the BCG vaccine. After this period, the maximum allowable papule size is no more than 8 mm, optimally up to 5 mm. With good immunity, many children have a negative reaction: after a couple of days, only a dot is visible at the injection site. Swelling, redness is practically absent. With an increase in infiltrate, the doctor will write out a referral for examination to a tuberculosis dispensary.

What factors affect the final result

The following factors often distort the response to the introduction of tuberculin:

• hemodialysis;
• real immunodeficiency;
• chemotherapy of various neoplasms;
• errors in the diagnostic test;
• use of low-quality tools;
• violation of the parameters of transportation / storage of tuberculin.

You can not panic with a positive Mantoux reaction. Doctors never diagnose TB only on the basis of a tuberculin test. Additional studies are required: sputum collection, chest x-ray, clarification of the timing of the BCG vaccination.

Indications

The Mantoux test is mandatory for all children aged 1 to 17 years. It is important to consider absolute and relative contraindications.

Doctors recommend tuberculin testing for all children who have no restrictions on the test. The Pirquet reaction is the most reliable method that reveals the body's reaction to the presence of tubercle bacillus. For this reason, for a hundred years the drug (tuberculin) has not undergone fundamental changes.

Contraindications

Tuberculin is safe for children: there are no living microorganisms, the minimum dosage, no effect on the immune system. Despite this fact, there are limitations to the study.

Important point! Has the child recently had ARVI, a cold, or another infectious disease? Has the group or class been quarantined due to a contagious disease? A diagnostic test for the detection of tuberculosis pathogens is allowed after a month after the removal of quarantine / the disappearance of all clinical signs of pathology.

Pay attention to contraindications:

• allergic reactions in children, especially 4–6 years old, with a weak immune system;
• epilepsy;
• infectious, somatic diseases (acute plus chronic form) with pronounced clinical symptoms;
• dermatological diseases;
• age up to 1 year (distorted reactions, inaccurate / unreliable answer).

All parents should know the list: setting the Pirquet test at the wrong time, in the presence of restrictions, often gives the wrong result. Parents with a child are forced to visit a TB dispensary with a certain frequency, to conduct repeated examinations, and the reaction, in fact, is a false positive. For example, not everyone knows that allergies + weak immunity in children often increase the size of the papule on the arm.

A page is written about massage for dacryocystitis in newborns.

At the address, read about the rules for the use and dosage of Orvirem for children.

Vaccinations and Mantoux: how to combine

Parents should know certain rules, control whether doctors observe the interval between vaccination and tuberculin test. A certain interval is needed for the return of immunity sufficient to deal with microdoses of inactivated and live vaccines. Intervals are needed to exclude the mutual influence of two stimuli.

Basic Rules:

• it is forbidden to test Pirquet and vaccinate. With a high load on the immune system, false positive reactions are often noted;
• after evaluating the results of the Mantoux reaction (in the absence of indications for referral to a tuberculosis dispensary), it is allowed to be vaccinated the next day;
• Is it time for routine vaccinations? After vaccination against tetanus, influenza, diphtheria using killed vaccines, the interval until the next Pirquet test is 4 weeks or more;
• after vaccination with live vaccines (rubella, mumps, measles, OPV), wait with a tuberculin test for 6 weeks or more.

How is the diagnosis

Testing for tuberculosis takes a little time, does not require special preparation from children and parents:

• tuberculin is injected with a special syringe into a certain area - the middle third of the forearm, from the inside;
• the needle is inserted intradermally to a minimum depth;
• dose volume for intradermal administration - 0.1 ml, which is 2 TU (tuberculous units);
• after an injection, a tubercle appears under the skin - a papule. The site of the test turns a little red, the compacted area slightly rises above the skin.

What can and cannot be done after the test

The child and parents must follow certain rules:

• Before testing, do not wet the area where the sample was placed. Did the child forget about the warning, accidentally wet his hand? Be sure to tell your doctor about this, especially if the spot has increased dramatically after the incident;
• it is forbidden to rub, comb, scratch the infiltrate;
• it is impossible to heat, smear with brilliant green or hydrogen peroxide papule and hyperemic (reddened) area;
• it is forbidden to seal the injection area with adhesive tape, bandage;
• it is important to wear clothes made from natural fabrics that do not irritate the skin of the forearm. Be sure to wear a flannel, knitted or cotton blouse under a wool sweater;
• you can not press, often touch the papule and hyperemic area.

