What to choose: Mantoux test or Diaskintest. Diaskintest - an alternative to the Mantoux test for children: differences in results, side effects and reactions Which is better Mantoux or Diaskintest

Despite the development of medicine, preventive measures, there is a high risk of contracting tuberculosis. Most diagnostic methods can detect the disease at an early stage, which increases the effectiveness of treatment. When choosing which is better and safer for testing immunity in children - the Mantoux test or Diaskintest, parents must first study the effect of the drugs used, indications and contraindications for them.

Mantoux test

Every schoolchild is familiar with this procedure, but not everyone knows why it is performed. The purpose of the test is to detect antibodies produced by the body against the causative agent of the disease. The drug tuberculin, which is destroyed mycobacteria, is injected under the skin using a syringe. The injection is painless and does not cause any discomfort in children.

The result is determined by the reaction that occurs at the injection site on the third day. Use a transparent ruler to measure the size of the seal. Its size from 4 to 16 mm indicates stable immunity and the presence of antibodies. If the compaction is more than 17 mm, there is a possibility of infection with tuberculosis. Then additional examination is required. The appearance of ulcers and blisters at the injection site may be the result of an allergy.

The Mantoux reaction is one of the methods primary diagnosis, the reliability of which is not absolute.

In addition, there are contraindications to the test:

• Stage of exacerbation of chronic diseases.
• Reception medicines.
• Manifestation of allergic reactions.
• Cough, runny nose, other cold symptoms.
• Skin problems.

If at least one of these factors is present, the procedure is postponed or replaced by another testing method.

The first test is performed on children aged one year. If there are no indications for a repeat test, Mantoux is done once a year. If the result is positive, it is allowed to increase the number of vaccinations per year to three.

What is Diaskintest

This test is safe alternative Mantoux. It allows you to determine the body’s response to the causative agent of tuberculosis and has been used recently. Unlike Mantoux, the drug contains a tuberculosis allergen, associated protein antigens of two types, which make it possible to identify the body's immune response.

Indications for Diaskintest:

• A test done to detect active and inactive forms of tuberculosis.
• The need to assess disease activity, monitoring changes in response during treatment.
• Differentiation from non-tuberculous diseases.

Sometimes Diaskintest is performed, if in the latter case it is detected positive result.

How is Diaskintest performed?

The test is placed in the forearm, usually in the less active hand - for right-handers it is the left, for left-handers it is the right. Parents are wondering whether it is possible to administer Mantu and Diaskintest at the same time. This option is allowed if you do a test on different hands. The drug is administered intradermally using a special tuberculin syringe with a very thin needle. The Ministry of Health recommends that all children aged 8 to 17 years be tested annually. Provided the following standards, with what frequency can Diaskintest be done: if the result is negative, re-testing is carried out after 2 months, after vaccination or previous infectious diseases no earlier than 1 month. For those who are registered with a phthisiatrician, the test is performed at intervals of 3 to 6 months.

Result evaluation

Like Mantoux, Diaskintest shows results on the third day. Based on examination of the injection site, measurement of the size of the papule,

The presence of redness distinguishes 4 variants of the result:

1. Negative. The size of the zone of hyperemia and swelling does not exceed 2 mm or is absent altogether. This is an indicator that there is no active infection in the body. Even if the Mantoux result is positive and the Diaskintest is negative, the person cannot be called sick.
2. Doubtful. There is slight redness, the size of the compaction is no more than 4 mm.
3. Positive. The size of the infiltrate (papules) is more than 5 mm. This indicates an inflammatory process associated with infection. However, this does not always lead to the development of the disease. Strong immunity often copes with mycobacteria.
4. Hyperergic reaction. Large compaction (exceeds 14 mm), possible presence of ulcers, inflammation of the lymph nodes.

All measurements must be carried out medical worker. In children and adults, the norm is when the result is negative.

Contraindications and side effects

Even in the absence of infection with the tuberculosis bacillus, the test may give a positive, questionable or hyperergic reaction. The reason is the presence of contraindications for which Diaskintest cannot be done.

They are almost no different from the Mantoux test:

• Infectious and colds.

• Exacerbation phase of chronic pathologies.
• Allergy.
• Skin diseases (rash, pustules).
• Epilepsy.
• Vaccination performed less than a month ago.

It is important to consider all indications and contraindications. Not only in a child, but also in an adult, Diaskintest can cause side effects - headache, general malaise. They pose no danger and pass quickly.

Main advantages and disadvantages of the method

Diaskintest has been used since 2009 as an alternative to Mantoux.

It has many advantages:

• High sensitivity to strains.
• Ability in people with BCG vaccination, as well as in those who have non-pathogenic microflora.
• Allows you to track your recovery, do Diaskintest during the treatment process.

