home Thyroid Side effects of the mantoux test. Mantoux test for children: an unjustified risk or an important diagnostic technique? Mantoux vaccination harm of vaccinations

Side effects of the mantoux test. Mantoux test for children: an unjustified risk or an important diagnostic technique? Mantoux vaccination harm of vaccinations

The Mantoux test - which many incorrectly call vaccination - measures the body's immune response to the intradermal injection of thermally sterilized and specially treated fragments of tuberculosis bacteria (tuberculin).

This test has been successfully used all over the world for over 70 years, i.e. The test has been given to the 3rd generation in a row, including in our country. Mantoux in adults shows whether a person is infected or not. For children, its main function is slightly different.

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What kind of test is this?

The Mantoux test causes a typical immune response.

In order for the immune system to respond to a particular microbiological invasion, it must be familiar with certain microorganisms. That is, normally the immune system reacts only to those threats that it “recognizes.” Until we have an infection (or until we are vaccinated with a vaccine), the immune system cannot begin to recognize it.

If tuberculin bacteria are known to the immune system, then special immune cells will begin to attack the injected tuberculin, causing a local inflammatory reaction.

How is it done?

The injection is given intradermally, that is, into the upper layer of the skin, specially lifting the skin with the needle upward. The place where the test is performed is the forearm, usually its middle part.

Why do they do it?

Since the tuberculin test is done in childhood, many parents are interested in the question of why their children are given Mantoux.

Goals:

Selection of uninfected children who do not have an immune response to tuberculin for the purpose of subsequent vaccination;
analysis of the dynamics of results over several years, according to which one can reasonably assume the presence of a Mantoux “turn”;
identification of a pronounced (hyperergic) reaction, which always requires additional tests.

Adults generally do not receive the TB vaccine for a long time (most of us have not been vaccinated since adolescence). Therefore, in adults, the Mantoux reaction is a sensitive and reliable test for the presence of a tuberculosis pathogen in the body.

Until what age is it done for children?

The test begins at the age of 1 year and is performed annually until the age of 15.

Preparation

The test is not done during any acute illness. First you need to heal.

The test method does not require any special preparation.

Composition of the drug

The tuberculin test consists of:

Fragments of tuberculosis bacteria, thermally and chemically processed;
stabilizer - twin-80;
preservative – phenol;
sodium and potassium phosphates;
sodium chloride
water.

Is Mantoux harmful?

The test is absolutely harmless.

The main complaints are made about phenol, which is part of the sample. Phenol is indeed a toxin. But its amount in the administered tuberculin test is so small (0.00025 g) that it does not have any effect on health.

Phenol is a natural metabolite: it is formed in tissues as a result of the activity of bacteria in the intestines. This substance is found in many foods. Phenol entering the blood is decomposed in the liver and excreted in the urine. About 0.1-0.15 g of this metabolic phenol is excreted from the body every day. This is several hundred times more than what a person receives with a tuberculin test.

The medical use of phenol in low concentrations is justified.

How often can this be done for a child?

Mantoux is done once a year.

With more frequent testing, an amplification effect is observed: the sensitivity of the immune system to tuberculin increases, resulting in the formation of a false-positive response.

There is no point in testing more than once a year.

Normal in children

Anti-tuberculosis immunity after the first vaccination lasts up to 7 years. Exactly how much can be judged approximately by the round scar left on the left shoulder from the vaccination.

Table 1. Preservation of anti-tuberculosis immunity after depending on the diameter of the post-vaccination scar.

If there is no scar, it means that the vaccination was not carried out, and the child does not have immunity against tuberculosis;

The size of the scar matters when answering the question of what the reaction to Mantoux should be in children.

Which Mantoux is considered normal depends on the age of the child. Let's look at it in detail.

Norm for 1 year

During the second year of life, all children have a positive or questionable reaction to Mantoux.

The norm at 1 year in the presence of any post-vaccination scar is a papule with a diameter of 5 to 10 mm.

Normal for 2-6 years

By the age of 2, the intensity of anti-tuberculosis immunity is maximum. With a post-vaccination scar of more than 8 mm, the normal size of Mantoux can reach 16 mm.

After 3 years of age, the immune response to tuberculin begins to fade. But still, at 4 and 5 years old, most children retain a dubious or positive reaction. The normal size of a papule at the age of 4-6 years is considered to be no more than 10 mm.

In order to understand what size Mantoux should be at this age, you should correlate the diameter of the papule with the post-vaccination scar:

Table 2. Correlation between the normal size of the papule and the size of the post-vaccination scar in children aged 3-5 years.

