The Mantoux reaction is higher than normal in children. Mantoux test: is it necessary?

Prevention of tuberculosis, a dangerous and widespread infectious disease that kills millions of people every year, is carried out in all civilized countries.

Children are especially vulnerable to infection first years of life. The disease begins unnoticed and develops rapidly.

Babies get infected from adults; they get BCG vaccination in the maternity hospital to all newborns, no matter how favorable social environment, in which they will live, how high is the likelihood of encountering an infection. After vaccination for children annually carry out an immunity test using the Mantoux test. The second function of Mantoux in children is the same as in adults - early diagnosis diseases.

Diagnosis of tuberculosis in children at two years of age

A conclusion about infection with tuberculosis is never made by specialists based on the Mantoux test alone. Information important for making a diagnosis may include general tests blood and urine. After Mantoux, the doctor sequentially prescribes several more checks for the child. Sputum analysis and bronchoscopy are not usually done at this age.

After Mantoux (and sometimes instead of it) it is carried out blood analysis for tuberculosis.

If infection is suspected two-year-olds children are tested by relatives and those with whom the child had contact. ELISA(method enzyme immunoassay) And biopsy used for diagnostics hidden forms diseases.

PCR ( polymerase method chain reaction ) is one of the most accurate ways to diagnose tuberculosis.

How and why Mantoux is made

After the BCG vaccination, the process of developing immunity begins in the baby’s body. In the first year of life, he will actually have to suffer from a local cutaneous form of the disease. Attenuated mycobacteria of bovine tuberculosis enter the body. In a month and a half an infiltrate forms, which festers for six months, then a scar appears - evidence of the development of immunity.

Exactly BCG vaccination- a serious burden for the body, but no one would think of refusing vaccination: it provides immunity during primary infection, protects against severe forms illnesses (including meningitis).

Mantoux - easy diagnostic procedure, which forms a single diagnostic complex with BCG. Amount of substance administered minimally, the immune system does not receive any additional stress, and health does not worsen.

Tuberculin does not contain live bacteria. Fragments of pathogen tissue have been repeatedly processed (both thermally and chemically) and do not pose any health hazard.

Water solution the drug is injected under the upper layer of skin of the forearm in an amount 0.1 mg.

Phenol, used as a preservative, is contained in each individual sample in an amount several times less than that which is released by the body itself daily during its life processes.

The reaction to tuberculin appears on the first day after the procedure. She expresses herself redness(hyperemia) and the appearance tumors. A compaction, an infiltrate that rises above the skin, is called a papule. It is the diameter of the papule that is the main indicator of the test result. The papule is created by active T-lymphocytes, which are concentrated at the site of infection from the nearest lymphatic ducts. If their number is large, the immune system is seriously strained.

Attention! The maximum tension of immunity in the child’s body after the first BCG vaccination is achieved by two to three years. The response to the Mantoux test at this age is most pronounced.

Reaction results: photo

The Mantoux test results are assessed in 72 hours after the injection.

Photo 1. Positive result of the reaction. At two years old this is the norm: the child has developed immunity.

Photo 2. Hyperergic reaction: the child is most likely infected or already sick with tuberculosis.

Using a special ruler, holding it perpendicular to the shoulder line, the doctor measures the diameter of the skin lump.

1. At no traces injection, with slight redness without swelling (or with swelling about a millimeter) the doctor states a “negative reaction” to the Mantoux test.
2. Small infiltrate ( from two millimeters to four), regardless of the size of the reddened area - a “doubtful reaction” to a tuberculin test.
3. Papule size half a centimeter or more- positive result, “positive reaction” to the Mantoux test.
4. Papule size in children 17 mm or more- an indicator of a “hyperergic reaction”, a sign of infection and disease.

Photo 3. An example of a dubious Mantoux test: the size of the papule does not exceed half a centimeter.

Papule size 10 mm - normal or not

The normal reaction to Mantoux at two years is positive, the size of the papule is on the forearm five millimeters or more.

A negative reaction is possible:

1. If the BCG vaccination carried out in the maternity hospital is unsuccessful, the scar after it is not noticeable and cannot be felt. In this case, the doctor may suggest to the parents repeat vaccination.
2. If a child develops disease related to general disorder immunity, and the mechanism of its formation after BCG does not work.

Small ( 2-3 mm) a scar after BCG indicates that there is a serious strain of immunity in the child’s body in first two years life didn't happen. In this case, when checking the Mantoux result, the papule will have a small diameter - from two to four millimeters.

This result is called a "dubious reaction", but in the case of two year old child Experts have no doubts about the possibility of infection.

