Technology and assessment of the mantoux reaction in adults. Mantoux sizes are the norm for adults

Tuberculosis in people who have reached adulthood is detected using fluorography, laboratory research blood or pulmonary sputum.

Mantoux in adults is checked when there is a suspicion of active form tuberculosis or when it becomes known about contacts with patients with this disease. In addition, the Mantoux test is performed for those adults who are to be re-administered the BCG anti-tuberculosis vaccine. If the Mantoux result is in doubt, more serious tests are already carried out.

Sample technology

The Mantoux test involves injecting a drug called “tuberculin” into a person’s skin, usually on the left forearm. It is produced on the basis of a culture of tuberculosis bacteria, but such vaccines do not contain live microorganisms, so the risk of infection with tuberculosis when administered is completely absent.

Usually the drug is administered in the amount of 2 tuberculin units, in a dose weighing 0.1 mg, and is labeled PPD-L. For administration, a disposable sterile 1 ml syringe is used, specially designed for this purpose and having a very small diameter needle. Each sample is strictly taken with a separate syringe, which must be disposed of immediately afterwards.

Any other vaccination should be done after the Mantoux reaction has been detected, since it can affect its result and distort it. In addition, during the period between taking the test and recording the result, which lasts for three days, water should not be allowed to come into contact with the area of ​​the skin where the drug was injected. It should not be touched again, much less combed, covered with an adhesive plaster or smeared antiseptics. Otherwise, it will be almost impossible to obtain a reliable Mantoux test result.

Mantoux reaction and its evaluation

In the place where the drug was injected, T-lymphocytes, or immune bodies, that once had contact with the Koch bacillus, which is the causative agent of tuberculosis, begin to accumulate. When, after three days, there is no swelling, redness or other visible traces left at the site where the tuberculin drug was inoculated, the reaction is considered negative. If any trace is observed, then the assessment depends on its characteristics. If a person has already had tuberculosis or is infected with Koch's bacillus, the Mantoux reaction, accordingly, occurs more violently.

The sample result is assessed by measuring with a regular ruler. A small swelling with a diameter of 0.5-1 mm also indicates that the tuberculin vaccination has given negative result. It begins to raise doubts when its diameter reaches 3-4 mm. If a tumor with a diameter of 5 to 17 mm forms at the injection site, then the Mantoux reaction shows a clearly positive result. The person is clearly infected with the tuberculosis bacillus. Well, in the case when the diameter of the tumor exceeds 21 mm, this means that the process of tuberculosis is most likely already beginning. A picture is possible when the tumor has a smaller diameter, but its surface is an open wound. This is also an undoubted sign of a positive reaction.

Possible reasons for distortion of the result and contraindications for the test

Do not forget that usually the size of the swollen area does not indicate either the localization of the disease in the body or the duration of the disease. It only indicates the presence of Koch's wand in it. There is enough a large number of factors that can distort the result of the Mantoux test. These can be various allergic or chronic diseases that a person suffers from. If he has relatively recently suffered from any infectious disease, this may also affect the test result, usually in positive side. In addition, the result of the Mantoux test can be influenced by advanced age, time menstrual cycle, as well as the individual characteristics of the skin, the general environmental situation in the person’s place of residence, and simply the quality of the tuberculin itself and the conditions under which the vaccination was made.

The Mantoux test can give both false positive and false negative results. Definitely contraindications for it are the presence of an acute infectious disease in a person and an exacerbation of chronic illness. In addition, the test should not be performed on patients skin diseases and those suffering epileptic seizures. Quarantine associated with viral diseases, also serves as an obstacle to her. Finally, a person may simply have an allergic reaction to the tuberculin drug. Therefore, swelling of the place where it was injected does not usually give complete confidence that a person has tuberculosis. This is just a reason to conduct more in-depth analyzes and research.

Typically, Mantoux tests are performed on adults to confirm the absence of tuberculosis infection in their body if their work is related to mass communication or food. These are catering workers, teachers, counselors and other similar professions.

In this case, such a test should be combined with fluorographic examination.

As a result, people with a positive reaction to the tuberculin drug are identified and it becomes possible to determine epidemiological indicators based on the degree of infection with the tuberculosis bacillus.

Lidia Mikhailovna Ivankova

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Norm of the Mantoux test in adults and interpretation of the results

Used for rapid diagnosis of tuberculosis different methods, the main of which are fluorography and the Mantoux test, the norm in adults helps determine the presence of infectious agents in the body. It is not often done in adults, since it is less reliable than a photo of the lungs, but if there are contraindications to exposure to x-rays or the need for a quick study, the 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, extensive tests for tuberculosis are required.

Mantoux test technology

When performing the Mantoux test, tuberculin is injected into the skin on the forearm - a drug consisting of a mixture of antigens isolated from a group of different types of mycobacteria. This kit allows you to determine the body’s response to any type of tuberculosis.

The preparation contains neither live nor dead Koch bacilli, therefore the Mantoux test is not considered a vaccine and does not in any way affect the body’s resistance to tuberculosis infection. 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 occur. It will appear locally in the form of papules of a certain size, which can be used to determine the presence of contact with the infectious agent.

Since a reaction to mycobacterial antigens will occur 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.

Carrying out the Mantoux test in adults involves administering 0.1 mg of tuberculin solution intradermal injection below the elbow. There is also a skin test, but in Russia it is not usually used. Tuberculin itself is also produced in several varieties; the most common is PPD (purified protein derivative). The substance is absolutely safe for humans and is used even when diagnosing infections in young children.

The test results are assessed after 3 days.