At 6-7 years of age, children almost always show a negative or questionable response to the test. This suggests that the immune system “forgets” how to respond to tuberculosis pathogens. A negative reaction at any age indicates the need for re-vaccination. Routine revaccination of all children is carried out at 7 years of age.

Normal for 7-14 years old

After revaccination at 7 years of age, the cycle repeats.

During the first 3 years, the maximum intensity of immunity is maintained;
after 10 years, the response to injected tuberculin fades;
By the age of 13-14, most adolescents will have a questionable or negative response to the test.

Table 3. Norm of Mantoux papules in children 7-14 years old

Normal in adults

The norm for adults is:

Lack of response;
redness of any diameter;
papule up to 4 mm.

Reaction by day

The reaction to tuberculin administration appears on the 2nd day. This may be redness and/or papule formation.

The immune system response reaches its maximum on the 3rd day.

Negative

A negative Mantoux test is the absence of any reaction.

A negative answer indicates that

The immune system “does not know” the tuberculosis pathogen;
the person does not suffer from either active or latent forms of tuberculosis.

A negative Mantoux reaction in children vaccinated in the next 5 years is bad. She says that the immune system does not remember the dangerous pathogen.

A negative Mantoux result in children whose vaccination has been more than 5 years old is good. It shows that the child is not infected with tuberculosis. The same is true for adults.

False negative

Over the years, the immune system of people infected with tuberculosis stops responding to injected tuberculin. In this case, they speak of a false negative sample.

Positive reaction

A positive Mantoux test is considered to be a papule more than 5 mm in diameter.

The child has

Analysis of a positive reaction to Mantoux in a child always involves an assessment of two factors:

Duration of vaccination and size of post-vaccination scar;
the presence of a Mantoux turn - the dynamics of the sample over several years;
character of the papule.

The correlation of a positive result with the duration of vaccination and the size of the post-vaccination scar was discussed above in the section on the norm.

The Mantoux turn is an atypical increase in the response to the administered tuberculin in dynamics compared to previous years. The following is recognized as a turn:

Transition of a negative or doubtful reaction into a positive one;
persistence of papule more than 10 mm after vaccination for 3 years and beyond;
an increase in the papule compared to the previous test by 6 mm (in practice, any increase is interpreted as a possible infection, for example - 10, 10, 14);
hyperergic reaction regardless of the time of vaccination.

The nature of the compaction that occurs is important for differentiating a papule that occurs against the background of a vaccine from a papule indicating the presence of a tuberculosis infection.

At any age, the papule that appears in response to the immunity acquired after the vaccine is always pale pink. The papule that appears in response to infection with the tuberculosis bacterium is always clearly defined and during the first week acquires a brownish tint (pigmentation).

In an adult

If the Mantoux reaction in an adult is positive, this means that with a probability close to 100% vol.

In the absence of an effect from vaccination, this method is the most sensitive and reliable test for tuberculosis.

False positive

A questionable or false positive response is considered to be:

The appearance of redness of any size;
formation of papules with a diameter of up to 4 mm.

A doubtful Mantoux reaction means that one or more statements are true:

The immune system “remembers” about tuberculosis;
any vaccination has recently been carried out;
a person is infected with non-tuberculous mycobacterium;
the person has an allergic skin reaction;
the person has recently been ill with an infectious disease (any).

In differentiating a positive sample from a false positive one, the following factors are of primary importance:

Presence of contacts with tuberculosis carriers;
living in an area where the disease is prevalent above average.

Complications and side effects

The main side effects are associated with the body's excessive response to the administered tuberculin.

Hyperergic reaction

A papule larger than 17 mm is called hyperergic.

Necrotic changes and obvious inflammation in the area where the test is performed are possible.

A hyperergic response indicates the presence of a tuberculosis infection in the body.

Allergy

Tuberculin is an allergen. It may cause an allergic reaction at the injection site.

If Mantoux itches

The test site may be itchy. It is necessary to prevent scratching so as not to provoke a hyperergic reaction.

Temperature

People with hypersensitivity to tuberculin may experience a slight increase in temperature.

Cough

Cough is not a side effect of the test. The appearance of a cough after the test is not related to tuberculin and has more trivial causes.

Contraindications

Testing is contraindicated:

In the acute phase of any disease;
for skin diseases;
for epilepsy;
for rheumatism;
for bronchial asthma.

Alternative tests for tuberculosis

A new alternative to the Mantoux reaction - . It gives a false positive reaction much less often, but also more often a false negative one.

Mantoux is a basic test that precedes the clarifying diaskintest.

What can and cannot be done?

It is not prohibited to wet your hand.