The child is healthy, but immunity against infection is insignificant, it will remain for a year; then, depending on the situation in the region and the baby’s environment, repeated vaccination may be considered appropriate.

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Scar and button sizes

Medium sized scar ( 4-6 mm) provides protection against infection up to the age of five. The diameter of the “button” when checking in this case will be moderate and not causing concern —from 5 to 8 millimeters.

Successful vaccination against tuberculosis in the maternity hospital provides the child with immunity until repeated vaccination in primary school, that is up to 7 years. The scar after BCG in this case is - about eight millimeters.

Important! With a large scar after BCG, the Mantoux test two year old child clearly expressed and this corresponds to the norm. The permissible size of a papule at two years is - 16 mm. "Button" diameter ten to fifteen millimeters absolutely normal.

Deviations from the norm in a child 2-2.5 years old

The child’s body receives immunity against any infectious disease in two ways: having been ill or having received the vaccine.

The first year of a baby’s life is spent fighting weakened but living bacteria in the BCG vaccine. By the end of the second year, the activity of T-lymphocytes is greatest, immunity is as strong as possible.

If there is a large scar on the child’s forearm and the papule reaches one and a half centimeters, the test was successful.

The maximum permissible result for a two-year-old child is just one millimeter from that border ( 17 mm), after which the reaction to Mantoux will be recognized as hyperergic, and the child will be sent to a tuberculosis clinic.

Such cases are not uncommon during the second check. They take up time and effort, leading to an unwise decision to refuse Mantoux checks in the future.

Attention! If the “button” on the hand of a two-year-old child is too large, don't rush to conclusions and trust a specialist. A papule indicating infection has specific signs , which only a doctor can accurately determine.

“Post-vaccination allergy” is manifested by a moderate tumor Pink colour. When infected, the “button” bright red, a trace of the same color goes to the elbow, it looks like "tracks". When infected, the boundaries of the papule are clear, pigmentation intensifies within a week, the infiltrate becomes brown. When infected, the wound festers, sometimes it looks like open wound, blisters appear on the forearm.

Possible causes of a large Mantoux

If the only one warning sign — increased size, no need to worry in advance. Perhaps the deviation from the norm is caused by extraneous reasons.

• increase in "button" by a few millimeters- a frequent consequence of the presence in the child’s body of other, non-tuberculosis mycobacteria;
• allergic body condition caused by different types allergens (food, medications, chemicals, plants or animal hair) is a common cause of “false-positive” Mantoux reactions, which will have to recheck in a tuberculosis clinic;
• violation of norms hygiene, mechanical irritation injection sites, getting into the wound sweat, water or dirt, contact with irritating substances will increase the papule by those few millimeters that separate a successful test result from a TB specialist requiring attention.

Known to every mother, the Mantoux test (Pirquet or tuberculin) is tuberculin diagnostics, a method for determining the severity of immunity to Koch's bacillus by studying skin reaction for tuberculin (a special preparation of mycobacteria). The purpose of the manipulation is to check whether the child has tuberculosis.

Purpose of the test

This technique is necessary to confirm the diagnosis and identify:

• primary infected;
• patients with tuberculosis for more than 1 year with a severe papule;
• infected for over 1 year, in whom the infiltrate is increased by more than 6 mm compared to the previous test;
• tuberculosis in those who have it but do not show symptoms;
• selection of children for anti-tuberculosis revaccination, which is done at the ages of 6-7 and 14-15 years.

If the epidemiological situation regarding tuberculosis is unfavorable, then revaccination should be carried out at 6-7, 11-12 and 16-17 years of age. Revaccination is possible only if the Mantoux result is negative.

Execution method

For the first time, the Mantoux reaction is assessed in one-year-old children. Previously, the test is uninformative: the body is not mature enough to demonstrate the required response.

The test is placed subcutaneously. Exactly 0.1 ml of tuberculin is injected. The accuracy of the dosage is important - the results of Mantoux are assessed as a response to the introduction of a clearly established number of tuberculin units.

The assessment is true only if the patient is completely healthy and more than 1 month has passed since the last illness. Therefore, during a preliminary examination of the pediatrician, it is necessary to clarify when the baby was last sick and whether he is sick now.

special instructions

The sample is placed at mandatory implementation such conditions:

• the last vaccination is at least 4-6 weeks old;
• the injection is done with a tuberculin syringe;
• the needle is inserted with the bevel upward, and the skin is slightly pulled back, ensuring that the drug penetrates the epithelium and not under it.

A small bump immediately forms at the injection site, which will change shape within 2 days. It should not be combed or covered with a band-aid.