During this period, an allergic reaction to tuberculin develops, which is manifested by the following symptoms:

• redness of the injection site;
• skin thickening.

The injection site should be protected from external influences that could affect the assessment. There is a myth that Manta cannot be wet, but in fact, it is enough not to scratch or rub it with a hard washcloth. In addition, during the ripening of the sample and a month before it, no vaccinations should be done.

Reaction assessment

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

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

The Mantoux reaction normally in adults has the following results:

1. Negative - the seal diameter is no 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. Active infection - papule larger than 21 mm or presence open wound at the injection site.

In addition to the actual size of the papule, the variation of the reaction is assessed - the difference between the diameters of the last sample and the one made last year. Changes can reach up to 6 mm. In this case, a turn is considered a diagnostic sign only if BCG vaccination has not been carried out during the past year.

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, additional examination is required at the dispensary.

Interpretation of results

Negative and questionable results of the Mantoux test in 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 had contact with infected people. If you have previously been vaccinated with BCG, 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 occurs with vitamin E deficiency and the use of low-quality tuberculin.

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

However, he does not always talk about the active form of the disease; To make a diagnosis, it is necessary to demonstrate additional signs, which include:

• the turn of the reaction, increasing over several years;
• papule size more than 12 mm for 4 or more years;
• release of infiltrate from the injection site;
• 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. Once the diagnosis is confirmed, tuberculosis treatment is prescribed. Tests may also show that the Mantoux vaccination was false. positive result. This phenomenon occurs quite often due to the fact that the functioning of the immune system is influenced by a variety of factors and internal processes in the body.

Reasons for a false positive reaction

Able physical stress Even the smallest influences on the body can cause an immune reaction.

Such a comparative aggressive procedure how the administration of tuberculin leads to vivid allergic manifestations even in the absence of infectious agents in the following cases:

• 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;
• 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;
• elderly age of the patient;
• a woman's menstrual period;
• poor quality of tuberculin or incorrectly performed procedure;
• the presence of skin diseases;
• poor environmental conditions in the patient’s place of residence.

This variety of factors influencing the result explains why adults are not given Mantoux in most cases. As preventative measure the test is carried out only on people whose work is related to food industry or contact with large numbers of people, especially children.

Even knowing what the reaction should be, you cannot draw conclusions on your own. Only additional studies at a tuberculosis clinic will confirm or rule out the presence of infection in the body.

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

Contraindications to the Mantoux test

For most people, the test is completely safe. However, in some cases, tuberculin leads to exacerbation of chronic diseases; Some health problems are guaranteed to skew the results. In such situations, the Mantoux test is not performed in adults and is replaced by fluorography. Because the preventive diagnostics Everyone must undergo tuberculosis; every person should know whether Mantoux can or cannot be done with its individual characteristics.

Contraindications to the reaction include:

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

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

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

Before carrying out the test, you should consult your doctor - he will tell you whether you can smoke and drink while the Mantoux test is maturing in a particular case.

Papule care

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 - caring for the papule is also important.

• do not scratch the tuberculin injection site;
• do not lubricate the papule with anti-itch medications;
• do not treat the injection site with antiseptics;
• do not cover the papule with a band-aid;
• avoid exposure high temperature on the skin.

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

In people with hypersensitive immune systems, the test may cause coughing and fever. These symptoms are normal and go away quickly.

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

The Mantoux test - a controversial study

What is the mechanism?

To carry out the test, inject into the skin tuberculin– extract from microorganisms that cause tuberculosis. Tuberculin does not contain living microorganisms, so infection during the test is impossible.

At the site of tuberculin injection, special immune cells accumulate - T lymphocytes. Moreover, only those that have already come into contact with the causative agent of tuberculosis, the Koch bacillus, accumulate. That is, if a person is infected or has already suffered tuberculosis, the reaction will be more violent, more lymphocytes will be attracted, and inflammation at the injection site will be more intense.

You can compare the immune reaction with an allergy when tuberculin is an allergen. Therefore, if a person has allergies, this may change the test results.

Carrying out the Mantoux test

The first Mantoux test is done at one year of age and then at intervals of 12 months. For the procedure, a special syringe with a very thin needle is used. Tuberculin is infused into the skin of the middle of the forearm from the inside in the amount of 2 tuberculosis units, which is 0.1 milliliter of solution. The drug is injected into the upper layers of the skin, only to the depth of the needle hole. It is very important that the drug gets into the skin, and not under it. If the procedure is carried out correctly, a characteristic swelling, called a “button,” remains at the injection site.

Mantoux test results

The results are taken 48 hours or on the third day after tuberculin administration. For this, only a transparent ruler with millimeter divisions is used. The diameter of the seal around the injection site is measured. In this case, the size of the redness may be larger, but it is not taken into account.

• The size of the seals is a negative reaction, the body is not infected with Koch’s bacillus,
• Size mm – a questionable reaction, the person is at risk, there is a possibility of infection,
• A seal size of 5 mm or more indicates high probability tuberculosis infection,
• The size of the compaction in children is 17 mm, in adults 21 mm, the appearance of ulcers or necrosis indicates a hyperergic reaction.

The size of the compaction does not indicate the intensity of the disease, the duration of the disease or its location, but only indicates the presence of infection.

• Allergic diseases,
• Chronic diseases
• Recently transferred infectious diseases,
• Patient's age
• Phase of the menstrual cycle,
• Individual skin characteristics,
• Unfavorable environmental conditions,
• Tuberculin quality and test performance.

Contraindications to the Mantoux test

1. Acute infections, and chronic infections in the acute phase ( the interval must be at least 4 weeks from the moment the patient recovers).

