The Mantoux test technique is a step-by-step algorithm. Technique for conducting the Mantoux test Staging the Mantoux reaction and assessing the indicators

Target: diagnostics.

Indications: selection of children to be vaccinated with BCG, determination of infection of children with Mycobacterium tuberculosis, early detection of tuberculosis in children and adolescents.

Contraindications:

1. Exacerbation of skin manifestations of exudative-catarrhal diathesis.

2. Epilepsy

3. Acute and chronic infectious and somatic diseases during exacerbation

4. Allergic conditions (rheumatism in acute and subacute phases, bronchial asthma, idiosyncrasy).

Equipment:

1. Sterile table with sterile material (cotton balls, napkins), sterile tweezers.

2. Sterile gloves

3. Standard tuberculin

4. Beaker for placing an ampoule in it

5. Tuberculin syringe

6. Tray with disinfectant solution for discarding syringes

7. Container with disinfectant solution for waste material

8. 70% ethyl alcohol

9. Sterile tray

10. Emery disc.

Required conditions:

storing tuberculin in the refrigerator at a temperature of +2 +8 degrees

freezing of the drug and overheating above 18 degrees is not allowed

the opened ampoule must be stored under aseptic conditions for no more than 2 hours

the test is performed intradermally on the forearm: in even years - on the right, in odd years - on the left

Warn parents or child not to wash, seal, or comb the injection site for 3 days.

Possible complications:

1. subcutaneous injection of tuberculin

2. infection of the injection due to non-compliance with care rules.

Stages		Rationale
I. Preparation for the procedure
	Wear a mask.
	Wash your hands with liquid soap at a hygienic level and dry your hands, treat your hands with an antiseptic, let them dry, put on gloves.	Ensuring infection safety.
	Prepare the necessary equipment.	Ensuring the accuracy of the procedure.
	Remove the tuberculin ampoule from the package. Assess the contents of the ampoule. (unclearly printed label, expired, presence of flakes - contraindication for use) Wipe the neck of the ampoule with a cotton swab moistened with 70% ethyl alcohol. Cut with an emery disc and break (throw the used cotton ball into a container with a disinfectant solution).	Ensuring infection prevention during injection time.
	Place the ampoule in a beaker.	Preventing the ampoule from falling.
	Treat the packaging of a disposable syringe with 70° alcohol Open the package of tuberculosis syringe. Place a needle with a cap on it, fix the needle on cannula. Remove the cap from the needle.	Ensuring infection safety. Prevention of needle falling during operation.
	Take an ampoule with tuberculin and draw 0.2 ml of the drug into a syringe.	Such a small dose can be taken only into a tuberculosis syringe.
	Ampoule with remaining tuberculin return to beaker and cover with a sterile gauze cap.
	Release the air from the syringe to 0.1 ml.	0.1 ml of standard tuberculin contains 2 TEs necessary for diagnosis.
	Place the syringe in a sterile tray
P. Execution of the procedure.
	Cotton ball soaked in 70% ethyl alcohol, treat the inner surface of the forearm with its middle third 2 times (drop the balls into a container with a disinfectant solution) Wait for the skin to dry.	Disinfection of the injection field.
	Stretch the skin of the injection area with fingers 1 and 2 of your left hand. Insert the needle with the bevel upward at an angle of 10. -15 degrees and slowly inject tuberculin intradermally under visual control formation of a “lemon crust”	The Mantoux test is performed only intradermally.
	Remove the needle. Do not treat the injection site with alcohol.	To avoid violating the principle of intradermal administration of diagnosticum.
	Dump the tuberculin syringe into tray with disinfectant solution.	Ensuring infection safety.
III. End of the procedure.
	Remove gloves and throw them in disinfectant solution	Ensuring infection safety.
	Warn the child (or parents) about compliance with the rules of care of the place injections: Do not contaminate the injection site Do not wet Do not tape or tie Do not comb Do not eat allergenic foods	Artifact prevention.
	Invite the patient to evaluate the Mantoux test on the 3rd day after its implementation.	The tuberculin test is assessed after 48-72 hours.
	To the nurse in the vaccination room make a record of the procedure performed in the journal, outpatient card and vaccination form.
IV. Evaluation of the Mantoux reaction..
	A transparent ruler is applied across the forearm and measure the diameter of the elements.
	If the injection there is no immediate reaction (0-1 mm) papules and no hyperemia, then the reaction negative.	There is no Mycobacterium tuberculosis in the child’s body.
	With a papule diameter of 2-4.9 mm or with presence of hyperemia without papule - the reaction is doubtful.	These may be artifacts or manifestations nonspecific allergy.
	If the diameter of the papule is 5 mm or more - positive.	This may happen when: Tuberculosis disease Post-vaccination reaction Infection.