The disadvantage is the likelihood of a false negative result in cases of bovine tuberculosis, chronic diseases, and weakened immunity.

Despite this, it is highly reliable. The effectiveness of the method is almost 100%.

Diaskintest and Mantoux - what is the difference

Both methods have significant advantages over x-ray methods. They are completely safe and do not require irradiation of the body. The likelihood of contracting tuberculosis after injection of Diaskintest or Mantoux is excluded. Both tests work on the same principle - a drug is injected intradermally, which determines the degree of familiarity of the body with the causative agent of the disease. The Mantoux test and Diaskintest are painless procedures that are well tolerated by children.

Tests are different active substance included in the administered drug. The Mantoux test contains tuberculin, a protein present in Mycobacterium tuberculosis. However, it is found in bacteria similar to tuberculosis and in BCG. Diaskintest contains a protein containing only the causative agent of tuberculosis.

In this regard, there is also a difference in the reaction to the tests performed. Mantoux reveals whether the body has previously encountered tuberculin. Diaskintest is positive only in response to active mycobacteria. Compared to Mantoux, the test performance is higher. Therefore, it is considered a more advanced test and is prescribed for the purpose of differentiated diagnosis. Test results may vary. The option when with a positive Mantoux Diaskintest is negative means that the child is healthy, his immune system is successfully fighting the causative agent of the disease.

Video

Video - death after Diaskintest

What to choose

Both methods can be used. The choice of the most effective for each specific case should be made taking into account the recommendations of the attending physician. Due to the higher reliability of the results and the minimal number of side effects, many parents choose Diaskintest for their babies. State clinics prefer to detect tuberculosis using the Mantoux method, tested over several generations. However, due to the child’s contraindications or for any other reasons, parents have the right to refuse the traditional test, replacing it with a more modern drug.

Dr. Komarovsky believes that Diaskintest, an analogue of Mantoux, is much more effective and safer. But if it is not possible to perform it, the old proven method of diagnosing tuberculosis will also serve as a replacement. The main thing is to take into account the existing indications and contraindications for the test.

Due to the fact that the risk of contracting tuberculosis is high and the disease is very dangerous, it is better not to refuse diagnostics.

Medicine is developing rapidly and new methods for diagnosing various diseases appear almost every day. Didn’t stay away from this “evolution” either.

There is an alternative to traditional vaccination called Diaskintest. The drug for this test is also administered subcutaneously, but many doctors consider this method of determining tuberculosis to be more accurate. Parents of many children are wondering what to choose, Mantu or Diaskintest? Let's consider the positive and negative sides each sample.

Mantoux test

This is a procedure during which a special drug, which determines the presence of tuberculosis bacillus. It consists of tuberculin, which is inactivated Koch bacilli.

Three days after administration of the drug, the body's reaction to it is assessed. It can be used to judge how ready the immune system is to resist bacteria.

Even the smallest children can make Mantu, since only 0.2 milliliters of the drug is used for the test and the procedure is almost painless.

The Mantoux reaction does not always give a clear answer about the presence of tubercle bacilli in the body. In case of a positive result, a additional research such as x-rays, blood tests, sputum tests and others. Many factors influence the accuracy of a sample.

False results can be obtained in the presence of chronic or acute illnesses The child has. In addition, the baby can independently damage the injection site, causing some local reaction. In this regard, the reliability of such a test is only 60-70%.

Some parents have heard about: many of them are unconfirmed horror stories. The safety of this test is on par with X-ray or PCR analysis.

Also, many parents think that the introduction of inactivated bacteria can lead to their baby becoming infected with tuberculosis. This is an erroneous opinion, since in tuberculin the Koch bacilli are in a destroyed state and cannot cause illness. However, it is possible for a child to become infected at the dispensary where the vaccination is given.

Therefore, administer tuberculin to children better at home or at the school health center. The test can only be dangerous for weakened children, for example, if the child suffers from a cold during the test. Therefore, it is important to do the test during the absence of illness.

Many parents think that the injection site should not be wet. This stereotype has existed since Soviet times. He is fundamentally wrong. Getting water into this area will not affect the result in any way. The Mantoux test can be performed on all children who are healthy at the time of the procedure. A contraindication to the administration of tuberculin, in addition to reduced immunity, is the presence of epileptic seizures.

The first test should be carried out at 1 year of age. If no unusual reaction was observed afterwards, the test is repeated annually until age 14.

If the test result is positive, a additional examinations. The result is assessed 3 days after the administration of the tuberculin drug. The absence of redness means that there have never been mycobacteria in the body before. If a papule appears at the injection site, its size is measured with a regular stationery ruler.