2. Dermatological diseases.

5. Quarantine period for infectious and viral diseases.

6. The period 4 weeks after any vaccinations.

Positive Mantoux test

We can talk about a high probability of having Koch bacillus in the body if a positive Mantoux test is combined with the following factors:

• The seal diameter is 5 – 6 mm larger than a year ago
• A positive reaction was 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 size of the seal is 12 mm and above
• The patient communicates closely with a patient with tuberculosis, lives in an area unfavorable for this disease, and eats poorly.

If the Mantoux reaction is positive, you should visit a consultation with a phthisiatrician. Additional diagnostic measures will be prescribed:

If none of the examinations confirm the presence of Koch's bacillus, the child most likely has an allergy to tuberculin. Sometimes the reason for a positive result is never determined. In this case, six months later another Mantoux test is done.

Complications after the Mantoux test

If the sample preparation was stored and transported under proper conditions, the only complication after the test officially recognized by doctors may be an allergy to any component of tuberculin, most often a stabilizer. Phenols or polysorbates, which are cytotoxic drugs, are used as stabilizers.

There is evidence that after the test it can develop idiopathic thrombocytopenic purpura. The number of such patients is very small - over five years of observation, Russian Federation after the Mantoux test, it developed in 10 children, but such a possibility cannot be excluded.

Mantoux test in adults

For adults, the Mantoux test is prescribed if there are signs or suspicion of tuberculosis or after treatment to monitor its effectiveness.

Mantoux test: pros and cons

1. Russian Federation and all countries 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 monitor the reaction immune system child for vaccination against tuberculosis and for the introduction of bacilli from external environment, since sooner or later any organism encounters this rod.

3. Using the test, you can identify children who need repeated vaccination against tuberculosis. This procedure is performed at the ages of 6–7 and 14–15 years.

1. Scientists have not fully studied the mechanism of tuberculin’s effect on immunity.

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 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, among other things, depends on the accuracy of the test. Incorrect measurement and inappropriate tools will defeat the purpose of this procedure. And improper storage of tuberculin can even be dangerous.

6. In some cases, after the Mantoux test, severe consequences and even death (in the spring of 2006, more than a hundred children were injured in Ukraine).

Refusal of the mantoux sample

According to the legislation of the Russian Federation, the child’s parents may refuse to perform the Mantoux test. At the same time, no one has the right to force people to undergo additional examinations, for example, fluorography, or to consult with a phthisiatrician or at a tuberculosis clinic.

Alternative to the Mantoux test

The most commonly used alternative methods for detecting tubercle bacilli are Suslov's test, blood test for immunogram, as well as a chest x-ray.

To carry it out, blood is taken from a vein, in which the number of special immune bodies and cells is determined.

• High price
• Quite low information content

The patient's blood is taken for analysis, into which tuberculin and complexone are injected. Based on the way the blood coagulates and what patterns appear, a conclusion is made about the presence or absence of Koch’s bacillus in the body.

Negative points of the method:

According to the National Institute of Phthisiology and Pulmonology of Ukraine, this method detects only 50% of cases of the disease and only 24% of infections.

As alternative methods tuberculosis diagnosis is also mentioned PCR reaction However, there is no consensus among doctors about the effectiveness of this examination.

Read more:

Reviews

I find out that my child had positive reaction on Diaskin! But the x-ray, in fact, doesn’t show anything, and she will be able to give me a certificate when I do the Diaskin test again in 1.5 months. If the test is positive, then you need to undergo chemical treatment. drugs. And he gives me a lecture about the rampant tuberculosis in Moscow. I think everyone already knows what this treatment is, but my child is only 4 years old.

I can no longer prove that the reaction was negative; time has passed. There is no point in waiting for a repeat. Firstly In a month and a half, the quarantine has not yet ended, when you can repeat the vaccination again. The possibility of getting a positive result increases. This is where my ignorance comes into play. If I make an excuse that they were at the dacha and couldn’t come, i.e. I’m stalling for time and doing the Diaskin test again, then where is the guarantee that she won’t see there again, for example, already 5 mm. NO WARRANTY! Where can I then run with my child to prove that the head of the children's department (who she is) saw something in the dark? Which doctor will agree to participate in this? And why does she need this? - they will think.

There is only one way out. Another TB doctor must do the test (examination). But this is done only at the place of residence. I am looking for a phthisiatrician in a dispensary in another area, through friends. Thank you that the world is not without good people. Money doesn't count here anymore. I won’t reveal the reason, because I know what professional ethics are. The doctor agrees to issue a certificate if I pass all the necessary examinations. We postpone the deadline, of course it’s not 1.5 months. Let's do it. Everything was negative, two doctors looked at it. They gave me a certificate. And I knew that it couldn’t be any other way. My child is allergic, like most children, who are sent for chemical treatment after a Mantoux reaction. It’s good that they started using the Diaskin test. It's time to introduce it everywhere, instead of the Mantoux reaction.

Now the question is, why does Doctor “K” need all this?

And this was found out. Judging by some information, she is writing some work to improve her qualifications☺. And she, naturally, needs statistics. What institute, department - everything is known.

Do you think my conscience will bother me if I snitch on her to that institute?

Take care of your children.

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What should the Mantoux reaction be in an adult?

Classification of Mantoux test results

Doubtful: the compaction does not exceed 4 mm or only redness occurs.

Positive: a compaction of 5-16 mm in size occurs. This reaction indicates that the person has immunity against tuberculosis. Based on changes in this reaction over several years, the doctor assesses whether a person has been infected with tuberculosis.