The nurse should make a note of the Mantoux results and enter it into the outpatient card and vaccination form 063.

MANIPULATION 6

Judging by your diet, you don’t care about your immune system or your body at all. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start improving. It is urgent to adjust your diet, to minimize fatty, starchy, sweet and alcoholic foods. Eat more vegetables and fruits, dairy products. Feed the body by taking vitamins, drink more water (precisely purified, mineral). Strengthen your body and reduce the amount of stress in your life.

You are susceptible to moderate lung diseases.

So far it’s good, but if you don’t start taking care of her more carefully, then diseases of the lungs and other organs won’t keep you waiting (if the prerequisites haven’t already existed). And frequent colds, intestinal problems and other “delights” of life accompany weak immunity. You should think about your diet, minimize fatty, flour, sweets and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, do not forget that you need to drink a lot of water (precisely purified, mineral water). Strengthen your body, reduce the amount of stress in your life, think more positively and your immune system will be strong for many years to come.

Congratulations! Keep it up!

You care about your nutrition, health and immune system. Continue in the same spirit and problems with your lungs and health in general will not bother you for many years to come. Don't forget that this is mainly due to you eating right and leading a healthy lifestyle. Eat proper and healthy food (fruits, vegetables, dairy products), do not forget to drink plenty of purified water, strengthen your body, think positively. Just love yourself and your body, take care of it and it will definitely reciprocate your feelings.

Conducting tuberculin diagnostics, or Mantoux test is carried out with the aim of selecting a contingent of patients for BCG vaccination and revaccination, as well as to detect tuberculosis and infection with Mycobacterium tuberculosis.

Indications for performing the Mantoux test

Doctor's prescription in accordance with the vaccination calendar:

• from 1 year to 7 years - 2 times a year (the interval between the Mantoux test is 6 months);
• from 7 years and older - once a year (interval - 12 months).

Contraindications to the Mantoux test

• Acute somatic and infectious diseases.
• Exacerbations of chronic diseases.
• Allergic conditions in any manifestations.
• Epilepsy.

The period is less than 1 month after vaccination.

Equipment

• Tuberculin syringe 1.0 ml.
• Tuberculin in standard dilution.
• Needle No. 085.
• Thin needle with short bevel No. 0415.
• Sterile tweezers.
• 70% ethyl alcohol.
• Sterile cotton balls.
• Transparent millimeter ruler.
• Mask, gloves, containers with disinfectant solution.
• Medical documentation - registration forms 112/u (child development history) or 025/u (outpatient card), f.063/u - preventive vaccination card, for organized children - f.026/u.

Sequencing

We wash our hands, put on a mask and gloves.

Open the ampoule with tuberculin.

We draw 0.2 ml of tuberculin into the syringe using a needle No. 085.

Using tweezers, we change needle No. 085 to needle No. 0415, and place the needle removed from the syringe into a container with a disinfectant solution.

We release the tuberculin solution from the syringe to the 0.1 mark into a sterile cotton ball, which we immediately place in a container with a disinfectant solution.

We treat the patient's skin in the area of ​​the middle third of the anterior surface of the forearm with a sterile cotton ball moistened with 70% alcohol twice. In even-numbered years, the Mantoux test is performed on the right hand, in odd-numbered years - on the left.

We wait 1-2 seconds for the skin to dry or blot it with a sterile cotton ball.

We insert the needle with the cut up into the top layer of skin parallel to its surface, that is. We administer the drug in an amount of 0.1 ml, which is equal to 2 TU (tuberculin units). With the correct injection technique, a whitish papule - an infiltrate - with a diameter of about 8 mm, the so-called “lemon peel”, forms in the skin.

We warn the mother, child or adult patient that the injection site should not be wetted, scratched, or injured.

We place the needle and syringe in special marked containers with disinfectant solutions.

We take off the gloves and also immerse them in the disinfectant solution.

Necessarily! We make a note in the child’s development history (or outpatient card) and in registration form No. 063 (and in form 026/u for organized children).

Accounting for Mantoux test results

The result is assessed 72 hours after the procedure.