Do not be afraid to perform a Pirque test in a child: the drug is safe for a growing organism. Annual tests show a complete picture of the presence of tuberculosis bacillus, reflect the dynamics, and speak of the strength of immunity. In case of deviations from the norm, follow the instructions of the doctor exactly, be sure to conduct an additional examination in a specialized institution.

A timely visit to a tuberculosis dispensary to diagnose a dangerous disease will prevent serious consequences. Remember: it is easier to identify and prevent the development of pathology than to treat the complications that patients face with an advanced form of tuberculosis.

More interesting information about Mantoux in a child in the following video:

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is the mechanism?

Conducting a Mantoux test

It should not be smeared with any antiseptics, it is advisable not to wet it until the results of the test are taken. This is especially true for swimming in open water, where there is the possibility of infection in the wound. You should not close the "button" with adhesive tape. Under no circumstances should you scratch it. Only after taking the results, it is possible to process the injection site of the solution ( if necessary).

Mantoux test results

• The size of the seal is 0 - 1 mm - a negative reaction, the body is not infected with Koch's bacillus,
• Size 2 - 4 mm - a doubtful reaction, a person is at risk, there is a possibility of infection,
• A seal size of 5 mm or more indicates a high probability of infection with tuberculosis,
• The size of the seal in children is 17 mm, in adults 21 mm, the appearance of abscesses or necrosis indicates a hyperergic reaction.

"Bend" Mantoux test is the increase in seal size compared to the sample a year ago. This is an important parameter that may indicate infection in the past year.

The following factors can influence the results of the Mantoux test:

• allergic diseases,
• chronic diseases,
• Recent infectious diseases
• patient's age,
• Phase of the menstrual cycle
• Individual features of the skin,
• unfavorable environmental conditions,
• Tuberculin quality and sample performance.

Contraindications to the Mantoux test

It is not advisable to do a Mantoux test for babies under the age of one year, since due to the formation of immunity, the result is likely to be unreliable. At the age of up to 6 months, it is completely impossible to obtain a reliable result.

According to various sources, the reliability of the sample ranges from 50 to 80%.

Positive Mantoux test

• Seal diameter 5 – 6 mm larger than a year ago
• Positive reaction detected for the first time, before that there were negative or questionable results
• Compaction with a diameter of 10 mm and above has been observed for several years in a row
• Suppuration, ulceration of the papule
• 4 - 5 years after vaccination, the seal size is 12 mm and above
• The patient closely communicates with a patient with tuberculosis, lives in an area unfavorable for this disease, and eats poorly.

With a positive reaction, Mantoux should visit a phthisiatrician's consultation. Additional diagnostic measures will be prescribed:

• x-ray
• sputum analysis, blood test, urinalysis
• examination of parents.

Complications after the Mantoux test

Mantoux test in adults

Mantoux test: "for and against"

For a trial:
1. The Russian Federation and all countries of the post-Soviet space are unfavorable regions in terms of the number of people infected with tuberculosis.
2. The test is one of the main methods for detecting Koch's bacillus in the body, and also allows doctors to track the reaction of the child's immune system to vaccination against tuberculosis and to the introduction of the bacillus from the external environment, since sooner or later any organism encounters this bacillus.
3. The test can identify children who need re-vaccination against tuberculosis. This procedure is carried out at the age of 6 - 7 and 14 - 15 years.

Against the sample:
1. Scientists have not fully studied the mechanism of the effect of tuberculin on the immune system.
2. The composition of tuberculin administered during the Mantoux test contains preservatives and stabilizers, which in certain quantities are toxic to the body.
3. The reliability of the result is influenced by many factors, including even such as lifestyle and diet. Therefore, its reliability in some cases does not even reach 50%.
4. In a third of people with tuberculosis, the test gives negative results.
5. The result also depends on the accuracy of the test. Incorrect measurement, unsuitable instruments make this procedure meaningless. And improper storage of tuberculin can even be dangerous.
6. In some cases, after the Mantoux test, severe consequences and even death develop ( in the spring of 2006, more than a hundred children were affected in Ukraine).

Refusal of the mantoux test

The right to refuse a sample is set out in the "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" dated 22.08.1993, article 33. And also in the Federal Law No. 77 "On the Prevention of the Spread of Tuberculosis in the Russian Federation", article 7.

At the same time, it should be borne in mind that the kindergarten management has the right to refuse admission to a child who has not passed

For express diagnosis of tuberculosis, various methods are used, the main of which are fluorography and the Mantoux reaction, the norm in adults helps to determine the presence of infectious agents in the body. It is not often done in adults, as it is less reliable than a lung scan, but if there are contraindications to x-ray exposure or a need for a quick study, a test can be done. In most cases, this test is only an addition to the main diagnosis - if it is not possible to give a clear assessment of the reaction, extended tests for tuberculosis are mandatory.