If the reaction in children exceeds 17 mm (in adults 21 mm) or pustules and ulcers appear at the injection site, the reaction is called hyperergic. It indicates a clear hit large quantities bacteria into the body and infection with tuberculosis. In a healthy person, the reaction may be hyperergic if he has recently suffered an infectious disease or is prone to allergic reactions.

Contraindications, care and Mantoux norm in adults

The Mantoux test is the most accessible, popular and cheapest method for diagnosing tuberculosis. Tuberculin is injected under the skin - a drug containing heat-treated, aged mycobacterium tuberculosis.

It is not capable of harming the body, but the body reacts to it in a certain way.

Tuberculin test

The Mantoux test, also known as the tuberculin test, is one of the simplest and cheapest tests that allows you to diagnose the presence of tuberculosis by age. The result of this analysis appears on the third day - the time when the response of the immune system to tuberculin reaches its maximum, and then it is already possible to determine what size the sample is and whether it corresponds to the standard size of the vaccine.

General description of the procedure

Many people remember how this study is carried out: the doctor gives a small injection, injecting a transparent substance under the skin, after which he urges you not to wet or scratch your hand in the coming days. In this case, tuberculin is injected under the skin - a drug containing heat-treated, aged mycobacterium tuberculosis. Mycobacteria treated in this way are not capable of harming the body, but it reacts to them in a certain way.

This is the idea of ​​the test: the body, which already has the tuberculosis virus, will respond with a violent reaction to a pest known to it, causing redness and mild inflammation at the site of injection of the substance.

Dimensions and Mantoux reaction, normal for adults

It is by the size of the inflamed tissue that the test result is determined. So, the Mantoux test: dimensions, norm in adults are the following indicators:

• papule (seal at the site of tuberculin injection) measuring less than four millimeters;
• redness. In itself it can be of any diameter and is not a cause for concern;
• lack of reaction.

The latter option is quite rare and means that the body is either unfamiliar with this pathogen or does not suffer from any form of tuberculosis.

Photo of the Mantoux test is normal

Photo 1. What Mantoux should look like for tuberculosis, the norm. The photo shows what size a Mantoux should be normally.

Photo 2. What the Mantoux reaction looks like, the norm in adults. The photo shows what the Mantoux reaction should be normally. Papule less than 4 mm in size.

If a person has had tuberculosis several times, but there is no reaction to Mantoux, we can talk about a false negative reaction - a case when the body stops responding to tuberculin.

INTERESTING: Initially, the Pirquet method was used, in which the patient’s skin was damaged with a special scarifier with tuberculin applied to it. It was decided to abandon this method, since the wounds allowed other infections to enter the body.

In addition, in some cases we can talk about a false positive reaction - a case when the papule reaches exactly four millimeters. At the same time, it cannot be denied that tuberculosis still exists in the body. This is usually caused by the following factors:

• allergy;
• recent vaccination or illness. At the same time, the body has not yet fully recovered and its immune reactions increased;
• infection with any other mycobacterium. Since tuberculosis is a type of mycobacteria, up to a certain point the immune system reacts to it in the same way as to other representatives of this species. This means that if there are “related” bacteria in the body, it will interact with tuberculin especially violently.

In this case, the reaction can be judged based on whether the patient has had contact with tuberculosis patients. Living in areas where the disease is very common may indicate possible exposure.

A positive reaction to the Mantoux test is the formation of a papule whose diameter is more than five millimeters.

In case of a positive or questionable reaction, a consultation with a phthisiatrician and additional studies will be required to confirm or refute the reaction.

IMPORTANT: Diaskintest is now gaining more and more popularity. This a new version Mantoux test with modified active substance. As practice shows, this type of research is more accurate and has fewer side effects than classic.

Contraindications. When is vaccination not advisable?

Like other types of diagnostics, the procedure has its contraindications and acceptable standards. Some of them are related to the fact that they can harm the patient himself.

Others are temporary and may affect the test, distorting its results.

• acute form of any disease and postoperative period. In this case, the immune system may respond inadequately to tuberculin, which will lead to the growth of the papule and give an incorrect result;
• skin diseases. In some cases, the very nature of the disease suggests the formation of papules, which also does not allow obtaining an accurate result;
• bronchial asthma. In rare cases, the administration of tuberculin leads to coughing, which negatively affects health;
• allergy to tuberculin or components of the sample. This type of allergy is quite rare, but it does exist and can be accompanied by feeling unwell. Unfortunately, this type of allergy is most often determined during a test;
• rheumatism and epilepsy. There is an opinion that tuberculin can lead to an attack or exacerbation of these diseases.

If any of these contraindications exist, other tests are carried out related to the examination of sputum, blood and other indicators.

IMPORTANT: In connection with the recent growing movement against vaccinations, the question of the need to conduct this study is increasingly being raised. According to the instructions of the Ministry of Health, the Mantoux test is mandatory, as this is the easiest way to control the spread of the disease among the population and prevent a pandemic. Mantoux vaccination is the norm. You must protect yourself and your loved ones.

Side effects

When performing a Mantoux reaction test, the following side effects may occur:

• cough. It is not related to tuberculin itself and is usually psychosomatic;
• allergy. As already mentioned, a person may have an allergic reaction to this drug, which itself is an allergen;
• temperature increase. It occurs quite rarely and in those people who are very sensitive to this drug. The increase in temperature is insignificant and does not affect well-being;
• Hyperergic reaction. An extremely acute reaction of the body to tuberculin. The papule looks unhealthy and grows up to seventeen millimeters; serious inflammation may begin, and in rare cases, necrotic changes in the form of an ulcer or small abscess at the injection site. This extremely rare manifestation of the reaction means that the body is already seriously infected with tuberculosis and immediate treatment is required.