We measure the diameter of the papule or hyperemia perpendicular to the axis of the hand with a transparent, colorless millimeter ruler.

If both a papule and hyperemia are present, only the size of the papule is taken into account. The size of hyperemia is taken into account only in the absence of a papule.

Necessarily! We record the result in the history of the child’s development or in the outpatient card, as well as in form No. 063/u (if necessary, also in form No. 026/u).

Evaluation of Mantoux test results

• Negative: complete absence of papule and hyperemia or the presence of a prick reaction.
• Doubtful - papule 2-4 mm or hyperemia of any size.
• Positive - papule 5 mm or more.
• Hyperergic - papule 17 mm or more, reactions with dropouts, necrosis, the presence of vesicles regardless of the size of the papule.

It's important to remember that Mantoux test is a very responsible procedure and requires the nurse to have clear knowledge of the procedure, as well as maximum concentration and responsibility.

• Operating principle of the Mantoux test
• Evaluation of injection results
• Contraindications to the Mantoux test

It is the main method of examining a person for tubercle bacilli. The Mantoux test technique is a skin injection that allows one to detect the presence of a specific reaction of the body’s immune system to tuberculin. This is a kind of immunological test with which you can obtain information about the presence of tuberculosis in the body.

The principle of action of the tuberculin test is based on provoking an allergic reaction of the body's immune system to tuberculin, which is a component of the causative agent of tuberculosis (Koch bacilli). If a person has had contact with tuberculosis bacteria at least once, the body’s defense system produces antibodies (lymphocytes) designed to counteract the repeated invasion of harmful microorganisms. Thanks to this, during the next contact with Koch sticks, the protective reflex is more powerful, which allows you to fight the infection more effectively and stop it in the initial stages.

The Mantoux test allows you to answer the question of the state of the body's anti-tuberculosis immunity. There are 3 possible options:

1. Normal immunity. If the patient has previously had contact with tuberculosis pathogens (for example, during an infection that did not develop into a disease or during the Mantoux test), then the anti-tuberculosis defense will function normally, and new contact with the pathogen will lead to a moderate reaction.
2. Lack of immunity. If the patient has not previously been exposed to Koch bacilli and has not been vaccinated, then injecting him with tuberculin will not cause any reaction, because the body does not have antibodies that would react to this infection.
3. Strongly activated immunity. If a person has tuberculosis or has recently suffered an infection, the body’s defense system produces a very large number of lymphocytes aimed at fighting tuberculosis. In this case, the introduction of tuberculin causes a violent reaction, the strength of which is reflected in the size of the papule.

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Algorithm for performing the Mantoux test

To carry out the injection, special disposable syringes with thin needles with a beveled cut are used. In this case, it is prohibited to use insulin or tuberculin syringes whose expiration date has expired. Before starting the procedure, the ampoule with tuberculin is thoroughly wiped with gauze soaked in ethyl alcohol, after which the neck of the container is filed with a tool for opening ampoules and carefully broken off.

Tuberculin is taken with the same syringe that will subsequently be used to perform the Mantoux test, and with a needle No. 0845. In this case, 0.2 ml of the drug is taken, which corresponds to two doses, after which one dose is dispensed into a sterile cotton swab.

The Mantoux test is performed by the patient in a sitting position, because in some cases the injection leads to loss of consciousness. The area of ​​skin into which the injection will be carried out (the inner surface of the forearm) is carefully treated with an alcohol solution and dried with sterile cotton wool. Then the needle is inserted under the upper layers of the skin parallel to its surface with the cut up.

After puncturing the skin, 1 dose of tuberculin is administered. If the test technique is performed without any violations, a small bump of about 8 mm in size will form under the skin.

After the injection, it is forbidden to treat the injection site with peroxide, brilliant green, etc. cover with adhesive tape and comb. Also, the injection area should not be wetted with water for 3-4 hours after the procedure.

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Evaluation of injection results

The results of the Mantoux test are assessed by the doctor 2 days after the injection by measuring the size of the button. To do this, take a regular transparent ruler and measure the transverse size of the tubercle.

Redness of the skin around the tubercle is not a sign of the presence or absence of Koch's rods.

Redness is taken into account only when the tubercle itself is absent.

The results of the Mantoux test are assessed as follows:

Negative reaction if:

• the tubercle is completely absent;
• there is slight redness around the injection site;
• Only a reaction from the injection is observed.

A questionable reaction if:

• tubercle diameter is 2-4 mm;
• there is redness without a button.