A size of 4-16 mm is considered normal. It's just a reaction immune system, which began to produce antibodies against the tuberculosis bacillus.

A papule size greater than 17 mm indicates a possible infection with tubercle bacilli. Some children may also develop a sore or ulcer in the injection area. This indicates an allergic reaction to tuberculin or additional components of the drug.

DST began to be made in 2009. To carry out Diaskintest, use completely new drug, which is considered more advanced in comparison with tuberculin and makes it possible to diagnose both active and. Its basis is a tuberculosis recombinant allergen, which contains two interconnected antigens. If the body is infected with Koch's bacillus, they will certainly determine this.

Diaskintest and Mantoux test involve the subcutaneous injection of a special solution. It can be done at any age, starting from 1 year.

The child sits on a chair, after which the doctor wipes the skin at the injection site with alcohol and injects 0.1 ml of the drug. After 3 days, the area is examined and the body’s reaction is assessed. Moreover, you can do Mantu and Diaskintest at the same time. The main thing is not to inject both drugs under the skin on one arm.

Unlike the Mantoux test, the reliability of the result is close to 100%. Diaskintest almost always gives correct result. The test drug has undergone thorough clinical studies. It was administered to both children and adults infected with Koch's bacillus, and healthy people. It was on the basis of these data that such a high reliability of the test was declared.

The drug for Diaskin does not contain active mycobacteria, so it is completely safe, and there is no chance of getting tuberculosis after its administration. But, like Mantoux, it can have some side effects.

These include:

• general weakness;
• poor appetite;
• slight increase in temperature;
• feeling overwhelmed;
• headache;
• sometimes a skin rash. But this is no longer side effect, but an allergic reaction to one of the components of the drug.

Such symptoms are not considered specific, since they can occur even after taking painkillers or antipyretic tablets. They do not pose any danger to the body and will soon pass.

The test can be carried out only after consultation with a phthisiatrician. He should also observe the patient in the near future after the procedure. Diaskintest is carried out for all children and people at high risk of developing tuberculosis. In many cases, the test is combined with other examinations. After how long to do it again depends on the first result.

If the reaction is negative, the test in children under 18 years of age is repeated once a year.

The test done is evaluated after three days. Some parents think that the result may be distorted if the child has recently taken anti-allergy medications. This is not entirely true. No pills affect the reliability of the test.

The measurement of the papule is carried out in the same way as after the Mantoux test. A rounded area of ​​redness with a diameter of up to 5 mm is considered normal. However, a positive result is not yet a reason to panic. In some cases, doctors advise taking pills and repeating the test after a few months.

Many people are interested in what is less traumatic - the Mantoux test or the Diaskintest? In both the first and second cases, it is injected under the skin small dose drug. However, with Diaskintest it is literally negligible, therefore the traumatic nature of such a procedure will be the least.

What is better for children, Diaskintest or Mantoux? This question is relevant for most parents. Both tests are similar, but Diaskintest is considered a more modern alternative to the Mantoux test, as it almost always gives the correct result and is much less likely to cause side effects. Therefore, if possible, this is what you should do for your child.

As is known, in the USSR the Mantoux test was used to diagnose tuberculosis. In fact, more than one generation of today’s Russians grew up on it. And now the good old “button” for children has been replaced with a certain Diaskintest. True, this innovation does not apply to everyone. But this was enough for supporters of the new method to find opponents. So who is right: those who believe that Diaskintest is a breakthrough in medicine, or their opponents? Why is this comparative new method diagnostics? We tried to understand these and other issues by inviting the chief pediatric phthisiatrist of the Yaroslavl region Lyudmila VASILYEVA, the chief phthisiatrist of the Yaroslavl region Natalya GORENKOVA and the head of the organization’s department to the traditional meeting “Over a Cup of Tea” medical care women and children of the Department of Health of the Yaroslavl region Natalya OLENDAR.

In return for Pirquet

– Yaroslavl is a pilot region for the implementation of Diaskintest. We have been using it to diagnose tuberculosis for 7 years – since 2009. Why was it decided to conduct this experiment in our area?

Lyudmila VASILYEVA:

-? Let's figure it out. Firstly, the pilot was not just one Yaroslavl region, but several at once. Secondly, we did the right thing: unlike other areas, using Diaskintest for diagnosis, we did not abandon the Mantoux test.

– But why do we need a new test at all?