During the Mantoux test, tuberculin is injected into the skin on the forearm - a preparation consisting of a mixture of antigens isolated from a group of mycobacteria of different species. This kit allows you to determine the body's response to any type of tuberculosis.

There are no living or dead Koch sticks in the preparation, therefore the Mantoux test is not considered a vaccine and does not affect the body's resistance to infection with tuberculosis. Only the response to antigens is determined - if a person has been infected with mycobacteria, his immunity will recognize specific proteins, and an allergy to tuberculin will start. It will manifest itself locally in the form of papules of a certain size, by which it is possible to determine the presence of contact with the infectious agent.

Since the reaction to mycobacteria antigens will be not only in the case of tuberculosis, but also after BCG vaccination, some experts do not consider the Mantoux test to be a significant diagnostic test.

The Mantoux test in adults consists in the introduction of 0.1 mg of tuberculin solution by intradermal injection below the elbow. There is also a skin type of test, but in Russia it is usually not used. Tuberculin itself is also produced in several variants; the most common PPD (PPD - eliminated protein derivative, purified protein derivatives). The substance is absolutely safe for humans and is used even in the diagnosis of infection in young children.

The test results are evaluated after 3 days.

• redness of the injection site;
• skin thickening.

The injection site must be protected from external influences that may affect the score. There is a myth that Manta cannot be wetted, but in fact it is enough not to scratch or rub it with a hard washcloth. In addition, during the maturation of the sample and a month before it, no vaccinations can be done.

Evaluation of the result of the test is to measure the papule formed at the injection site. If the patient has not been in contact with mycobacteria, the immune system will not recognize the injected antigens, will not produce T-lymphocytes, and there will be no reaction to tuberculin.

A complete lack of response is rare, given that most people carry mycobacteria or are vaccinated against tuberculosis with the BCG vaccine. Most often, there is an immune response, and it manifests itself in the form of local redness and the formation of papule (seal). Hyperemia is a normal reaction even in a healthy person; the assessment is given precisely to the seal, by the diameter of which the presence of the disease is determined.

1. Negative - the diameter of the seal is not more than 1 mm.
2. Doubtful - the diameter of the papule is from 1 to 4 mm.
3. Positive - diameter from 4 to 17 mm.
4. Infection in an active form - a papule more than 21 mm or the presence of an open wound at the injection site.

In addition to the actual size of the papule, the turn of the reaction is evaluated - the difference between the diameters of the last sample and that made last year. Changes can reach up to 6 mm. At the same time, a turn is considered a diagnostic sign only if BCG vaccination has not been carried out over the past year.

A positive reaction does not indicate infection with tuberculosis - only the presence of passive mycobacteria in the body. In some cases, the immune response to tuberculin is caused by extraneous factors. Only a specialist can give an accurate interpretation of the sample.

Even if the skin turns red and swollen after the Mantoux test, this does not provide any accurate information about health. For adults with a positive reaction, an additional examination in the dispensary is required.

The negative and doubtful results of the Mantoux reaction in normal adults indicate that the immune system does not recognize the proteins characteristic of Mycobacterium tuberculosis and does not know how to fight the infection. This means that the person has never encountered tuberculosis and has not been in contact with infected people. If BCG was previously vaccinated, a negative Mantoux test indicates the ineffectiveness of preventive measures and the need for re-vaccination.

In rare cases, a false negative result occurs - if a person has had tuberculosis many times, his body can adapt and stop reacting sharply to the introduction of tuberculin. This also happens with a deficiency of vitamin E and the use of low-quality tuberculin.

A positive result means that Koch's wand is present in the body.

• the turn of the reaction, increasing over several years;
• the size of the papule is more than 12 mm for 4 or more years;
• isolation of infiltrate from the injection site;
• the formation of an erosive wound at the site of the Mantoux test.

If there is reason to believe that a person is infected with tuberculosis, he is sent for additional examinations - fluorography, blood and sputum tests. When the diagnosis is confirmed, tuberculosis treatment is prescribed. Also, tests may show that the Mantoux vaccination gave a false positive result. This phenomenon occurs quite often due to the fact that a variety of factors and internal processes in the body affect the functioning of the immune system.

In a state of physical stress, even the smallest impact on the body can cause an immune response.