Such reactions of the body are quite rare; most people tolerate the study very easily, without encountering any of the above effects, which is why this method has become widespread.

IMPORTANT: Tuberculosis is a fairly common disease that for a long time may not manifest itself in any way until the immune system weakens. In this regard, it is especially important to check your health in order to prevent the development of the disease and infect others.

Caring for the injection site so that the test for tuberculosis is reliable

In order for the reaction to the Mantoux test to be most reliable, you should follow a few simple requirements for caring for the injection site:

• do not scratch the injection site. The papule may itch, this is a normal Mantoux reaction, this is how the body reacts to an irritant. If you comb it, it can grow, which will give the wrong result;
• tape or otherwise restrict air access to the injection site. The effect will be the same as when visiting the steam room - possible slight growth of the papule;
• Do not smear the injection site with creams, brilliant green and other substances that may cause irritation;
• You should not eat foods that can cause allergies. As with any testing, allergic reactions may affect the test result. The same applies to some medications that can have a similar effect.

IMPORTANT: Despite the first very common misconception, Manta can be wetted. You can even wash yourself calmly in the shower, the main thing is not to rub the injection site with a washcloth. This misconception appeared after the first tests were carried out, which involved dissecting the skin and then adding tuberculin.

Useful video

Diaskintest is more accurate and has fewer side effects.

Choosing a test and clinic

Thus, the Mantoux test is the most accessible, popular and cheapest method for diagnosing tuberculosis. Due to the ease of producing tuberculin, it is widely used to this day, allowing people of any age to be tested en masse for tuberculosis, although it cannot boast of the 100% accuracy that more expensive laboratory tests have.

For example, the Mantoux reaction test is carried out in most schools, kindergartens and clinics. These studies are routine and mandatory for all children who do not have contraindications. You can also conduct this research for a fee, but there is no significant difference between private and government agencies No.

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Online magazine about tuberculosis, lung diseases, tests, diagnostics, medications and more important information about it.

The Mantoux reaction or “button” test is a test for the presence of tuberculosis infection in the body. The second name for medical manipulation is tuberculin test. It is not considered a vaccine, although it occupies a certain place in vaccination calendar. It is given even to those children who are exempt from vaccinations for health reasons (have medical exemptions). What should the Mantoux reaction be? healthy child? And how to handle the injection site so as not to get an erroneous diagnosis?

The causative agent of tuberculosis is Koch's bacillus (named after its discoverer, Karl Koch). Tuberculin is obtained from destroyed Koch bacteria and their metabolic products, which is then used to perform the Mantoux test.

Initially, tuberculin was applied to damaged skin. Later, the French doctor Mantoux introduced another type of tuberculin administration - subcutaneously. Thus, the introduction of tuberculin into the body received the name of the French doctor - the Mantoux test.

Previously, medical procedures used alttuberculin. This is an extract from tuberculosis bacteria that are rendered harmless by heating. This type of old tuberculin contains a large number of impurities that enhance the allergic reaction, often leading to an incorrect diagnosis of the presence of infection.

Modern medicine uses purified tuberculin without the protein components of the environment in which it was grown. This substance is less likely to cause allergic reactions, which means it increases the accuracy of diagnosis. However, in addition to purified tuberculin, the sample contains phenol (as a preservative), sodium chloride, and a stabilizer called Tween, which can also be sources of allergies.

Therefore, performing a Mantoux test does not provide reliable information about the presence of infection. Requires additional examinations and more accurate diagnosis.

Who gets the Mantoux test?

This procedure is done en masse once a year to check the body for possible infection with the tuberculosis bacillus. Symptoms of the disease may not yet appear, but the Mantoux reaction after infection will already be noticeable (enlargement of the button compared to last year’s result by more than 4 mm).

In addition, this procedure is used to determine the need for another BCG. If a child has a negative mantoux, this is regarded as a reason to re-administer the vaccine.

Features of medical manipulation

Tuberculin is administered subcutaneously in small doses. The amount of drug that is administered to a child during diagnosis is called 2TU or 2 tuberculosis units. At the injection site, an accumulation of lymphocytes occurs, compaction and redness form. The strength of the response, the size of the compaction and redness around the injection depend on whether the body has previously encountered the tuberculosis bacillus.

• If so, the body produces special lymphocytes and a “button” is formed.
• If not, the injection site will heal without forming a “mark.”

Our children get first pathogenic bacterium massively - with BCG vaccination in maternity hospital. This vaccine is classified as live; it does not contain remnants of dead bacteria, which should cause a similar reaction and form immunity. This is one of the few vaccines with a live attenuated pathogen.

Therefore, the rate of mantoux per year (12 months after vaccination) almost always exceeds 10 mm. For modern children this is the rule.

Over time, the body counteracts the infection, and the Mantoux button decreases to 4-6 mm. In some children it may disappear completely, turning into a negative result - a period. If this happened before the age of 7, then the child is prescribed a second BCG revaccination at 7 years of age. A weakened Koch bacillus is reintroduced to him, forcing the body to fight it. In this case, a year after revaccination, the Mantoux reaction will again be explosive - more than 10 mm.

Mantoux sizes are measured three days after the test. The data obtained is used to assess the body's response to the presence of infection. What should the mantu be?

What can a mantoux sample be like?