– The fact is that the Mantoux test, which replaced Pirquet, is an “extract” of mycobacterium tuberculosis killed by heating. She reacts to everything: not only BCG vaccine, which, as you know, is done to a baby right in the maternity hospital, but also for all allergens, and there are more and more of them every year. Remember Soviet times? A bunch of bananas on the radiator, a box of chocolates on New Year? Then there were many fewer allergens than now, but even 40–50 years ago Mantoux could produce false positive result. For example, a papule (“button”) showed a size of 12 millimeters or more in completely healthy person. What can we say about the present time...

– So allergens are to blame?

- And they included. But first of all, this happens because all of us are already infected with tuberculosis. Let's return to the BCG vaccination, which is given on the third day of life. This is done so that when encountering tuberculosis bacteria, the child already has immunity to this disease. Tuberculosis is very dangerous disease, it is especially difficult in children. So the Mantoux test shows how much this immunity is formed after vaccination and whether it exists at all. A papule up to 12 millimeters is considered normal; the “button” is measured 72 hours after intradermal injection of tuberculin. Normally, by the age of seven, the papule should become negative, that is, decrease from year to year. But sometimes it can be 13, 15 millimeters, or more. What do you order to do in these cases? Treat a child for tuberculosis? What if he is healthy and this is just an excessive allergic reaction to tuberculin?

– What did you do before?

- Treated! That is why scientists tried for a long period of time to develop a new method for diagnosing tuberculosis. Diaskintest was created in 2007 and after clinical trials, registration with the Ministry of Health and testing was launched in several regions of Russia at once.

The result is negative

– And what is the difference between Diaskintest and Mantoux?

Natalya GORENKOVA:

– Diaskintest is a genetically engineered drug created on the basis of the DNA of the tuberculosis bacillus taken from a sick person. There are no analogues to this test anywhere in the world. It reacts to two proteins that are dangerous to humans, which are present in strains of Mycobacterium tuberculosis. But it reacts only when man is walking reproduction tubercle bacilli. It is at this moment that the patient needs to be taken under observation. Diaskintest, unlike Mantoux, does not give a false positive reaction to the BCG vaccination; it simply does not react to it. This means that if a person is not sick with tuberculosis, the process of reproduction of bacilli has not begun in his body, Diaskintest will always show negative result.

– And if you are sick, is it always positive? There are cases where children were sick with tuberculosis, but Diaskintest did not recognize it...

Lyudmila VASILYEVA:

– This happens extremely rarely; there are no tests in medicine with 100% accuracy. And only if a person develops an extrapulmonary form of tuberculosis, which is usually a consequence of sharply reduced immunity due to taking medications that suppress it, for example, during treatment oncological diseases or advanced HIV infection. In addition, this happens in children when severe forms tuberculosis. But in this case, diagnosis with both Mantoux and Diaskintest will not be enough. Here the corresponding symptoms are already making themselves felt. With extrapulmonary tuberculosis, complaints arise from the organ that is affected. There are completely different methods of diagnosis, and the knowledge and experience of TB specialists and doctors of other specialties are included here. Doctors pay attention to urine analysis, enlarged lymph nodes and much more. But we are talking about the most dangerous, pulmonary form of the disease, the one that is very easy to become infected and which practically does not manifest itself at all. long time. A person can feel great and at the same time be a carrier of infection, get sick open form tuberculosis. So with diagnostics exactly pulmonary form Diaskintest copes well with tuberculosis.

Nobody canceled anything

– Let’s say the new test is really better than samples Mantoux. Why leave it then? Or will Manta still be cancelled?

Lyudmila VASILYEVA:

- They won’t cancel it. Children under eight years old will still be given Mantoux because post-vaccination reaction The BCG vaccine remains eligible until this age. It is Mantoux that makes it possible to identify a risk group before this age - those who need revaccination, because their immunity has faded after vaccination. These are children in whom a papule does not form, that is, the injection site does not turn red or swell. Diaskintest is performed for children only when Mantoux does not decrease until 7 years of age. It is also done if a so-called turn is observed.

- What it is?

– An increase in the volume of the papule compared to last year’s result by more than 6 millimeters. In all these cases, Diaskintest is used, but only as an additional diagnostic method.

– And after eight years?

Natalya GORENKOVA:

– And after this age it is useless to make Manta! If by the age of eight the papule is, for example, 10 millimeters, then it will never become the norm - negative. What then is the point in diagnosing using the Mantoux test? Diaskintest is more informative here, this is our general opinion. The incidence of tuberculosis in children and adolescents in the Yaroslavl region increased in 2009, not because more people were suffering from tuberculosis in our region, but because Diaskintest began to be used in diagnosis. It was thanks to him that a real risk group was identified, and all children and adolescents with positive and questionable results of this test began to be examined with a computed tomograph. Previously, these children were underexamined and missed. Some of them, of course, had an X-ray, but this, as a rule, was not informative, because it does not always see tuberculosis in initial stage development of the disease in children.

