Pirke disease. Tuberculin test or Mantoux test: norm for children and useful information for parents

Pirquet's test The test is the cutaneous application of dry purified tuberculin. diluted to a content of 100 thousand TE in 1 ml. A drop of this tuberculin solution applied to the skin is used to scarify the skin. The result is assessed after 48 hours. The subcutaneous tuberculin test, proposed by Koch, consists of injecting 10 - 30 - 50 TE PPD-L under the skin at the lower angle of the scapula. The results of the Koch test are assessed by local, general and focal reactions. At the site of tuberculin injection, an infiltrate with a diameter of 15-20 mm appears after 48-72 hours. The general reaction is characterized by an increase in temperature. body malaise 6 - 12 hours after the administration of tuberculin, and focal - exacerbation of tuberculin. changes (appearance or worsening of cough, infiltration around lesions in the lungs, enlarged lymph nodes with specific lymphadenitis, pain and swelling of the joints with specific arthritis). The test with subcutaneous injection tuberk. at specific eye damage. Indications. During mass tuberculin diagnostics, the Mantoux test with 2 TU is performed on all children and adolescents vaccinated with BCG, regardless of the previous result, once a year. The child receives the first Mantoux test at the age of 12 months. For children not vaccinated with BCG, the Mantoux test is performed from 6 months, once every six months until the child receives BCG vaccinations, in the future - according to the generally accepted method once a year. The Mantoux test can also be used for individuals. tuberculin diagnostics. It is carried out in the conditions of a children's clinic, somatic and infectious diseases hospitals for differential diagnostics tuberculosis and other diseases, in the presence of chronic diseases with a torpid, undulating course, in the ineffectiveness of traditional methods. methods to treat. and availability of additional risk factors for infection or disease with tuberculosis (contact with a patient with tuberculosis, lack of vaccination against tuberculosis, social risk factors, etc.). In addition, there are groups of children and adolescents who are subject to the Mantoux test 2 times a year in a general medical network: - patients diabetes mellitus, peptic ulcer stomach and duodenum, blood diseases, systemic diseases. HIV-infected people receiving long-term hormonal therapy(more than 1 month); with chronic nonspecific diseases(pneumonia, bronchitis, tonsillitis), low-grade fever unknown etiology; not vaccinated against tuberculosis, regardless of the child’s age; children and teenagers from social risk groups located in institutions (shelters, centers, reception centers) that do not have medical services. documentation (upon admission to the institution, then 2 times a year for 2 years)

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More on topic 28. Koch test and Pirquet test. Indications for use:

1. 26. Tuberculin diagnostics. Tuberculin Mantoux test with 2TE. Staging technique, contraindications.

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Diagnosis of tuberculosis is the main measure, which becomes not only a guarantee successful treatment, but also a way to prevent an epidemic, since in fact one sick person can infect an entire team. For this reason, it is worth regularly carrying out diagnostics for preventive purposes. This is why tuberculin tests are carried out in children's institutions. This article describes what a tuberculin test is, how informative it is and what consequences it can have.

What is a tuberculin test?

Children are regularly tested for tuberculin; this right is enshrined in law. What is it? This test, carried out in most cases, is subcutaneous injection natural tuberculin preparation or synthetic origin depending on the type of sample. Usually, the drug is injected under the skin in the wrist area, but it can also be injected into other places, for example, in newborns.

Action this drug causes local reaction on the skin - first redness appears and swelling forms, after a day a papule begins to form. Based on the size of this papule, the doctor makes a conclusion about whether the patient is sick. What types of reactions can there be?

• A positive reaction is observed when a large papule has formed after 72 hours. This indicates that the causative agent of tuberculosis is present in the body. The patient is sent for mandatory examination;
• Doubtful. There is a papule, but its size is not sufficient to diagnose the presence of tuberculosis. It may appear if a natural vaccine against this disease was recently introduced. With this result, the patient is most often referred for examination;
• A negative reaction is one in which any changes in the skin are completely absent. She talks about absence pathological process. But it can also indicate that the patient is not vaccinated against the disease or the vaccine “did not work,” that is, immunity was not formed.

Thus, deciphering the research results does not cause any significant difficulties.