On the third day after vaccination, the injection site may look like a barely noticeable dot (such a reaction is extremely rare in modern children) or an inflamed red spot. In this case, the site of inflammation can only turn red or thicken with the formation of a papule - a “button”. To assess the body's response to tuberculin, it is not the size of the redness that is measured (it can be larger), but the size of the reddened skin thickening.

Depending on what the injection site looks like, the Mantoux result is called:

• negative;
• doubtful;
• positive.

What are their differences, and what are the dimensions of the Mantoux norm in children?

Negative, positive, doubtful

• Negative reaction- This complete absence redness or thickening of the skin. This result suggests that there was no contact with the tuberculosis bacillus, or it took place a very long time ago and the body managed to overcome the infection (this often happens in the bodies of healthy children for several years after BCG - they simply suppress the resulting infection and cleanse the body of any remnants Koch's sticks).
• Questionable reaction is the formation of redness without thickening of the skin. In this case, the size of the redness does not exceed 2-4 mm. This reaction is also regarded as the absence of Koch's wand in the child.
• Positive Mantoux reaction- this is the presence of redness and compaction. This reaction indicates that the bacillus is in the body, infection has occurred, and special lymphocytes are present that are formed during the fight against tuberculosis. Infection can be natural (from a sick person) or artificial (through vaccination - BCG vaccination). In this case, a positive mild reaction is distinguished (compaction from 5 to 9 mm), moderate (10-14 mm), pronounced (15-16 mm), excessive (in which not only the diameter of the papule exceeds 17 mm, but also there is skin ulceration, inflammation nearest lymph nodes).
• Normal Mantoux reaction in children depends on age and time of previous BCG vaccinations. So the Mantoux norm per year is up to 17 mm. In this case, the normal indicator also takes into account the size of the mark (scar) from the vaccination on the shoulder. If the scar is large (up to 8 mm), the norm of the mantoux reaction (the size of a “button”) can also be increased to 15-17 mm. If the scar is small (2 mm), then for such a scar the size of the “button” should not exceed 10-11 mm (at the age of 1 year).

The Mantoux norm does not take into account the size of the post-vaccination scar when examining a child over 2 years old.

What is turn and blister effect

Another survey result is called “turn”. This is a sharp increase in the Mantoux test compared to last year's result by more than 6 mm. Or changing a negative Mantoux to a positive one without administering a vaccine. This result is always accompanied by a referral to a tuberculosis clinic for further examination. The child is suspected of having tuberculosis.

Also a reason for referral is persistent large mantu (more than 16 mm for at least 4 years).

The mantu test is done once a year. However, when special indications(suspected infection with tuberculosis) it is done more often - once every 3 months. In this case, a so-called booster effect often occurs. Its essence is that when Mantoux is performed frequently, the body reacts by increasing the papule (which can be regarded as a sign of infection, which in fact does not exist).

Positive mantoux reaction and visit to a phthisiatrician

If a child has tuberculosis or the size of the “button” is steadily increasing, then the local doctor, without analyzing possible allergens or internal diseases writes parents a referral to a tuberculosis dispensary.

At the tuberculosis dispensary, the TB doctor will prescribe a mandatory chest x-ray, as well as a sputum test.

Often even in the absence accurate diagnosis, if the x-ray did not show the presence of foci of infection, or sputum examination did not confirm the presence of Koch’s bacillus, the child may be prescribed a preventive course of treatment “just in case.” According to the principle “it’s better to be safe than sorry,” a child not infected with tuberculosis is prescribed a course of strong chemotherapy drugs to prevent the spread of an imaginary infection.

Therefore, if you have a consultation with a TB specialist and hear about a possible infection in your child, request a full examination. It is necessary to determine the threshold of sensitivity to tuberculin and examine the blood for antibodies to viruses. Examine the sputum three times before prescribing chemotherapy, and get a positive result (presence of a rod in the sputum).

What factors influence the results?

The Mantoux reaction is not a 100% reliable method. The survey results are influenced by more than 50 different factors. Chronic diseases, inflammatory processes, recently suffered illnesses (colds), adenoids and even a common runny nose - contribute to an increase in the local reaction, an increase in the size of the “button” after the test.

Let us list those factors that are often forgotten, and which, no less than others, interfere with the correctness of diagnosis.

Vaccinations enhance the reaction

Mantoux cannot be given after vaccinations. The results of the reaction will be stunning, the “button” will be very large, due to the presence of the infectious agent from the vaccine in the body (or its traces, secretions). In addition, vaccinations contain preservatives, which themselves are allergens and, when exposed to tuberculin, increase the reaction of redness of the skin at the injection site.

Since Mantoux itself is an allergy test, the presence of any allergic manifestations causes its increase in the body.

At allergic reaction In the body, the size of the “button” reaches 20 mm or more in diameter.

It doesn’t matter what kind of allergies your child is worried about (food, household, or animal hair, bleach). The Mantoux reaction will show a big “button”.

Worms and intestinal flora disorders

Emissions from chemical or metallurgical enterprises and automobiles form chronic poisoning body. On the background toxic poisoning local inflammation occurs, which causes a strong positive Mantoux reaction, and also initiates the appearance of allergies.

Adverse reactions of mantoux vaccination

The Mantoux test has quite a lot of side effects, many of which are not recognized official medicine and pediatricians working in official system. However, private practices, independent of public policy, confirm the possibility of the following adverse reactions after Mantoux:

• elevated temperature;
• lethargy and apathy;
• skin rashes;
• gastric disorders;
• cough (7-10 days after the test).

These factors resemble the body’s reaction to toxic substances. From which it follows that Mantoux contains toxins, despite their small quantities, they cause side effects in a certain group of children.