- But my mother doesn’t want to agree to Diaskintest, she wants to give Mantoux to her ten-year-old child...

Natalya Olendar:

- Yes, please, let him do it. We are not talking about a ban on Mantoux. We are talking about mass screening of the child population. So, during screening since the beginning of 2016 in our region, Diaskintest is widely used to diagnose tuberculosis from the age of eight. But if parents are categorically against this diagnostic method, which I personally doubt, because now they have more complaints about Mantoux, then please let them examine their child with other methods. But at the same time, let them not forget to bring the results of the study to the TB dispensary.

Make a choice

– Tell me, is there an alternative to Mantoux and Diaskintest?

Natalya Olendar:

– In our opinion, this is for children best methods diagnosis of tuberculosis. But some parents, unfortunately, try to find the root of all troubles in every screening or vaccination. Therefore, they are looking for an alternative even to what they don’t need to look for. Some prefer the quantiferon test because “tuberculin is not injected under the skin and does not infect the child.” Dear mothers! It is impossible to infect a child with tuberculosis either using the Mantoux test or Diaskintest! This is an axiom that does not require proof. But if you, despite years of proven methods, do not want to do tests, want to pay at least five thousand rubles and traumatize your child by donating blood from a vein - this is how the quantiferon test is done, no one can forbid you from doing this.

– There is also a certain polymerase method chain reaction, more popularly known as the PCR method...

Lyudmila VASILYEVA:

– PCR diagnostics of blood cannot detect tuberculosis in children. Don't waste your money.

– Explain what preparation is needed for the Mantoux test? To Diaskintest?

– Preparation for testing is necessary in children prone to allergies. Two weeks before testing, switch to hypoallergenic diet, that is, exclude chocolate, citrus fruits, nuts and other foods that can cause allergies. Three days in advance and on the day of the test, give the child antihistamines. That's all, actually. By the way, it is possible to wet the “button”, contrary to the popular belief of parents. There is no need to rub your hand or go to the pool during these three days. And take a shower, please.

– And if a child has a runny nose, is it possible to do Diaskintest and Mantoux?

- It is forbidden. By generally accepted rules After an acute respiratory viral infection, a month should pass, after a slight illness, the same runny nose, two weeks.

Natalya Olendar:

– Since we are talking about diseases, I would like to say a few words about antibiotics, or more precisely, their uncontrolled use. It is no secret that some parents give them to their children whenever the temperature rises and take them themselves, although fever is not always a bad thing. It shows that the immune system is struggling. And then we wonder why it is so difficult to cure tuberculosis. Not only because it serious disease, but also for the reason that the body stops responding to antibiotics. He simply got used to them.

Tuberculosis is no joke

– How long does it take to treat tuberculosis on average?

Natalya GORENKOVA:

– From six months to two and a half years. It takes about two million rubles to cure one patient.

– Are there incurable cases?

- Unfortunately yes.

– Describe the social portrait of a patient with tuberculosis.

– If earlier it was possible to say that this is a person who came from places not so remote, a man over forty, drinking alcohol, suffering from a stomach ulcer, now there is no such “portrait”. Anyone can get tuberculosis, including quite successful businessmen - people of both sexes, low-income people, and children of all ages. This is why diagnosis is so important.

– Is this still fluorography for the adult population?

- Yes. This is the most informative method. It needs to be done once a year.

The Mantoux reaction, the familiar “button”, has been used in schools and clinics for more than 100 years. Finally, the old remedies have been replaced by new technique, which is called Diaskintest, is a modern development of biologists and doctors that allows you to diagnose tuberculosis more accurately. An alternative to the classic Mantoux test is distinguished by its lightweight composition, ease of evaluation of test results and safety for the child’s body.

Allergy test for tuberculosis Diaskintest

What is Diaskintest and how does it differ from Mantoux?

Diaskintest is a new skin diagnostic drug that allows you to detect tuberculosis in children. Today, clinics use it instead of Mantoux because of the more accurate result and its specificity. The product contains 2 antigens that contain the causative agent of tuberculosis. In the active stage of the disease, the test will show the presence of the pathogen in the blood. However, previous BCG vaccination does not affect the results in any way.

Diaskintest is used not only for the initial diagnosis of tuberculosis, but also to evaluate the effect of anti-tuberculosis therapy. The features of the drug make it possible to determine when the process of active reproduction of the pathogen subsides, thus monitoring the effectiveness of anti-tuberculosis therapy.