• stay in the sun for a long time;
• comb the papule (lump at the injection site);
• wet it;
• be physically active.

The meaning of the Mantoux reaction

The Mantoux test causes specific inflammation, simulating the tuberculosis process, provoked by the infiltration of T-lymphocytes responsible for cellular immunity.

Fragments of mycobacteria “induce” lymphocytes contained in the blood circulating in nearby blood vessels. The signal is perceived only by those T-lymphocytes that are “familiar” with mycobacteria.

If there was contact with Koch’s bacillus, then tuberculin will be drawn to the injection site large quantity corresponding T-lymphocytes, which makes inflammation at the injection site more intense, i.e. the results of the Mantoux test will be positive - this will indicate that the child is infected with mycobacterium tuberculosis.

Grade

Medical worker 48-72 hours after the injection, examines the resulting papule (palpable compaction, infiltrate). Children are examined in good lighting.

The papule should take the shape of an oval (circle) and stand out slightly above the skin. The normal color of the infiltrate is from flesh-colored to reddish, but blue discoloration is unacceptable. When lightly pressed, it turns slightly white.

The size of the papule is determined by measuring with a transparent ruler. It is installed across the longitudinal line of the forearm. The reaction is assessed only in relation to the elevation - the convex part of the papule.

Redness around the injection site is not a sign of immunity to tuberculosis or infection, but this fact is recorded if there is no infiltrate.

It is important to track the individual dynamics of the result.

Classification of results

The classification of test results is presented in the table.

Children may also have a false negative result when the patient is infected, but the Mantoux test did not reveal this, which is explained by:

• anergy when the immune system weakened and unable to respond to tuberculin, which is typical for immunodeficiency states(for AIDS, etc.). Then they do an anergy test with a 50-fold increase in the dose of tuberculin to 100 TU;
• “fresh” (no more than 10 weeks) infection;
• child under 6 months of age.

In children, the test may also be false positive when the baby is healthy and the papule has gone beyond the normal limits, which is possible if:

• infection with non-tuberculous mycobacteria;
• allergies;
• recent illness.

In case of a false positive result when a mycobacterium is suspected, it is impossible to determine that it is tuberculosis. The assertion that a patient is infected with Koch's bacillus becomes more likely if:

• the injection site became very inflamed;
• a lot of time has passed since the BCG placement;
• a person has recently visited or lives in a region with active circulation of mycobacterium tuberculosis;
• contact has been established with a carrier of tuberculosis or one of the relatives has had it.

"Turn"

The child may have an increase in the diameter of the infiltrate compared to last year's study. “Virage” is recognized if the papule:

• became positive for the first time and reached a size of 5 mm or more with a previously negative or questionable result;
• became larger than the previous one by 6 mm or more;
• reached 17 mm or more without taking into account the date of vaccination;
• more than 12 mm 3-4 years after BCG administration.

This reaction indicates a possible infection that occurred in the last year.

BCG and Mantoux test

In Russia, anti-tuberculosis vaccination with BCG is mandatory for newborn children, i.e. all vaccinated children are immune to tuberculosis. Accordingly, it is important to distinguish between positive reactions during infection and the result of vaccination. To do this, explore:

• post-vaccination sign - BCG scar;
• date of last vaccination (re-vaccination);
• previous reactions;
• The child’s last test is also important.

A post-vaccination scar remains on the child’s left shoulder, between the upper and middle third. It is round, its size is 2-10 mm.

There is a direct relationship between the size of the scar and the duration of post-vaccination immunity: if the scar has a diameter of 5-8 mm, then immunity is 5-7 years old, with a diameter of 2-4 mm - 3-4 years.

If there is no scar in the first couple of years of the child’s life, and the Mantoux test shows 10 mm, the baby is probably infected. 1-1.5 years after BCG, positive reactions are recorded in 60% of children, negative or doubtful in the rest. In the first 2 years of life, a papule size of up to 16 mm is considered normal, the average value is 5-11 mm. An infiltrate measuring 12-16 mm is observed together with a scar measuring 6-10 mm.

After 3-5 years, a child’s post-vaccination immunity weakens, and a test of 12 mm will indicate infection. In 6-7 year old children who do not have tuberculosis, negative and questionable reactions are recorded.

Pigmentation at the site of infiltration 1-2 weeks after Mantoux helps to accurately distinguish between post-vaccination immunity and infection. The papule that arises as a result of a reaction to BCG becomes pale pink, does not have clear contours and does not leave pigmentation. When infected, the infiltrate is characterized by a clear contour, it is brightly colored, and pigmentation persists for up to 2 weeks.