It is forbidden. Colds and coughs have an infectious cause. The test is contraindicated for 1 month. after illness.

Is it possible to swim after the test?

Can. Do not rub your hand with a washcloth, brush or otherwise irritate the injection site.

Useful video

The Mantoux test and its importance for the prevention of tuberculosis at an early stage are described in detail in the video:

Conclusion

Most parents think that the Mantoux test checks whether the child has tuberculosis. However, the test gives a positive result in 80% of cases. In this case, the diagnosis is confirmed in no more than 0.5% -1%, often not confirmed at all. As we have seen, the purpose of testing children is to obtain an answer to the question of whether the child can resist real tuberculosis bacteria.

For adults, the Mantoux test is the main, most sensitive and accurate way to detect tuberculosis infection.

For decades, almost all schoolchildren have been exposed to the Mantoux test. Analyzing the “button”, the doctor concludes that there is a risk of contracting a very serious and dangerous disease - tuberculosis. The procedure is repeated annually. However, many parents do not fully understand how necessary this event is and whether it is harmful.

The benefit of Mantoux is that it is a kind of indicator of the presence of the causative agent of tuberculosis in the body. Given that the number of people infected with tuberculosis is increasing every year, all newborns should be vaccinated against tuberculosis (BCG). Mantoux allows you to monitor the effect of vaccination in order to promptly identify the disease and begin therapy.

Despite the fact that Mantoux is the main method of preventive examination of children for tuberculosis, the test has a number of contraindications

Mantoux test - benefit or harm?

Recently, the number of tuberculosis patients has been rapidly increasing. One of the most accessible and simplest means of identifying this infectious disease is to conduct a tuberculin test. Mantoux is not a vaccination, but a test for the presence of tubercle bacilli in the body. The main condition is a preliminary examination by a general practitioner, who must rule out fever, any skin diseases, impaired immune function, and also assess the likelihood of allergies.

From 1 year old to 15 years old, Mantoux is considered a mandatory procedure once a year. A small amount of neutralized enzymes of tuberculosis bacteria, which are thermally treated, is injected subcutaneously into the forearm area. By analyzing the child’s body’s reaction to the “button,” the doctor can assess the process of developing immunity against tuberculosis and the child’s chances of resisting this dangerous disease.

Despite the fact that Manta has been used for diagnostic purposes for quite a long time, doctors have divided opinions regarding its safety. Some experts believe that the test is not a vaccination, so it does not have any effect on the immune system. And others believe that unexpected negative consequences are possible, since the mechanism of interaction between tuberculin and immunity is still not exactly known, and the composition of tuberculin that is administered to a child contains many harmful substances.

Tuberculin is a heterogeneous mixture of organic substances of varying complexity, which are obtained from mycobacteria. It does not contain the Koch bacillus itself, but only its metabolic products. In addition, the drug contains sodium chloride, Tween-80 stabilizer, salts of phosphate buffer solution and phenol, which acts as a preservative. Traces of ballast impurities may also be present.

After the introduction of tuberculin, the body does not produce specific antibodies, so it cannot be called an antigen. It is also not a toxin. Most experts classify it as a group of incomplete antigens.

Normal reaction to Mantoux

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The reaction can be analyzed when three days have passed, but not more than a week after the test. It is during this period that you can see a specific papule, which is denser and differs in redness against the background of the rest of the skin. To measure its diameter, doctors use a transparent millimeter ruler, which is placed across the forearm. In cases where the papule is not visible, the hyperemic area of skin is of no diagnostic value.
The result is considered negative if there are no changes at the site of the Mantoux test, and if a papule is present and there is redness of the skin, then positive (more details in the article:). The diameter of the papule directly depends on the number of pathogens present - the more of them there are in the child’s body, the larger the diameter of the “button” will be. The diagnostic results are recorded in the medical record.
Temporary contraindications
Mantoux is allowed to be given to a child only if he is absolutely healthy at the time of the test and has not been sick with anything during the previous 30 days, including colds. Otherwise, the result may be distorted.
The following conditions are contraindications to the Mantoux test:
skin rash of any nature;
allergy;
chronic and acute infectious diseases;
any colds.

Another contraindication is to vaccinate and Mantoux in the same period, because the latter greatly weakens the immune system, which can cause an incorrect reaction to the test. The break between procedures ranges from several weeks to two months, depending on the type of vaccine. A TB doctor may insist on temporarily refusing to carry out the test if the child has recently suffered a complex infection or suffers from prolonged allergies. This period can last up to six months. If quarantine is declared in the group that the child attends, the test can be done only after the quarantine is lifted.
Absolute contraindications
To avoid the development of complications associated with the test, it is necessary to understand under what conditions the procedure is unacceptable. A certain category of children cannot be tested due to existing diseases. This includes children suffering from:
dermatitis;
chronic forms of infectious diseases;
rheumatism;
bronchial asthma;
epilepsy;
schizophrenia;
various neurological diseases.