Why look for new methods if the old ones are good for diagnosis? Of course, the classic “button” and Diaskintest are similar due to active substance and method of administration. However, the differences between these drugs are still significant. Mantoux is a “live” test; it contains tuberculin, extracted from the causative agents of tuberculosis. This protein is also found in some types of tuberculin bacilli used in BCG, which are not the cause of the disease - they are the ones who make it possible to obtain false-positive results.

The components of Diaskintest are synthetic proteins that are characteristic only of tuberculosis pathogens, which reduces the likelihood of obtaining an incorrect result to a minimum. Medical statistics shows that the classic “button” gives an accurate result in only 70% of cases, while the reliability of the result of an alternative to the standard Mantoux (Diaskintest) is 98%, which is much better. The difference is obvious.

Coincidence in 44% of cases (diaskintest accuracy is 90%)

Does Diaskintest replace the Mantoux reaction?

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The Mantoux test and the modern Diaskintest are not interchangeable; they have different mechanism detection of the disease, and they do not influence each other’s results. Diaskintest does not give a positive answer when infected with the “bovine” strain of tuberculosis, which is often found in pastoral areas. It is part of the BCG vaccine. According to some reports, Diaskintest may be false positive at the very beginning of the disease, with a recent infection. Doctors advise first taking a Mantoux test, and then, if you receive questionable results, confirm or refute them using a more modern test.

How often are tests for tuberculosis done?

Children's immunity is not yet fully developed, and they are at risk. That is why doctors recommend at least once a year, and more often if necessary, to be diagnosed with tuberculosis. If the epidemiological situation in the country worsens, the Mantoux test or Diaskintest is performed on children twice a year. To exclude tuberculosis, instead of the standard Mantoux, children over 15 years of age undergo a chest x-ray.

Diaskintest can be carried out to confirm or refute a diagnosis made on the basis of the Mantoux test, or simultaneously with it. The sample and Diaskintest are injected into the baby’s body at the same time, into the forearms. different hands, but sometimes doctors advise doing them in different time with a certain interval. The modern drug is considered safer than its outdated counterpart - using it, you cannot become infected with tuberculosis.

Do not forget that a medical examination is indicated before the test. Also, the test is postponed for a month if the child receives a routine vaccination.

Norms of Diaskintest indicators

Based on examination of the injection site, changes in the size of the papule, and the presence of redness, 4 possible results are distinguished:

• the reaction is negative;
• the reaction is false positive, or doubtful;
• the reaction is positive;
• hyperergic reaction.

On the first day, the result is not visible, there may be slight redness or hematoma at the injection site. Doubtful, positive or hyperergic reactions to Diaskintest can be not only a consequence of tuberculosis - this is possible for the following reasons:

• the test was carried out against the background of a latent viral infection;
• after Diaskintest, the child’s injection site became infected;
• presence of undiagnosed autoimmune or somatic diseases, hidden allergy to one of the components of the drug.

Decoding the results

The Diaskintest result is assessed a few days after the test, usually after 3 days. The assessment is carried out by a doctor or a specially trained nurse using a special transparent and flexible ruler to measure the size of the papule. How the Diaskintest indicators are interpreted with explanations various reactions for testing, you can see in the photo.

The reaction is negative

A negative reaction to Diaskintest is considered normal. If the Mantoux test gives a positive result, and the Diaskintest is negative, this indicates that the baby is healthy (we recommend reading:). Signs of a negative reaction:

• absence of infiltration;
• there is no redness, or they have a small diameter (up to 2 cm);
• a small hematoma at the injection site is possible if the drug is administered unsuccessfully.

The reaction is false positive or questionable

If the patient’s reaction is questionable, a TB specialist should examine him and prescribe additional methods examinations to clarify the diagnosis. Biochemical blood parameters and radiography may be required.

A questionable reaction to a vaccine has the following signs:

• slight hyperemia;
• absence of dense infiltrate;
• the presence of papules with a diameter of up to 4 mm.

The reaction is positive

The main sign of a positive Diaskintest reaction is the presence of a papule whose diameter exceeds 5 mm. Positive reaction indicates the presence inflammatory process associated with infection. If the baby good immunity, he can cope with mycobacteria on his own, and then Gon foci or calcifications form at the site of infection.

Hyperergic reaction

A hyperergic reaction indicates the presence in the body large quantity tuberculin bacteria. The patient should be shown to a TB specialist, who will prescribe additional examination methods to clarify the diagnosis. Signs that indicate a hyperergic result:

• the infiltrate diameter reaches 14 mm;
• pronounced redness;
• sores around the injection site;
• enlarged lymph nodes.