Primary infection with mycobacterium tuberculosis is suspected if the child:

• for about 3-5 years a papule of 10 mm or more is observed;
• hyperergic reactions are observed regardless of the timing of vaccination;
• a test of more than 12 mm appeared 3-4 years after BCG.

If it is not possible to establish a relationship between the child’s anti-tuberculosis vaccination and positive Mantoux, a conclusion is made that the etiology of the reaction is unclear. The test is repeated after 6 months. If the assessment is again positive, the patient is sick. If the papule has decreased, they talk about the post-vaccination factor in the previous test.

Mantoux test: why do it to a child, is it dangerous? If there are no contraindications, mantoux test best test for tuberculosis
Reaction to manta ray in a child at different ages How to make Mantoux - principles of testing

Tuberculosis incidence statistics indicate its rapid spread among the population and various age groups. Current issue in medicine there was and remains the diagnosis of this disease. Children's bodies are especially susceptible to pathogens infectious diseases, therefore in pediatric practice The tuberculin test (Mantoux) is widely used, the purpose of which is to confirm or refute the fact of infection with tuberculosis.

Timely execution of the Mantoux reaction plays a role important role in the prevention of childhood tuberculosis. This procedure required before administration routine vaccine BCG.

Sample characteristics

The Mantoux reaction is a diagnostic method, the essence of which is the subcutaneous administration low dose tuberculin. At the site of drug administration, a focal reaction is formed, which is expressed in the form of local redness and thickening (papules). WITH diagnostic purpose The papule is measured. Based on the data obtained, medical specialists make a conclusion about whether the baby is infected with the tuberculosis bacillus or not.

Indications

The primary diagnosis of tuberculosis using the Mantoux test is performed when the baby is 1 year old. It is not recommended to administer tuberculin before this period, since age characteristics child's body may provoke unexpected systemic reactions.

Further, the Mantoux reaction is performed annually. Children who do not suffer from infectious and inflammatory diseases at the time of tuberculin administration are allowed to undergo this procedure. The formulation of a new reaction does not depend on the results of the previous one.

Due to lack of experience, many parents do not pay attention to those nuances that are important to obtain a reliable result. tuberculin test. Such nuances include the general well-being of the baby and his diet. Presence of signs respiratory infection And poor nutrition cause increased local reaction body to administer the drug.

Important! After one performance of the Mantoux reaction, it is impossible to assess the reaction of the child’s body to tuberculin. This information can only be obtained by assessing the dynamic parameters of the papule size.

The injection site for the drug is the area between internal part elbow bend and wrist. The reaction procedure is performed in a clinic setting.

Normal indicators

At the age of 1 year, the tuberculin test is assessed 3 days after administration of the drug. The papule is measured using a centimeter scale or a regular ruler. At the age of 1-2 years, the reaction to tuberculin is assessed according to the following parameters:

• indicators up to 1 mm correspond to the norm;
• a size from 2 to 4 mm indicates a questionable sample reaction;
• if the papule is larger than 5 mm, then the reaction is considered positive.

Papule sizes over 10 mm indicate hyperreaction and tuberculin. In this case, the baby is advised to consult a pediatric TB specialist.

With each subsequent year, the Mantoux test changes downward. A cause for alarm is an increase in the papule compared to last year by more than 5 mm.

If the tuberculin test is not accompanied by redness at the injection site, then the papule can be carefully felt with a finger and measured. The diagnostic value is the size of the compaction, and not the resulting red spot. The presence of local redness does not give reason to consider the Mantoux reaction positive.

A positive reaction to the administration of tuberculin is often pronounced (hyperergic) in nature. In this case, a large compaction with elements of ulcers and pustules forms on the surface of the baby’s skin. This reaction indicates massive damage to the child’s body by Mycobacterium tuberculosis.

If, on the eve of the reaction, the baby’s parents did not take into account the mandatory conditions for preparing and caring for the papule, then the test may be false positive. Reason false positive reaction This can include scratching, water getting into the injection site, rubbing with a washcloth when bathing, and also covering the papule with an adhesive bandage.

Receiving questionable or positive test Mantoux is the basis for redirecting the child to a tuberculosis clinic for the purpose of undergoing additional examination. A more informative analysis is Diaskintest, performed if infection with Mycobacterium tuberculosis is suspected.

Allergic reaction to tuberculin

Often, in the body of children prone to developing, an aggressive reaction to the administration of tuberculin occurs. The body of such a child may not have encountered the tuberculosis bacillus, but the Mantoux test gives a positive result. Predisposing factors are family history and a tendency to allergies.