Before performing the Mantoux test, the doctor must clarify whether the child has any temporary or absolute contraindications
Testing this category of children may lead to a severe allergic reaction and give a distorted result. That is why the TB doctor is provided with the entire medical history of the child to prevent an undesirable reaction. Only a doctor can decide whether the test can be performed on the baby or whether there are contraindications.
Side effects and complications in a child
Many parents are concerned about the question: can Mantoux cause complications? Official medicine claims that the risk of complications is minimal, but in pediatric practice a slightly different picture is observed. It has been established that Mantoux vaccination can cause the following side effects:
violations by housing and communal services;
weakness and apathy;
temperature increase;
vomit;
skin rash;
redness and peeling of the skin;
a week after the test, the child may begin to cough.

In children with weak immunity and allergies, the Mantoux test can cause side effects similar to symptoms of intoxication
The symptoms after the test are quite similar to the manifestation of the body’s reaction when interacting with toxic substances. This suggests that Mantoux still contains toxins (phenol), albeit a small part, so it can cause side effects in particularly sensitive children prone to allergies. Symptoms usually go away on their own after 1-3 days. If you experience significant side symptoms that last more than 3 days, you should definitely consult a doctor.
If the doctor did not check for a runny nose in the child before performing Mantoux, then the body’s reaction may be unpredictable. Your child may tolerate the test without any unusual symptoms, or the runny nose may worsen and become chronic. Thus, carrying out the test is advisable only if the child is absolutely healthy and the doctor has not seen any hidden pathologies.
Are there alternative methods of testing for tuberculosis?
In most cases, the Mantoux test is used to diagnose tuberculosis, which is carried out once a year. However, for a certain category of children this method is unacceptable, so doctors use alternative options for testing the body’s reaction to Koch’s bacillus. The most popular of them:
immunogram;
Suslov method;
Diaskintest;
interferon test.

Immunogram
To perform an immunogram, blood is taken from a child's vein, which is then examined for the number of cells produced to fight mycobacteria. The indicator allows you to analyze the ability of the child’s immunity to resist the disease.
Suslov method
Suslov's method is based on studying a drop of venous blood with the addition of a certain amount of tuberculin. Through a microscope, a specialist examines the characteristic pattern of blood cells. The reliability of this method is only 50%. Such diagnostics are always carried out in conjunction with additional measures, the list of which depends on the age of the baby (x-ray of the lungs, fluorography, tomography, etc.).
Diaskintest
Diaskintest is a highly sensitive intradermal test that can be used to completely safely test a child for carriage and infection with tuberculosis. The principle of interaction is the same as with Mantoux: a specific protein that is part of the administered drug causes a reaction, based on the intensity of the interaction the probability of the disease is calculated.

Most of the contraindications for Mantoux remain with Diaskintest (fever, acute forms of illness, vaccination and allergic reactions). The combination of Mantoux and Diaskintest makes it possible to give the baby an accurate diagnosis.
Interferon test
A modern development in the field of tuberculosis research is the interferon test (quantiferon). It is based on the analysis of specific interferon, which is produced by T-lymphocytes that have contact with a vaccinated or infected mycobacterium. The advantage of this test is that it has no contraindications or side effects and is well tolerated even when the baby is ill.
The accuracy of this diagnosis is the highest, it is not influenced by external factors, and distortion of the results is minimized. The only drawback is that the result of infection and disease is not distinguishable.
If we consider the cost of these methods, the Mantoux test remains the most affordable method today, but conducting a quantiferon test will cost the most. Early diagnosis of the disease is very important, therefore, even if the Mantoux test is contraindicated for a child, it is worth using any alternative options.

In 1890, Robert Koch discovered tuberculin and was sure that this substance would help get rid of tuberculosis, but he was wrong. However, his discovery helped create the simplest way to diagnose this terrible disease - the tuberculin test or, as it is also called, the Mantoux reaction.

Very often, people confuse Mantoux with vaccination and this is fundamentally wrong. This test has nothing to do with vaccination and is a special diagnostic test necessary to detect the presence of Koch bacillus in the body.

The test is carried out using intradermal injection of tuberculin and subsequent assessment of the reaction that occurs in response to this injection. There are two main types of tuberculin diagnostics:

Individual. Carried out only when indicated;
Massive. This type is performed on all children at a certain age in countries with high incidence rates.