Hyperergic reaction

Contraindications to Diaskintest

Before conducting Diaskin testing, you need to be sure that it is not contraindicated for the baby. An alternative to Mantoux - Diaskintest - has absolute and relative (temporary) contraindications. The presence of absolute contraindications for the baby means that he cannot undergo Diaskintest under any circumstances, while temporary ones simply postpone the test until the baby’s health condition returns to normal.

TO absolute contraindications relate:

• intolerance to the components of the drug;
• epilepsy;
• heavy chronic diseases with possible exacerbations;
• hepatitis;
• colitis;
• pancreatitis;
• age up to 1 year.

Before conducting an allergy test, a child must be examined by a doctor for the presence of absolute and temporary contraindications.

Temporary contraindications:

• increased body temperature of unknown etiology;
• spicy infectious diseases: The Diaskin test can be performed after at least 3 weeks have passed after the baby has finally recovered;
• exacerbation dermatological diseases, allergies;
• pneumonia: the test is carried out a month after recovery;
• exacerbation of chronic bronchitis;
• recent vaccination: a month must pass after vaccination;
• exacerbation of somatic pathologies;
• during quarantine in kindergartens and schools.

In order to be sure that there are no absolute or temporary contraindications to the test, you should consult your doctor before the procedure. Based on the results of the tests and examination, the doctor will make a conclusion whether the child can undergo Diaskintest (a modern alternative to the tuberculin test), or will tell you how much time should pass between them if it is necessary to obtain a more accurate result.

Side effects

However, despite everything Taken measures precautions, after the Diaskin test, minor side effects, which take place over several days:

• slight increase in body temperature;
• headache;
• weakness;
• deterioration of health;
• loss of appetite.

Parents should remember that enzyme immunoassay testing is aimed at timely detection of tuberculosis. If your baby has no contraindications, do not ignore the doctor’s recommendations and go through everything necessary examinations and samples.

Tuberculosis is an insidious disease. Its pathogen adapts very quickly to antibiotics. Treatment in this case is expensive and does not always help. Therefore, it is so important to identify infected people in a timely manner. The Mantoux test has been coping with this task for more than 100 years. She was replaced by Diaskintest. Scientists argue: is the replacement equivalent and will it become the source of a new epidemic of tuberculosis among children?

100 years at lunch

Tuberculosis has been declared a social disease. If a person eats well, lives in favorable conditions, then he should not get sick - Koch’s bacillus (as mycobacterium tuberculosis is traditionally called) cannot take root in strong body. However, problems with immunity and close contact with a person who releases bacteria can play a fatal role. For example, in 2013, the Bataysky Railway College in the Rostov region was closed due to a tuberculosis epidemic among students. The source of infection was a student with an active form of the disease. He was sick and coughed for a long time until he infected more than two dozen of his classmates. A similar incident happened just a few months ago at the Yaroslavl Railway College. The situation is being discussed on blogs, mothers of sick children are indignant, but the case was hushed up.

The Mantoux test has been used to identify people infected with tuberculosis for more than 100 years. It has been in use in the USSR since 1952. Tuberculin is injected intradermally - a mixture of filtrates of killed cultures of mycobacterium tuberculosis of the “human” and “bovine” species. The drug detects people infected with all eight known types of mycobacterium tuberculosis. Allergic tuberculin reactions are most pronounced in the initial period of the tuberculosis process. At this time, the lesions in the organs have not yet formed or are so small that it is impossible to detect them radiographically. WHO considers the Mantoux reaction to be the most effective means to detect tuberculosis.

Unwitting Rivals

Years passed, and complaints about the Mantoux sample accumulated. Parents did not like the fact that the child could develop a fever after the test, and the “button” could not be wetted. Moreover, fear of BCG vaccination“advanced” mothers and fathers transferred to the diagnostic test, considering it a vaccination. Scientists were looking for new diagnostic methods. In 2008, Diaskintest, an intradermal test with an artificial allergen, entered the market in Russia. It consists of proteins from Mycobacterium tuberculosis of the “human” species grown in coli genetic engineering method. It is clear that the test will be positive for those infected with “human”, that is, only one of the eight types of tuberculosis bacillus. All other pathogens remain “overboard”.

For eight years now, heated debate has not ceased about which type of tuberculosis diagnosis is more effective and safe. The chief pediatrician of the Yaroslavl region, Lyudmila Vasilyeva, believes that the Mantoux test today has largely lost its significance due to “literally an avalanche-like increase in allergic reactions in children.” However, there is no smoke without fire. The Russian medical school of Abrikosov - Strukov - Serov has reliably proven that the “bovine” type of mycobacterium can cause extrapulmonary tuberculosis with foci in the kidneys, bones, brain and other organs. Extrapulmonary forms of tuberculosis are deprived of the attention of phthisiatricians and are diagnosed at very low late stages. The epidemiology of the “bovine” type of tuberculosis has been practically unstudied due to the lack of an accessible method for its determination. But it can be assumed with a high degree of probability that if 40-90% of people have a positive Mantoux test, and the Diaskintest is negative at the same time, then people are infected with tuberculosis mycobacteria not of the “human” type, but of another type: in Russia, most often “bovine”. These carriers must be identified and treated.