Important! Often, an allergic reaction to a tuberculin test is provoked by a substance - phenol, which is part of the finished product. injection solution. This component is highly toxic, but in small doses it is safe for the baby’s body.

Dietary restrictions after tuberculin administration

When the baby was tested, it was recommended to exclude foods with high allergic activity from his diet. These products include citrus fruits, chocolate, and any products containing cocoa.

Sample care

Receipt collateral reliable results is proper care behind the papule. After administering tuberculin, it is strictly forbidden to perform the following actions:

• Allow moisture to enter the papule area. Within 3 days from the date of the test, parents need to carefully bathe the child, avoiding getting the papule wet.
• Comb and scrub the sample area with a washcloth. Parents need to carefully ensure that the baby does not scratch the papule.
• Cover the injection site with adhesive tape. Many parents practice this activity to reduce itching, but between the surface of the adhesive plaster and skin moisture accumulates, which can affect the reliability of the results.

Contraindications

The production of Mantoux does not pose a threat to the child’s body at any age. In the presence of chronic diseases internal organs and systems, the reliability of the test is beyond doubt. The vaccine does not contain microorganisms that are dangerous to the baby.

Among which are:

• the presence of acute infectious and inflammatory diseases;
• skin diseases accompanied by rash, peeling, suppuration, itching;
• the presence of individual intolerance to vaccine components;
• severe allergization of the child’s body;
• epilepsy and other disorders of the central nervous system.

Adverse reactions

The main side effect of tuberculin administration is an allergic reaction. Intensity this process depends on individual characteristics child's body. Side effects when tested, they have similar symptoms to ARVI.

These symptoms include:

• complete or partial loss of appetite;
• increase in body temperature to 38 - 39 degrees;
• the appearance of a skin rash;
• weakness and general malaise;
• anaphylactic shock (in severe cases).

Allergic symptoms tend to appear not only at the site of drug administration, but also on the face, buttocks, knees and groin folds.

How to help your baby

If, against the background of tuberculin administration, alarming symptoms, then parents are recommended to show the child as quickly as possible medical specialist. An increase in body temperature above 38 degrees is the basis for the use of antipyretics (Ibuprofen,).

In case of severe allergies, the child is prescribed antihistamines. medicines. If adverse reactions are accompanied by weakness, malaise and loss of appetite, then bed rest is recommended for the baby, drinking plenty of fluids and daytime naps.

Modern legislation allows parents to refuse the Mantoux test, but such measures make it difficult timely diagnosis tuberculosis in children of preschool and school age.

Tuberculosis is one of the most dangerous and common diseases, which especially often affects the body of young children.

That is why children are vaccinated against tuberculosis a few days after birth while still in the maternity hospital.

Does a child need mantoux and BCG preparations?

Immunization is intended to prevent and prevent severe and fatal dangerous current tuberculosis. All newborn children who have no contraindications to it are subject to vaccination. Children who were born prematurely or with low birth weight are vaccinated with a drug with a smaller amount of antigen. To vaccinate healthy children, the vaccine used is BCG-M, premature and low birth weight children.

Vaccination against tuberculosis in children cannot be carried out on the same day as immunization against other diseases. If the child is certain reasons upon discharge from the maternity hospital did not receive a dose of vaccine against this disease, such manipulation should be carried out in a children's clinic.

The BCG vaccine consists of different subtypes of Mycobacteria bovis. To obtain bacteria for the production of a medicine that protects children's bodies from tuberculosis, a technique is used to inoculate bacilli on a nutrient medium. This cell culture grows in a nutrient medium for a week. The bacillus is then isolated, filtered, concentrated, turned into a homogeneous mass, diluted with water, and the vaccine is ready for use to prevent tuberculosis.

Currently, many different BCG vaccine preparations are produced in the world, but 90% of all medicines contain one of the following strains of mycobacteria:

• French "Pasteursky" 1173 P2;
• Danish 1331;
• strain "Glaxo" 1077;
• Tokyo 172.

Vaccination against tuberculosis in children is equally effective regardless of the strains of mycobacteria used. Prevention of the disease is carried out only by registered Russian Federation drugs - BCG and BCG-M.

The primary dose of BCG vaccine contains 0.05 mg of the drug diluted in a solvent. Vaccination is carried out in the maternity hospital on days 3–7 of a newborn’s life. morning time in a room specially designated for such manipulations. The vaccine preparation can be introduced into the child’s body only after the child has been examined by a specialist.

In a children's clinic, if vaccination was not carried out in the maternity hospital, the local pediatrician examines the child using thermometry. If necessary, blood and urine tests may also be taken, as well as consultation with specialist doctors. The history of a child who is being immunized against tuberculosis includes the date of vaccination, series and control number of the vaccine, manufacturer and expiration date of the drug.