This study is necessary to identify children who need to be vaccinated, as well as to timely identify those infected.

Two types of tuberculin are used to conduct the study.

Altuberculin (ATK). The so-called Koch tuberculin. Consists of heat-inactivated mycobacteria. Its main disadvantage is that it contains impurities, so the risk of a false positive reaction is quite high. That is why now this type is practically not used in medical practice;
Purified tuberculin (PPD). This type of tuberculin is characterized by the fact that it is completely purified from all impurities that could be obtained during the growth of mycobacteria on a nutrient medium.

Is Mantoux vaccination harmless, what are its contraindications?

It is important to understand that the Mantoux test is necessary for the early detection of tuberculosis, so its implementation is of great diagnostic importance. Most pediatricians agree that this procedure is completely safe for children. Moreover, both healthy and for children with various chronic diseases.

However, there are contraindications for this procedure:

acute infectious diseases;
allergic conditions;
skin diseases;
a history of epileptic seizures or a confirmed diagnosis of epilepsy.

In addition, the test is postponed if the child was vaccinated less than a month before it was carried out.

Reaction to Mantoux in a child at risk

There are several types of reactions to a tuberculin test:

Anergy. There is no reaction to the test (negative);
Normergy. There is a moderate reaction;
Hyperergy. Insufficient response;
Hypoergy. Increased reaction.

It should be noted that the severity of the reaction can be influenced by third-party factors, for example, a decrease in sensitivity to the Mantoux test is observed in the following conditions:

taking antiallergic drugs;
a history of recent polio vaccination;
taking hormonal medications;
taking vitamins. in particular, group B. a decrease in reaction is also possible when taking vitamin C and D.

Increased sensitivity can be observed in certain diseases, namely:

thyroid diseases. in particular, Graves' disease;
pneumonia;
bronchial asthma;
acute rheumatic fever;
the presence of chronic foci of infection;
flu.

It should also be said about the turn of the Mantoux test.

This concept refers to the early period of tuberculosis infection, during which a hyperergic reaction is possible, but there are no local signs of the process.

The turn is established in the following cases:

When a negative test turns positive;
An increase in the diameter of the sample in comparison with the previous one by 6 mm or more.

In any case, the variation of the test does not indicate that the child has tuberculosis. This may indicate that mycobacterium tuberculosis has entered the body, but not the development of the disease itself.

Mycobacterium tuberculosis under a microscope

Normally, the Mantoux test is performed from 12 months and is done every year until the child reaches 14 years of age. However, there are risk factors due to which the test must be done twice a year starting at 6 months. These factors include:

for any reason, the child was not vaccinated with BCG in the maternity hospital;
HIV infection;
diabetes;
Chronical bronchitis;
long-term treatment with hormonal drugs.

If a child who was not vaccinated in the first year of life is given BCG-M, the Mantoux test schedule changes to normal.

Mantu care

It is extremely important to understand what rules must be followed after the test. Thus, it is prohibited:

scratch the injection site;
lubricate the papule with any medications or creams;
Apply a bandage or plaster to the injection site.

Some parents mistakenly believe that after performing the Mantoux test, you should not wash or wet the injection site. However, this is fundamentally wrong.

The reason for this erroneous judgment is that previously tests were used that were administered not intradermally, but subcutaneously, and water entering the injection site could distort the result.

Now this method of administration is not used, so after the test you can safely take a bath.

How to measure Mantoux in a child

The first thing you need to know is that the sample is assessed three days after the administration of tuberculin. First, an external assessment is carried out. The reaction can manifest itself in two ways:

Redness;
Infiltration. This type is characterized by the formation of a dense protruding area at the injection site - papules.

Then the size of the papule is measured with a transparent ruler in the transverse direction. It is important to remember that it is not the redness that is being assessed, but the size of the infiltrate.

Thus, the following types of reaction are distinguished:

Negative. There are no changes on the skin at all;
Doubtful. The papule is absent or does not exceed 4 mm;
Weakly expressed. The size of the papule varies from 5 to 9 mm;
Moderate. The size of the papule is 10-14 mm;
Expressed. The size of the papule is more than 14, but less than 17 mm;
Hyperergic. The diameter of the papule exceeds 17 mm.

In any case, the Mantoux test occurs individually in all children and depends on several factors.

Mantoux norm in children by year

Depending on age, the normal size of papules may vary.

In the first year, the large size of the papule is explained by recent vaccination. Also, the results of the examination may depend on the immunity transmitted from mother to child.