Mantoux contraindications and refusal to perform the test

When does the Mantoux test not show a reliable result? We list the conditions in which this manipulation cannot be performed:

• acute infectious diseases;
• chronic diseases, especially during exacerbation;
• allergic reactions, bronchial asthma (as a rule, this disease is based on allergies);
• skin diseases;
• quarantines (perhaps the child is already infected with a flu virus or another disease, but the symptoms of the disease have not yet appeared; in this state, Mantoux may show “tubvirage”).

Every parent should know the contraindications. Of course, you must be warned at the medical institution about contraindications for the test. However, the health worker often misses this point. Therefore, tracking down the presence of reasons that can give a false positive diagnosis and giving up Mantoux for 1-2 months is the task of a sensible parent. It is better to be persistent in diagnosis than to run around to dispensaries for many months, proving that the child does not have tuberculosis, but simply caught a cold on the eve of the test.

Refusal of Mantoux is not a reason to deny a child visit kindergarten. In addition, there are other more precise methods examinations for the presence of infection.

Conditions for vaccination

The Mantoux reaction in children may look different. This depends on the individual characteristics of the body (health status, allergic mood, previous manipulations).

• Is it possible to wet manta rays? In some cases, the “button” may become larger after getting wet. However, there are other examples where the injection site became wet within three days, and this did not contribute to the increase in the size of the redness. For diagnostic reliability, it is not recommended to wet manta rays for three days.
• You should also not treat the injection site with cologne, alcohol, hydrogen peroxide, or other disinfectants. The injection does not need to be scratched, rubbed or covered with a band-aid.
• Mantoux vaccination is done before other vaccinations. You can do it after the calendar routine vaccination in 1 month. Earlier, the results will not be accurate.
• After a blood transfusion or use of blood preparations for treatment, Mantoux can be done no earlier than 2 weeks later.

Mantoux - diagnostics of the presence of tuberculosis. Previously, the Mantoux test was recommended for all children. Today there is a question about the dubiousness of this diagnosis, the presence of side effects and unreliable conclusions. In order not to run around to phthisiatricians after the test, remember a simple rule: you can only do Manta healthy child. And for allergy sufferers an appointment is necessary antihistamines 3-4 days before and within 3 days after the injection. Then the reaction will show a more or less real result.

The principle of the Mantoux reaction is the intradermal injection of small doses of tuberculin into the human body - specific antigen, obtained from Mycobacterium tuberculosis, and subsequent monitoring of local reaction. T-lymphocytes, the blood cells responsible for anti-tuberculosis immunity, react to the injection of the drug, so redness and swelling occur at the injection site.

When the test is considered positive

The intensity of the inflammatory reaction depends on the content and activity of mycobacteria in the body. If a person had a chance to “get acquainted” with Koch’s wand, the test result will be “positive”. In this case, inflammation prevails over natural reaction caused by the administration of tuberculin. The Mantoux test involves measuring a papule, a lump that can be felt under the skin. The measurement is carried out 72 hours after placing the sample in a transverse direction to the axis of the hand, transparent and under good lighting conditions.

What the results say

The result will be positive if the seal diameter is 5 mm. With a papule size of 5-9 mm, the reaction is assessed as weakly positive, 10-14 mm - medium intensity, 15-16 mm - pronounced. An inflammatory reaction is considered hyperrhetic when the papule size is 17 mm in children and 21 mm, as well as in the presence of vesicular-necrotic formations, regardless of the diameter of the compaction. An important sign of tuberculosis infection is the presence of pigmentation (brown coloring) at the injection site 1-2 weeks after the Mantoux test. Unlike the usual pink lump, a post-infectious papule has clear contours and lasts about 2 weeks.

A positive Mantoux reaction is no reason to panic!

The Mantoux test is just an indicative test. For diagnosing tuberculosis and prescribing specific treatment a whole range of important factors. Therefore, a positive result is only a reason to consult a TB doctor who will prescribe microbiological examination sputum and chest x-ray. If infection is not confirmed, then this reaction of the body may be the result of an allergy. Carrying out the test within a month after preventive vaccination, previous illness or exacerbation of allergies may cause a false positive reaction.

To figure out what a mantu should be, you need to know how the results are classified. It is generally accepted that the mantoux reaction is negative if the seal is completely absent, and also if there is only a slight pricking reaction, no more than one millimeter. If the size of the papule is from 2 to 4 millimeters, or there is only redness, the size of which does not matter, then the reaction is considered doubtful.

A positive mantoux reaction is characterized by the presence of a pronounced papule, the diameter of which exceeds 5 mm. Moreover, a papule size of 5 to 9 millimeters is considered a weakly positive reaction. With sizes from 10 to 14 mm, they speak of a reaction of medium intensity. A pronounced positive mantoux reaction in adults is a papule measuring 15 to 16 mm. It is also possible to react too strongly to manta rays. In the case of adult patients we're talking about about a papule whose size exceeds 21 millimeters. If there is the formation of pustules or partial tissue necrosis, the reaction is called vesiculo-necrotic. In this case, the size of the papule does not matter.

If the size of the papule has increased by six or more centimeters compared to the previous result, then mantu in adults is considered an intensifying reaction. Also in some cases, false negative reactions occur. In this case, even if a person is infected with tuberculosis, the mantoux reaction is negative. There are several explanations for this. The first reason is anergy. Some people's bodies do not respond to an irritant such as tuberculin because their immune system is not capable of it. This is typical for people suffering various types immunity deficiency, including AIDS. In such a situation, a special anergy test may be used. In addition, you can examine the immune system and identify or exclude the possibility of defects. If a person was infected with tuberculosis less than 10 weeks ago, then the reaction given by the mantoux vaccination will not show anything. If there is a suspicion that a person has been infected, but not enough time has passed, then the mantoux test in adults should be repeated when another 10 weeks have passed.