A positive reaction if the diameter of the tubercle is more than 4 mm (up to 9 mm - weak reaction, 10-15 mm - average reaction, more than 15 mm - strong reaction).

Hyperergic reaction if:

• in children the size of the tubercle is more than 17 mm, and in adults - more than 21 mm;
• An abscess forms at the injection site and the lymph nodes become enlarged.

In some patients, the result may be negative even if Koch's bacilli are present in the body (false negative reactions). This may be caused by:

• recent infection (within the last 1-2 weeks);
• anergy, that is, the inability of the immune system to respond to tuberculin (can occur in people with various diseases of the immune system, for example, AIDS);
• some viral and bacterial diseases (typhoid, whooping cough, measles, chickenpox, etc.);
• violation of sample technology;
• taking certain medications;
• violation of tuberculin storage conditions.

In case of false positive reactions in a healthy person, the Mantoux test can show the presence of tuberculosis in the body. In most cases, this is due to infection with non-tuberculosis bacteria. Other reasons include the presence of allergic disorders or a recent allergic disease.

Sometimes the Mantoux test is accompanied by some adverse reactions:

• allergies;
• disruption of the digestive system;
• increased body temperature, dizziness, itching, vomiting, headache;
• inflammation of the lymph nodes.

The Mantoux test is also known as the tuberculin test, Pirquet test, tuberculin diagnostics and PPD test - this is a method for studying the human immune system to Koch's bacillus (the causative agent of tuberculosis). The doctor evaluates the body's reaction to the administered drug tuberculin. The Mantoux test is an immunological test that detects tubercle bacilli and prevents the development of the disease.

Historical information about tuberculin diagnostics

The drug tuberculin was invented by the German doctor Robert Koch at the end of the 18th century. The tuberculin diagnostic technique was created by pediatrician Clemens Pirquet at the beginning of the 19th century. The doctor decided to apply the medicine to the damaged skin and monitor the patient’s reaction.

A little later, the technique was improved and skin scarification began to be carried out using a special lancet. In the mid-90s, French physician Charles Mantoux proposed administering tuberculin intradermally. In the Russian Federation, doctors began to conduct an immunological test in 1965 and the study is popular today.

Tuberculin (alttuberculin or AT) is intended to detect Koch's bacillus in the human body. Now in many medical institutions, to carry out the Mantoux test, medical personnel use the modern medicine tuberculin, which includes a phosphate buffer solution, sodium chloride, various stabilizers, and hydroxybenzene.

Features of the Mantoux test

The reaction to the PPD test occurs due to the injection of a special drug under the skin. An inflammatory process occurs on the skin at the injection site of the medication. If the patient’s body was previously “familiar” with Mycobacterium tuberculosis, then the number of lymphocytes will be very large, so the inflammation will be more pronounced, and the reaction will be “positive” (infection is present).

The doctor measures the diameter of the papule (plaque, button) with a ruler or measuring tape and evaluates it according to generally accepted standards. The human body’s reaction to the drug is somewhat similar to an allergy, so in case of allergic diseases, the Mantoux test may not be reliable.

Also, the effectiveness of the study can be affected by infectious diseases, chronic pathological processes, age-related changes, and immunity to tuberculin. Often, the effectiveness of the test is affected by changes in the body during menstruation and the special sensitivity of the epidermis.

Negative environmental factors that may negatively affect the diagnosis. This is an increased rate of radiation, emissions of chemicals from enterprises into the atmosphere, explosions and fires. An unreliable test result can be obtained if the test procedure is violated: improper transportation and storage of the drug, the use of low-quality instruments, incorrect interpretation of the Mantoux reaction.

If tuberculin diagnostics showed a “positive” result, then this is not one hundred percent proof of the presence of tuberculosis in the patient’s body. To confirm or refute the diagnosis, you should undergo a series of tests and laboratory tests: microbiological culture of sputum, to exclude a connection with vaccination against tuberculosis. It is worth noting that a negative reaction cannot guarantee that a person does not have the tuberculosis bacillus.

Indications and contraindications

In countries with a high incidence of tuberculosis, in particular in the Russian Federation and CIS countries, the Mantoux test is carried out for control purposes. In America and France, children and adolescents are required to undergo this immunological test.

The PPD test is needed to detect Koch's bacillus, infected people for more than 12 months with hyperergic reactions to the drug, patients with an increase in infiltrate by 5-6 millimeters, people who have an infection in the body but do not show symptoms, children who should carry out revaccination against the disease.