Side effects of the Mantoux reaction and allergy symptoms

The most common side effects of the procedure are all kinds of allergic reactions. So, quite often, in the form of side effects, the following are detected:

However, side effects are usually associated with errors by doctors who performed the Mantoux test in the presence of contraindications.

What does Dr. Komarovsky say about the Mantoux test in children?

According to Dr. Komarovsky, supporters of the ban on Mantoux often say that the administered mixture contains phenol.

However, it is contained in such a low dosage that more than 1000 samples must be administered to have a negative effect on the body. It should also be noted that phenol is formed in the body normally, and is also found in many foods that are often eaten.

The Mantoux test must be performed before vaccinations;
If this was not possible, then the test is allowed only a month after vaccination;
It is not recommended to perform a Mantoux test after using blood products. You must wait 2 weeks;
It is recommended to carry out the annual test in the same season. Best in autumn;
When introducing samples, you must alternate hands. For example, in even years to the left, in odd years to the right.

Thus, according to Dr. Komarovsky, Mantoux is a fairly safe test, which is extremely important in the diagnosis of such a serious disease as tuberculosis.

Refusal of the Mantoux test, search for an alternative

Sometimes, parents have an extremely negative attitude towards this test, or the child has a strong allergic reaction to Mantoux. In such cases, conducting research is impossible. However, it is important to control the development of such a serious pathology as tuberculosis.

For this purpose, modern medicine offers the following research methods:

Immunogram. This study allows you to assess the state of the body's immune system. However, it does not accurately determine whether an infection has occurred or not;
Suslov's method. It involves examining a drop of blood to which tuberculin is added. This technique is also characterized by low diagnostic significance and is considered reliable only in half of the cases;
Serological study. Aimed at identifying IgG specific for mycobacterial antigen;

In any case, the Mantoux test remains the most accessible and accurate method of testing for tuberculosis.

Additional information about the Mantoux test, its accuracy and necessity is in the next video.

Tuberculin test, also called the Mantoux test, is a common diagnostic method.

Contrary to popular belief, the Mantoux test is not a vaccination, but its widespread annual administration to children from one to eighteen years of age makes it possible to quickly detect tuberculosis and begin treatment on time.

Allergy to Mantoux in a child does not occur too often, but can distort diagnostic results, and in the most severe cases, seriously worsen the child’s condition.

You can find out what the diagnosis of “TB infection” in a child means from ours.

General information

The immune system, encountering one of the components of the Mantoux test, can begin to produce antibodies against it, which activate the production of substances responsible for the symptoms characteristic of allergic reactions.

There are a number of contraindications that should be taken into account to avoid getting a false positive result associated with an allergic reaction:

Shortly after vaccination with BCG. In the first weeks after BCG, antibodies are extremely sensitive to tuberculin, so the result will be erroneous, and the child will experience symptoms characteristic of allergic reactions.
During the course of any infectious disease or shortly after recovery. The tuberculin test should be performed only a month after recovery, otherwise the weakened immune system will react inadequately to tuberculin. Also, an infectious disease that the child had may recur.

This rule should be adhered to especially carefully if the child is very weakened and his illness is severe.

Tuberculin intolerance. If the baby has previously had specific reactions to tests and, after examination, tuberculin intolerance is revealed, a tuberculin test cannot be performed. It is important for parents to consult with their pediatrician about the advisability of other preventive tests.
During periods of exacerbation, allergies. If a child has hypersensitivity to a large number of allergens or one of these diseases, it is important to consult with a pediatrician before testing.
Epilepsy. In most cases, the Mantoux test cannot be performed on epileptic children.

If, after performing a tuberculin test, a papule has formed in the injection area, this may indicate both positive and false positive reactions, which is a mild form of allergy.

If the papule is necrotic or its diameter is more than 1.5 cm, this indicates the presence hyperergic reaction, which may also indicate both the presence of tuberculosis and the development of a severe allergic reaction.

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Causes

The main factors that increase the likelihood of a false positive reaction:

The risk of allergies also increases in weakened children with chronic diseases who have repeatedly undergone long courses of antibiotic therapy. It is important for parents of such children to consult with a pediatrician before administering vaccines and a tuberculin test.

In some cases, allergy symptoms are not associated with Mantoux, and a component of some kind could act as an allergen.

Cross shape

Tuberculin is extract of a number of bacteria, most often leading to the occurrence of tuberculosis in humans.

When it enters the body, the immune system can react inadequately, which will lead to the appearance of characteristic symptoms.

Bacteria injected into a child dead, but are able to activate the production of antibodies.

If a child has tuberculin intolerance, he will have an allergic reaction when receiving the BCG vaccine.