Vaccination against tuberculosis is strictly administered intradermally in left shoulder. First, you need to inject a small amount of the vaccine preparation under the skin, and, after making sure that the needle has entered to the desired depth, release the entire dose of the medicine. Immediately after vaccination, subject to the rules of vaccine administration technique, a papule should form at the injection site white measuring 7–9 mm, which usually disappears after 15–20 minutes. Injecting the vaccine under the skin is not allowed, as this can lead to the formation of a cold abscess. Do not apply a bandage to the injection site, treat it with iodine or other antiseptics. Revaccination is carried out for all children aged 7–14 years who have a negative reaction to the Mantoux test.

Many parents want to know whether a child needs Mantoux, especially those who decide against certain vaccinations. This procedure is not immunization, it does not protect the body from the development of the disease, its purpose is completely different. Mantoux is given in order to determine whether antibodies to tuberculosis have been developed, that is, based on its results, one can judge the effectiveness of the BCG vaccination.

Mantoux reactions for tuberculosis: positive and negative

In the 20th century, the Frenchman Charles Mantoux used the substance tuberculin, which occurs in human body when infected with tuberculosis infection. From that time to this day, tuberculin has been used all over the world to determine the Mantoux test for tuberculosis in children and adults.

At its core, this is not a vaccination, but a test to determine the presence of tuberculosis infection in a child’s body. Many parents talk about the existence of Mantoux tuberculosis vaccination, although in fact such manipulation is just an allergy test, completely safe for children.

If the mantoux is negative for tuberculosis, this means that the child’s body did not react in any way to the introduction of the vaccine drug into it, so it did not develop antibodies to the infection. Children who had negative reaction for manta rays, it is recommended to carry out this manipulation twice a year to minimize the risks of complications from tuberculosis.

How does the mantoux test work on the body? The composition of tuberculin, which is administered subcutaneously to a child, contains weakened mycobacterium tuberculosis. If the body has previously been in contact with the tuberculosis bacillus, it reacts to this test.

When and how often do children receive mantu? The first vaccination is for a one-year-old child.

When is manta made for children for the first time? The first allergy test is carried out at 1 year of age, at which time the effect of the BCG vaccine is checked. Then it is placed annually, then on the right, then on the left hand. The sample is placed on inner surface forearm subcutaneously, resulting in the formation of a small bubble. After 72 hours from the moment tuberculin is introduced into the child’s body, the condition of the injection site is checked. The size of the circle at the injection site will show whether the body is infected with the tuberculosis bacillus or not.

When asked by parents how often manta is given to children, experts answer that the procedure is carried out twice a year in order to timely detect infection in the body. When increased risk development of tuberculosis in a child, the test is performed starting from 6 months of age.

The first mantu is given to a child at 12 months of age. Mantoux one year old child set to determine the effectiveness of vaccination against tuberculosis carried out shortly after birth.

A positive mantoux for tuberculosis 72 hours after administration of the drug increases in size, turns red and thickens. To correctly determine the size of the injection site, it is important to measure not the amount of redness, but the papule itself. To measure, a transparent ruler is usually used; you should measure across the arm rather than along it. Sometimes, for a more accurate measurement, the papule is first circled with a ballpoint pen, and only then measured.

What kind of mantoux should a child have: photo of the normal reaction and large sample sizes in children

Below in the photo, parents can familiarize themselves with what mantu looks like for tuberculosis possible options allergy tests.

Reactions can be different, namely:

Positive. The Mantoux norm for tuberculosis in children can range in size from 5 to 16 mm in diameter. The seal may have different sizes, based on the severity of the reaction. It can be mild when the size of the compaction reaches 5–9 mm, medium – 10–14 mm, intense – 15–16 mm.

Strongly positive – hyperergic. This is a large mantu in a child; in this case, the papule reaches 17 mm or more in diameter. Experts also talk about this type of reaction when there are foci of inflammation on the skin, the appearance of edema and enlarged lymph nodes.

Negative. It is also possible that 72 hours after tuberculin is introduced into the body, there will be no reactions on the child’s body. It is not normal to have a mantoux reaction in children when there are no traces at the injection site - no redness, no hardening, no swelling.

Doubtful. In this case, there is redness, but there is either no compaction at all, or it does not exceed 4 mm in diameter. A questionable reaction to the Mantoux test is usually equated to negative.

In the photo above, the norm for mantoux in children will help parents become familiar with possible acceptable reactions to this manipulation. If a child has a sharply positive reaction to the Mantoux test, he should be examined by a phthisiatrician as soon as possible. The specialist will conduct some medical events aimed at identifying active tuberculosis bacteria in a child’s body.