In addition to false negative reactions, false positive reactions also occur. This scenario is very likely if a person is infected with any non-tuberculosis microbacterium. Common reasons for a false positive mantoux reaction include allergic disorders and recent infectious diseases. The Mantoux reaction in adults and adolescents can be false negative, since there is a so-called “booster” effect. More high level development of the immune system, apparently, causes the body to stop responding to tuberculin over time, even if a person is infected with tuberculosis. If there is a suspicion that the mantoux reaction is negative precisely because of the booster effect, then re-vaccination is carried out after a week or three weeks.

Both in Russia and in the CIS countries, mandatory, universal BCG vaccination is carried out. In order to be able to distinguish tuberculosis infection from immunity developed after vaccination, it is necessary to take into account factors such as the size of the scar on the skin that appeared after BCG vaccination, as well as how much time has passed since the last vaccination. Important role Information about what the last reaction to the mantoux vaccination was also plays a role. That is why it is so important to record the data of what the papule was. Based on this, you can judge what kind of mantu should be. Over time, the immunity acquired as a result of vaccination is lost.

If the mantoux reaction is negative, but the likelihood of infection is high, you should definitely undergo all examinations prescribed by your doctor. If there is even the slightest doubt that the results shown by the mantoux test are correct, it is imperative to exclude the possibility of infection by all available methods, and if the fact of infection is still confirmed, begin treatment immediately.

The Mantoux test is performed quite rarely in adults; it is most common in children and minors. When a person reaches adulthood, he is tested for tuberculosis using pulmonary sputum examination, laboratory blood testing, or fluorography. But in some cases, when there is a clear suspicion of an active form of tuberculosis or when it becomes known that there has been contact with patients, Mantoux can be administered in adults. If the test result is questioned, then more serious analyzes can be carried out.

How to put

The principle of production for adults is not very different from that for children. The sample is placed in the skin on the forearm of the left hand. A drug called tuberculin is introduced, created on the basis of a culture of tuberculosis bacteria, but does not contain real microorganisms, therefore there is no likelihood of real tuberculosis infection.

An adult is injected with two tuberculin units weighing 0.1 mg using a disposable sterile syringe with a volume of 1 ml. To make the reaction as accurate as possible, the needle is used with a very small diameter.

Limitation

You cannot give other vaccinations when the Mantoux test has been given, otherwise the readings may be distorted. Also, adhesive plasters should not be applied to the area of ​​skin where the test was taken, and this area should not be smeared with antiseptic agents. Although it is a myth that the Mantoux test is afraid of water, you still shouldn’t get it too wet to avoid distorting the potential result.

Grade

The Mantoux test in adults is assessed three days after vaccination. By that time, in the place where the sample was introduced, T-lymphocytes begin to accumulate, as well as immune bodies that previously had contact with the Koch bacillus, which provokes tuberculosis. If after this period of time there are no traces at all, no swelling, no redness, or anything else, then the reaction is considered to be negative. If there is a certain trace, then it is necessary to evaluate it separately.

• If the reaction produces a very small diameter and a swelling of less than a millimeter, it is considered that the tuberculin vaccination gave a purely negative result.
• If the reaction produces a swelling, the size of which is up to 4 mm, then the result is doubtful, it is necessary to carry out additional research for more specific clarification.
• If the test yields a swelling of 4 to 17 mm, this means that the result is positive, infection with the tuberculosis bacillus has occurred, but still such a reaction is still the norm.
• If the diameter of the tumor exceeds 21 millimeters, then the reaction takes place in an enhanced format, this most likely means that the risk of tuberculosis is especially high. In this case, this is no longer the norm; the sizes become too high for normal indicators of this sample.

Potential Distortions

But even a strong reaction is not a guarantee that the disease is definitely occurring in an adult’s body; vaccination does not make it possible to accurately identify its location or estimate the duration of its course. It simply helps to more accurately understand that Koch’s bacillus is formally present in the body. But many factors can distort the course of the disease. These factors include the following:

• recent infectious disease;
• chronic or allergic diseases;
• advanced age;
• features of the menstrual cycle;
• individual distinctive features skin;
• quality of tuberculin;
• the conditions under which this vaccination was given;
• ecological features of the region of human habitation.

Therefore, vaccination can give quite strong errors and even false positive/false negative results. It may also have contraindications that arise from the above consequences. In particular, when an adult has acute chronic diseases or chronic diseases in the acute stage, vaccination is not carried out. The test is not performed if the person suffers from epileptic seizures or skin diseases. Vaccination is not given during quarantine associated with viral diseases.

In rare cases, a person may have an individual intolerance to the tuberculin drug. This is a rather unlikely phenomenon, but it still happens, and then the sample is also distorted.

It turns out that any Mantoux test performed in adults is not an unambiguous indicator of the presence of a problem or, conversely, a favorable situation, but a reason for carrying out additional more in-depth research, aimed at identifying the true situation - and taking further actions.

What's next?

To clarify the analysis, a fluorographic study is further carried out. It allows you to more accurately determine whether a person has an infection, and if it does, then at what stage it is. Based on this, certain measures are taken and appropriate treatment is prescribed.

Mantoux test: why do it to a child, is it dangerous? If there are no contraindications, mantoux test best test for tuberculosis