Phenol is added to the Mantoux liquid to slow down changes in it and maintain its quality. It is also present in some vaccines.

Phenol is toxic substance: one gram of it can lead to death. However, in vaccines and material for the Mantoux test, it is contained in minute quantities and is not capable of causing any harm.

Phenol is formed in small quantities during metabolism in the body of a healthy person, and its amount in the sample is approximately equal to the amount contained in 5 ml of urine. Accordingly, it is not dangerous and will quickly be eliminated naturally.

This substance actively used in production, therefore, a child with hypersensitivity to phenol may experience a reaction upon contact with anything that contains it, including cosmetics, furniture, some foods, clothing, toys, paints, linoleum.

The likelihood of an allergic reaction is especially high if the item containing phenol is heated. Its vapors, once in the respiratory system, will cause symptoms characteristic of allergies.

Severe allergic reactions upon contact with phenol rarely occur.

Signs of an allergic reaction

Allergy to Mantoux in a child - photo:

An allergic reaction to Mantoux is often similar in symptoms. In rare cases More severe symptoms are observed:

body temperature rises very high: up to 39-40 degrees and above;
there is a loss of appetite;
the child quickly loses weight;
skin rash occurs;
the child has an increased level of fatigue and complains of weakness;
increase;
In the area where the test is placed, severe itching is felt and pain may occur;
there is a large papule.

If your child exhibits the above symptoms, you should call your pediatrician at home.

Diagnostics

When a papule appears, the child is referred for research that will help understand what exactly caused the reaction: developing tuberculosis or allergies.

List of studies to identify tuberculosis:

clinical blood test;
chest x-ray;
fluorography (only for teenagers over 15 years old);
leukocyte tests;
CT scan of the lungs.

Diagnostics allergies:

consultation with a pediatric allergist;
prick testing;
identifying the concentration of immunoglobulin E in the blood.

Treatment

The main medications that are prescribed if a child is allergic to the components of a tuberculin test:

If the child does not have any significant symptoms other than the presence of a papule, treatment is not prescribed.

If the condition worsens, it is important for parents to take the child to the hospital again.

Prevention

To reduce the likelihood of an allergic reaction to a tuberculin test, you should:

Pay close attention to ensure that your child did not test if there were contraindications. It will also be useful to consult with a pediatrician about whether it is possible to perform the Mantoux test on a child who has recently been ill, and when exactly it will be safe.
If a child often has allergic reactions, a few days before the test it is important to give him antihistamine.
Make sure that the child didn't injure the area where the sample was placed and did not wet it.

The tuberculin test is a safe method for diagnosing tuberculosis, but parents should be aware that its components can cause an allergic reaction, especially in weakened children.

If a child develops suspicious symptoms in the first five to six days after the test, you should go to the hospital.

Could it be Allergy to the Mantoux test in a child? Find out about it in the video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Every year, millions of children throughout Russia are given the Mantoux test. This is due to the unfavorable epidemiological situation regarding tuberculosis in the country. Both children and adults can become infected simply by using public transport, visiting school, clinics and any other crowded places. The Mantoux reaction cannot be considered a vaccination. This is a diagnostic procedure aimed at early detection of the presence of Koch's bacillus in the body, so it is not necessary for a child to do this test. Parents may refuse to administer tuberculin to their child if they believe that it may harm him. Sometimes the Mantoux test can have side effects and lead to the development of complications, but if you refuse it, you can easily miss tuberculosis.

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What is a tuberculin test?

The Mantoux test is a test for tuberculosis, the body’s reaction to the introduction of tuberculin. In fact, the mechanism of this reaction is the same as that of an allergy. Fragments of Mycobacterium tuberculosis seem to attract immune cells - lymphocytes, but not all of them, but only those that are already “familiar” with Koch’s bacillus. Because of this, a specific inflammation occurs at the site of injection of the drug into the skin - redness, the formation of a papule (inflammatory swelling, “plaque”).

Diagnostic value of the Mantoux test

Parents often have doubts about the need for this test. The WHO answer is categorical: the Mantoux test must be done. For countries with a high prevalence of tuberculosis (which is what the Russian Federation and CIS countries are now), this test is one of the simplest and most effective measures for identifying patients at an early stage, and, therefore, controlling the infection. Even in countries with a low incidence of tuberculosis, a tuberculin test is mandatory. It is widely used to detect those infected with tuberculosis in high-risk groups.

The Mantoux reaction (test) for tuberculosis is needed for:

identification of persons infected with tuberculosis for the first time;
identifying those infected for more than one year with enhanced reactions to tuberculin;
diagnosis of asymptomatic forms of tuberculosis;
confirmation of the diagnosis of tuberculosis;
diagnosing a possible disease in persons who have been in contact with a patient with tuberculosis;
selection of children subject to BCG vaccine for revaccination against tuberculosis.