• recent non-tuberculosis infection or vaccination - immunity in this case is active and reacts sharply to external attacks;
• tendency to allergies caused by hypersensitivity of the immune system;
• the presence of chronic diseases;
• active inflammatory process in any part of the body;
• individual intolerance to tuberculin or its components;
• infection with non-tuberculous mycobacteria - although they do not lead to the development of infection, the cells of microorganisms produce similar proteins, to which the body reacts in a similar way;
• advanced age of the patient;
• menstrual period in a woman;
• poor quality tuberculin or improperly performed procedure;
• the presence of skin diseases;
• poor environmental conditions in the patient's place of residence.

Such a variety of factors influencing the result explains why Mantoux is not done in adults in most cases. As a preventive measure, the test is carried out only on people whose work is related to the food industry or contacts with a large number of people, especially children.

Even knowing what the reaction should be, it is impossible to draw conclusions on your own. Only additional studies in a tuberculosis dispensary will confirm or rule out the presence of an infection in the body.

Despite such a serious drawback as the lack of clarity of results, the Mantoux test is an important part of tuberculosis prevention. Like fluorography, it is the basis for obtaining epidemiological data and developing infection control measures.

For most people, the study is completely safe. However, in some cases, tuberculin leads to an exacerbation of chronic diseases; some health problems lead to a guaranteed distortion of the results. In such situations, the Mantoux reaction in adults is not carried out and is replaced by fluorography. Since everyone is required to undergo a preventive diagnosis of tuberculosis, each person should know whether Mantoux can or cannot be done with his individual characteristics.

1. The presence of any acute disease or recovery period after surgery.
2. Skin diseases. They themselves cause the formation of papules and redness, which makes it difficult to determine the results of the test.
3. Bronchial asthma. The introduction of tuberculin leads to an exacerbation of the disease, the appearance of coughing, shortness of breath or suffocation.
4. Allergy to the constituent components of the solution for the test.
5. Epilepsy and rheumatism. Tuberculin leads to exacerbations of these diseases.

In addition, one of the patient's lifestyle factors may affect the result of the test. First of all, these are bad habits - smoking, alcoholism, drug use. Narcotic substances have a particularly strong effect - almost all systems in the body, including immunity, do not work properly in drug addicts, so there is a high probability of an inadequate reaction to tuberculin. Alcohol and tobacco should be dealt with separately.

It all depends on the individual characteristics of the organism. In general, alcohol and nicotine cause the activation of H1-histamine receptors, which leads to an increase in the sensitivity of the immune system. As a result, even in the absence of active mycobacteria in the body, the papule may grow more than normal.

Before conducting the test, you should consult with your doctor - he will tell you whether it is possible to smoke and drink during the Mantoux test in a particular case.

In addition to internal processes in the body, the result of the Mantoux test is influenced by external influences on the skin at the injection site. Therefore, it is important to know not only contraindications - papule care is also important.

• do not scratch the injection site of tuberculin;
• do not lubricate the papule with medicines for itching;
• do not treat the injection site with antiseptics;
• do not seal the papule with a plaster;
• avoid exposure to high temperatures on the skin.

Any mechanical impact can lead to an increase in the size of the reaction and a false positive test result.

In people with hypersensitive immunity, the test may cause coughing and fever. These symptoms are normal and pass quickly.

Knowing what the Mantoux reaction should be in a normal adult and what affects it, it is easy to avoid panic when an allergy appears after a test. It is important to remember that this test does not give 100% accuracy, and only a doctor can give a conclusion about the presence of a disease.

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• Congratulations! The chances of you being over TB are close to zero.

  But do not forget to also monitor your body and regularly undergo medical examinations and you are not afraid of any disease!
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• There is reason to think.

  It’s impossible to say with accuracy that you are ill with tuberculosis, but there is such a possibility, if it’s not, then something is clearly wrong with your health. We recommend that you immediately undergo a medical examination. We also recommend that you read the article on.

• Contact a specialist immediately!

  The likelihood that you are affected is very high, but remote diagnosis is not possible. You should immediately contact a qualified specialist and undergo a medical examination! We also strongly recommend that you read the article on.

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Task 1 of 17

1 .

Does your lifestyle involve heavy physical activity?

1. Task 2 of 17

   2 .

   How often do you have a TB test (eg mantoux)?

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   3 .

   Do you carefully observe personal hygiene (shower, hands before eating and after walking, etc.)?

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   4 .

   Are you taking care of your immunity?

4. Task 5 of 17

   5 .

   Have any of your relatives or family members suffered from tuberculosis?

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   Do you live or work in an unfavorable environment (gas, smoke, chemical emissions from enterprises)?

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   How often are you in a damp or dusty environment with mold?

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