All parents can familiarize themselves with the permissible sizes of mantu for children in the photo below:

Knowing what kind of mantoux a child should have, parents can independently determine whether the injection site is normal. After tuberculin is injected, a fluid-filled lump, better known as a “button,” forms on the skin.

Improper care of the injection site can affect the result, so parents should familiarize themselves with the basic rules of behavior after the Mantoux test:

• until the reaction is assessed, the “button” should not be treated with brilliant green or other antiseptic agents;
• Do not allow the seal to come into contact with water or other liquids;
• It is forbidden to cover the injection site with adhesive tape, as the skin under it sweats;
• Parents should not allow the child to scratch the tuberculin injection site.

After the Mantoux test reaction has been checked, if a wound or abscess forms, the tuberculin injection site can be treated with antiseptic agents.

How many times are mantu given to children and contraindications for vaccination

You should understand how many times manta is made for children and follow all the rules stated above. There are situations when the Mantoux test cannot be performed on a child. Contraindications include any skin diseases, exacerbations of chronic diseases, acute somatic disorders. The test can be performed only a month after all symptoms have completely disappeared.

Allergic conditions of the child's body and bronchial asthma are also contraindications for allergy testing. Absolute contraindication By the Mantoux test epilepsy develops.

On the day of the tuberculin test, you cannot carry out other vaccinations - and others. If this rule is not followed, there is a risk of false positive reactions. If immunization against other infections was carried out before tuberculin diagnostics, an interval of one month should be maintained, and only then a Mantoux test should be performed.

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Mantoux test - effective prevention tuberculosis. It is a test to determine whether an infection is present in the body.

The vaccine is used to regularly monitor the presence of Koch bacilli, which can be activated under favorable circumstances.

Why is the Mantoux reaction performed?

For adults, the Mantoux test is performed to determine presence of tuberculosis, but in children the reason is somewhat different. Why is it done? First of all, to identify children who have poor response to tuberculin. This is important for further vaccination.

It is necessary to conduct an analysis annually to reliably determine the presence or absence of a reaction in the body. If a strong reaction occurs, you should take a test. additional tests.

Additional examinations

It is impossible to draw a conclusion about the presence or absence of tuberculosis only on the basis of the test results. If infection is suspected, it is necessary to perform additional diagnostic methods definitions of disease.

1. Radiography in the chest area. The results will be displayed on the resulting image.
2. X-ray chest area . The results are displayed on the monitor. The procedure determines the presence of fluid or air in the pleural area.

Fluorography. Today, medicine can produce not only film fluorography, but also digital one. It is mainly carried out for diagnostic purposes and is performed annually, like the Mantoux test.

CT scan . Considered the most informative method determines the condition of the lungs and helps determine the presence of tuberculosis.

CT allows you to view the state of an organ in a cross-section in 1 mm increments. Thanks to the procedure, it is possible to diagnose even minor foci of tuberculosis and clarify their location.

3. MRI also a very functional and highly informative examination option based on the action of magnetic fields.

Various fluids may be tested to determine the presence of the pathogen. Samples of sputum, blood, urine, feces, pleural fluid, cerebrospinal fluid, and conjunctival and throat swabs are often taken.

Preparation for the procedure

In fact special methods There is no preparation for the procedure. Almost every child can undergo the Mantoux test. The only important limitation is the presence of infectious diseases in acute form(high temperature), which is a contraindication to the test.

Mantoux sizes and their interpretation

The Mantoux test is performed for the first time at the age of 1 year and then executes annually. By the time immunity is formed BCG vaccine already works well and provides an effective immune response against Koch's bacillus.

If the test results are suspicious, doctors will refer him to a tuberculosis clinic, where he will undergo full examination. For maximum accurate results Necessarily within 1 month maintain the child’s usual diet. Additionally, it is recommended to check the child for allergens.

It is important to know that a one-year-old child’s immunity is still developing, so the reaction to the Mantoux test should be completely be absent or insignificant.

After the injection and the time allotted for incubation, a papule will form on the arm. It may be red. Depending on the spot size a conclusion is drawn about the test results.