Result evaluation

The result of the vaccination must be registered three days (72 hours) after the administration of tuberculin. To do this, examine the injection site, feel the papule and measure it with a ruler across the arm.

The reaction happens:

negative - papule less than 1 mm in size or absent, no redness;
doubtful - papule up to 4 mm in size, redness of any size without papule;
positive - papule measuring from 5 to 16 mm.

One of the variants of a positive reaction is hyperergic (intensified) - a papule measuring 17 mm or more, the formation of ulcers and pustules. The result may also be false positive. This reaction is externally similar to a positive reaction, but is the result of improper care of the sample: combing, gluing with a band-aid, rubbing with a washcloth when washing.

After recording the result of the sample, it is evaluated.

A negative Mantoux test indicates that the child is healthy and has not had contact with tuberculosis patients. Such children can be revaccinated against tuberculosis with the BLC vaccine.
The questionable result of the Mantoux vaccination (a very small papule, just reddened skin at the injection site) requires additional research.
A positive test is almost always a reason for a visit to a TB specialist and can occur in the presence of acute tuberculosis. The exception is children who have been vaccinated with BCG in the last three years. During this period of time, a positive reaction to the Mantoux vaccination is the norm (post-vaccination reaction).
A hyperergic reaction is a reason to urgently consult a doctor. Also, if children experience complications or side effects, they should receive immediate help.

It is important to remember that children may have individual characteristics of immunity, so we cannot talk about a specific norm for the size and manifestations of the Mantoux reaction - each child has his own norm.

Contraindications for the test

The most common and important contraindications to Mantoux vaccination are the following conditions:

inflammatory and purulent skin diseases (eczema, dermatitis, streptoderma, etc.);
acute diseases and exacerbation of chronic ones (pyelonephritis, hepatitis, gastritis, etc.);
epilepsy;
individual intolerance to the components of the drug;
acute respiratory diseases;
any allergies (hay fever, bronchial asthma, etc.) in the acute stage.

Also, the Mantoux test should not be given along with other vaccinations or immediately after them, as they can cause a false positive result due to a strained immune system. The Mantoux reaction, so that it does not cause harm to the body, can be performed a month (full 30 days) after an exacerbation, acute illness or the last vaccination against other infections.

Side effects and complications

Undesirable consequences of the Mantoux vaccination occur suddenly and are usually similar to a common cold. The following symptoms may appear:

heat;
rashes on the skin (not only at the injection site, but also on any other areas of delicate skin - in the groin, on the buttocks, on the face, on the elbow);
loss of appetite;
general weakness, lethargy;
allergic reactions of various types, including anaphylactic shock.

In most cases, the cause of complications and adverse reactions to tuberculin is the low quality of the vaccine, incorrect composition and poor purification. An allergy to Mantoux in the form of a positive reaction or other manifestations (itching, rash, difficulty breathing with wheezing) may occur due to intolerance to phenol, which is part of the administered drug. This substance is absolutely safe for healthy children, as it is contained in the vaccine in small non-toxic doses. But in children with intolerance to this substance, an allergic reaction is guaranteed to occur.

Only a doctor can determine the exact cause of an allergic reaction to Mantoux and the severity of the harm caused to health, so if a child shows signs of illness after vaccination, it is necessary to urgently seek medical help.

Is it worth trying?

The Mantoux test cannot be considered a vaccination; it is simply a test for the presence of tubercle bacilli in the body. Like any other vaccine, it nevertheless loads and changes the immune system in a certain way, which is why it weakens and there is a risk of the above-mentioned complications, so each parent must decide for himself whether his child needs a Mantoux test. But it is important to remember that the risk of developing complications is much higher lower than the risk of tuberculosis infection in Russia and the CIS countries. This is why vaccination in childhood is so important.

If a parent is afraid of harming their child and does not want undesirable consequences, then it is easy to refuse the Mantoux vaccination by filling out a standard refusal form at the clinic. To do this, you can use other diagnostic methods.

It is not necessary to give your child exactly Mantoux; there is another test for tuberculosis - Diaskintest, in which the risk of developing allergies is lower. There is also a test for antibodies to the tuberculosis bacillus, for which you just need to donate blood from your finger.

To choose the most appropriate diagnostic method, it is better to contact a pediatrician who keeps records of the child’s health from birth. Taking into account all the characteristics of the child’s body, the doctor will help you choose the method that can be easily tolerated without complications.