Children and adolescents are selected for revaccination based on diagnostic results at 6-7 years of age and 14-15 years of age.

In areas where a frequent incidence of tuberculosis is recorded, revaccination is carried out at 6-7, 11-12, 16-17 years. Revaccination for tuberculosis is given only to healthy patients with a negative Mantoux test result.

The study is contraindicated if the patient has:

• skin diseases;
• acute and protracted somatic and infectious diseases (diagnosis can be carried out 30 days after the disappearance of symptoms or a few days after quarantine is lifted);
• allergic reactions;
• rheumatism;
• epileptic condition, bronchial asthma.

The immune system after vaccinations given for the purpose of prevention can cause individual intolerance to alttuberculin, so it is advisable to do the test before any vaccination. If the patient is vaccinated, the Mantoux test should be performed after 1-1.5 months.

Tuberculin diagnostics is considered harmless and painless. The medication contains no microorganisms, and a small dosage does not negatively affect the immune system and internal organs. There is no point in performing such a test on children under one year of age, since at this time the child’s immunity is only strengthening and the test result may be false.

Features of the Mantoux test

To give the injection correctly, the doctor uses special disposable syringes (they must have thin needles and a beveled cut). It is not allowed to use tuberculin or insulin syringes whose service life has come to an end. The specialist treats the ampoule with the medication with a cotton swab previously soaked in. Next, the doctor carefully opens the ampoule and withdraws the medicine with a syringe - 0.2 milliliters. Then 0.1 milliliter must be “released” into a sterile cotton swab.

The patient is asked to sit on the couch, and the specialist treats the skin with an alcohol solution and wipes it with a sterile cotton pad. The place where alttuberculin will be injected is the inner surface of the forearm. The doctor inserts a needle under the upper layer of the epidermis parallel to its surface (the cut should be on top), then the medicine enters there. If everything is done correctly, then a tubercle measuring 7-8 millimeters will form under the skin. The place where the injection was given should not be treated with brilliant green, peroxide, iodine or other medications. It is forbidden to seal the papule with a plaster or cover it with cotton wool. The injection area should not be wet for several hours after the procedure. The lump may itch, but it is advisable not to touch it.

After performing the Mantoux test, the patient may experience side effects: an allergic reaction, disruption of the gastrointestinal tract, inflammation of the lymph nodes, increased body temperature, chills, nausea, vomiting, severe dizziness, itching. If any side symptoms occur, you should seek qualified medical help. The doctor will listen to the patient’s complaints, send for laboratory tests and prescribe effective symptomatic treatment.

Evaluation of results

After the administration of alttuberculin, after 3-4 days a thickening of the skin is formed, which is called a plaque or papule. In appearance, this formation is similar to a red round area of ​​​​the epidermis, rising above the skin. With a large number of lymphocytes, the papule will be large. The doctor measures the parameters of the papule with a ruler 2-3 days after administration of the drug. The ruler should be positioned transverse to the longitudinal axis of the forearm. You only need to measure the parameters of the tubercle.

The results of the Mantoux reaction are assessed differently in each country, but most often doctors resort to two approaches: Russian and American.

A negative reaction is considered to be: complete absence of compaction, slight redness at the injection site, infiltrate size up to one millimeter. A questionable result is a plaque measuring 2-4 millimeters, the presence of redness without a papule. A “positive” test result is accompanied by a “button” of more than 5 millimeters (from 5 to 9 millimeters - a mild reaction, from 10 to 14 millimeters - an average reaction, from 15 to 16 millimeters - a strong one).

A hyperergic reaction in children and adolescents is observed with a tubercle that has a diameter of more than 16 millimeters. If in adult men and women the papule is more than 21 millimeters in size, then this indicates a very pronounced result. Often, doctors can observe a vesicular-necrotic reaction (formation of ulcers, tissue necrosis, enlarged lymph nodes).

Some patients may have a false negative reaction. This is due to recent infection, concomitant use of certain medications, improper storage of alttuberculin, violation of procedure technology, previous bacterial and viral diseases, and weakened immunity.

If the test is “positive,” you should contact and undergo additional tests to establish an accurate diagnosis. It is recommended that all family members be examined at an anti-tuberculosis dispensary. If the patient’s diagnosis of tuberculosis is indeed confirmed, then preventive therapy with special medications must be carried out under the supervision of a qualified phthisiatrician.