Normal reaction rate in children aged 1 year

Relation of papule size to test results:

1. Norm. U one year old child There is no redness or thickening of the tissue at the injection site. It is also normal to have a slight thickening and redness (the diameter should not exceed 1 mm).
2. Questionable reaction. The size of the papules is larger than normal, there are clear boundaries of redness and swelling on the skin. Most often the size is within from 2 to 4 mm. If such a reaction occurs, doctors search for patients from the baby’s environment. An examination by a phthisiatrician is required.
3. Positive reaction. This reaction is indicated by the presence of a large red bump that reaches 5 mm in height. To eliminate the risk of error, after receiving positive result a repeat test is performed.
4. Hyperergic response. A similar result is obtained if the seal diameter exceeds 17 mm or appear at the puncture site ulcers, purulent discharge. This reaction signals the penetration of a significant number of bacteria into the body; there is a risk that the person is sick or infected.
5. False positive result . Cause similar phenomenon consists of non-compliance with the rules of care for the injection site.

Photo 1. An example of a positive test reaction is a large red bump.

Depending on the type of severity, Mantoux tests are also divided into:

• Poorly expressed. The height of the tubercle is 5-9 mm.
• Moderate severity(with size 10-15 mm).
• Strong expression. Swelling height above 15 mm.

In young children the expression may simply be absent up to 3 years, but the papule can be found by touch. The reason is the gentle and soft skin.

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Result evaluation

The results are assessed based on examination of the injection site, where there is or is no scar from the injection of the vaccine. If there is a person near the injection scar, then most likely the Mantoux test is positive, which is quite normal. In most cases, there is no need to see a doctor. You will have to make an appointment for a consultation if the reaction becomes alarming (the diameter of the papule exceeds 16 mm).

Let's give an example. After the Mantoux procedure, redness of the skin with a diameter of 5 mm and height 8 mm.

This shows about a positive result. Similar reaction not considered serious, there is no need to seek help.

If after administering the test there is no reaction for days, this is also considered normal, because a scar may not form.

Negative result indicates that the child has never had any interaction with or against a Koch stick there is no immunity.

A positive reaction indicates that the person already has have immunity to bacteria, that is, there is a sick person in his environment.

If a hyperergic response is present, this indicates entry into the body. large quantity virus. After monitoring the reaction for a long time, the doctor determines its cause.

Contraindications

In general, the introduction of a tuberculin test is safe procedure regardless of the child's age. The presence of somatic diseases in chronic form It is not a contraindication and is well tolerated by the body. Tuberculin is safe remedy, which does not include hazardous components.

After complete recovery it is necessary wait1 month before the vaccination procedure. Contraindications include skin diseases, relapses of chronic diseases infectious etiology. Only sharp forms somatic ailments can be prevented by the administration of Mantoux.">

The presence of an allergic reaction to any substance in the drug can harm your well-being, so the Mantoux test is not performed. In the presence of bronchial asthma or epilepsy, administration of the substance is undesirable.

Mantoux test should not be performed on the same day as other vaccinations, otherwise the risk of a false positive reaction increases many times over. Usually the test is carried out before various vaccinations; if due to any circumstances the chronology has changed, you must wait 1 month since the last injection of the substance.

Important! If live bacteria were used as an injection, the procedure is transferred to 1.5 months.

Possible complications and deviations from the norm

The Mantoux test indicates the presence of contact of the body with tuberculosis pathogens. The larger the diameter of the papule, its height and severity, the larger the child comes into contact with pathogenic bacteria. If there is a positive reaction, it is necessary to determine the causes and sources of the Koch bacillus.

If Mantoux is very small or completely absent, this is normal phenomenon, which indicates that the child had no contact with pathogens.

In some cases, this can be a problem, because there may also be no reaction if the immune system is very weak.

U one year old the child may not have a reaction due to the formation of immunity; there is no reason to panic.

In rare cases, the test may cause unwanted effects. Complications are mainly caused by misuse vaccines.

1. False results . To obtain correct conclusions, it is necessary to prevent water and sweat from entering the injection site; You cannot lubricate it with iodine, brilliant green, creams, etc. The main problem is that you will have to use additional diagnostic methods, most often fluorography, which is harmful to a fragile child’s body. Incorrect diagnosis can lead to unnecessary treatment.
2. Poor quality vaccine. There are cases of low-quality vaccines being used. It is necessary to check the reputation of the clinic.
3. Diet. To prevent distortion of the results, it is advisable within 72 hours After the vaccine, do not consume dairy and meat products.
4. Features of the body. Sometimes (rather rarely) tuberculin provokes allergies. The results in this case cannot be judged.

Conclusion

Tests should be taken at specialized medical institutions who have good reputation. Public hospitals are not always able to provide adequate attention to the patient. There is no need to skimp on the vaccine; Perhaps a paid procedure will help identify the infection in time.

Useful video

Check out the video, which tells in detail about the Mantoux test, the procedure, why and how many times it can be performed on a child.

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