Coming in second

Diaskintest has many fans both among healthcare organizers and among practitioners. They name many advantages. For example, Anna Starshinova, Head of the Department of Phthisiopulmonology of the Federal State Budgetary Institution "SPbNIIF" of the Ministry of Health of Russia claims that the Diaskintest test, having high sensitivity and specificity, allows you to accurately identify individuals on early stages diseases, as well as persons at high risk of developing tuberculosis. This allows the use of a test with the drug Diaskintest for screening children and adolescents for tuberculosis instead of the Mantoux test.

However, there are also opposing opinions, and very well-reasoned ones. According to Irina Mikheeva, professor, head of the immunoprophylaxis laboratory of the Central Research Institute of Epidemiology of Rospotrebnadzor, the sensitivity of the Mantoux test in detecting active tuberculosis in children is significantly higher than Diaskintest. Therefore, when switching to screening using DST, the number of missed cases of active tuberculosis in children as a whole Russian Federation may amount to more than 300 cases per year. And this is already the beginning of the epidemic.

Not instead, but together

Perhaps in Russia there are opponents of scientific progress who put a spoke in the wheels of the implementation of innovative diagnostic method? Not at all. The problem of diagnosing tuberculosis has not been solved at the global level. Head of Laboratory immunological methods And molecular diagnostics Tuberculosis Research Institute of Phthisiopulmonology, Doctor of Medical Sciences, Professor Mikhail Vladimirsky conducted comparative analysis foreign publications. The conclusion is clear: methods using specific peptides of Mycobacterium tuberculosis, despite their high specificity, are not sensitive enough. Last year's research conducted in Denmark with complete analogue Russian Diaskintest, clearly showed this. So Russian opponents of a complete transition to DST cannot be accused of bias. And the Ministry of Health, which hastened to put an end to the discussion, was at least in a hurry.

Now on the official portal of legal information there is an Order on the procedure for conducting medical examinations to detect tuberculosis. In accordance with it, tests with Diaskintest will be replaced with the Mantoux test in all groups of the population, except for children under 7 years old, this fall. This contradicts the current SanPiN, which has the form of a law.

It is quite obvious that it is too early to put an end to the discussion about a complete transition to DST. “It should be noted that the intradermal test with DST was officially approved only 5 years ago and so far only in Russia,” we read in issue No. 2 of the journal “Epidemiology and Vaccine Prevention” dated 2013. - From our point of view, at present there is no certainty scientific evidence that latent forms of tuberculosis due to the abolition of the Mantoux test, missed in older children age groups and teenagers, in a few years they will not respond with an “epidemic rebound” in the form of a sharp increase in the number active forms tuberculosis,” says the author of the article, head of the department of microbiology, virology and immunology of St. Petersburg State Pediatric Medical University, laureate of the USSR State Prize Alexander Korolyuk.

His assumptions are justified: according to official statistics, against the backdrop of a decrease in 2015 compared to 2014 overall indicator Tuberculosis incidence in the population increased by 3.0%; there was an increase in incidence among adolescents in 48 of 85 subjects of the Federation (56.5%), and among children - in 35 (41.2%) regions. In 2015, an increase in the incidence of children and adolescents occurred in 64 of the 85 constituent entities of the Federation, which is 75.3%. This growth occurred against the backdrop of the use of DST.

But this does not mean that the creators of DST did a lot of work in vain. “Diaskintest and tuberculin have their own niches in the diagnosis of tuberculosis and should in some cases complement (but not replace) each other,” believes Head of the Department of Immunobiotechnology, Deputy Director of SPbNIIVS Professor Igor Krasilnikov. - For primary mass diagnosis of tuberculosis, the Mantoux test should be used in a standard setting with a modern tuberculin preparation. And Diaskintest is a convenient and effective test for subsequent confirmation of the specificity of tuberculosis disease.”

Safety is in question

One of the arguments of DST supporters was its improved tolerability. However, DST can cause serious allergic reactions. In December 2015, the Generium company was forced to suspend the production and sale of one of the drug series. This happened after the death of six-year-old Anechka during a DST injection at an anti-tuberculosis dispensary in Smolensk. Roszdravnadzor began an inspection, but on June 2, 2016, sales of this series of the drug were resumed.