In itself, the reaction develops because the administered drug causes a reaction of the immune system and in the presence of tuberculosis pathogens, the immune reaction will be stronger, that is, the volume of the papule will become larger. Whereas, if there is no pathogen in the body, then the immune system has not developed the appropriate antibodies and does not react in any way to the pathogen entering the bloodstream as part of the sample. Of course, such a small volume of an inactive pathogen cannot cause infection.

History of the appearance of tuberculin

Tuberculin tests are carried out with the substance tuberculin of natural or artificial origin. How did it come about? Tuberculin was discovered by the same scientist who discovered the “Koch stick” - Robert Koch. This happened in 1890. At the very beginning of the 20th century, pediatrician Clemens Pirquet from Austria introduced the concept of allergy into medicine and substantiated the informativeness of the tuberculin test. He proposed to carry it out by scarification by skin method– this was the first such test, but it was not widely used due to the inexpediency of the method used.

Very soon, in 1908, Charles Mantoux, on the one hand, improved, and on the other hand, only slightly modified the Pirquet test, proposing to administer a tuberculin solution intradermally. This diagnostic method got much more widespread, as it has proven its maximum accuracy and efficiency. In this unchanged form, the Mantoux test is carried out in kindergartens and schools to this day.

Until recently, natural tuberculin was used, which includes waste products of the bacteria that cause the disease. But this composition is very allergic, therefore, at the injection site, except immune reaction An allergic reaction also manifests itself, which significantly reduces the information content of the test, since the result can be regarded as a false positive.

Therefore, this drug is gradually being replaced by purified tuberculin (PPD). Such tuberculin was discovered back in 1934 and approved World Organization health care in the 1950s, but became widespread more recently. The advantage of the new drug is not only its higher specificity and test accuracy, but also that the drugs used are more sterile.

Types of tuberculin tests

Currently, the Mantoux test is widely used, but in addition to it there are also alternative ways administering the drug and assessing the results based on the reaction, since the symptoms also differ. In addition to the Mantoux method, the Koch and Pirquet methods are also implemented. These approaches have various contraindications and indications, features, and therefore can be interchangeable in different conditions.

Subcutaneous Koch test

The indication for such a study is the need to clarify the diagnosis of tuberculosis. The test is very highly sensitive, has greater accuracy than the Mantoux test, but is also more expensive. It is usually performed when the Mantoux reaction is not informative enough.

The drug is administered subcutaneously. The difference is in the dosages and sampling schedule. First, the drug is injected under the skin in a volume of m10-120TE. If no result is obtained, then up to 50 or 100 TE is introduced. After such a volume of the drug, both general and local focal reactions are detected. Such tests are also used in gynecology for suspected urogenital tuberculosis.

The test result is deciphered as follows:

1. No reaction after administration of 100 TU of the drug – no tuberculosis;
2. General reaction (fever, deterioration of health, leukocytes in the blood and ESR increase, etc.) – tuberculosis is present;
3. A focal reaction (observed in the lesion) is established by radiography, sputum examination, etc. - tuberculosis is present, even despite the absence of a general reaction;
4. Local reaction - a papule in the injection area with a diameter of 1.5-2 cm is uninformative if there are no other symptoms, that is, if there is a papule, but there are no symptoms, then there is no tuberculosis.

This is a fairly informative and effective test, more effective than the Mantoux test. But it is complex, more expensive, and may also be less tolerated by the patient.

Pirquet skin test

It is carried out if necessary to confirm the diagnosis of tuberculosis. It is used quite rarely, as it is less informative than the Mantoux reaction. Such testing cannot be carried out if there is bronchial asthma, allergic reaction, local skin reaction, rashes and skin injuries in the injection area, with bronchitis, acute respiratory infections, acute respiratory viral infections, etc.

This test is done for both children and adults and is performed using the scarification method, that is, just like a traditional allergy test, which is what it is. The site where the drug is applied is disinfected with carbolic acid, usually the product is applied to the forearms. Using a scarifier, small incisions are made on the skin, and then the drug is applied to them.

Within 5-6 minutes the drug is absorbed into the skin, then its remnants are washed off paper napkin. The patient is monitored for 48 hours, during which his body's reaction to the test is monitored.

As a result, several papules are formed. They, as in all other methods, are differentiated by size.

• A papule up to 3 mm indicates that it is necessary to re-vaccinate, and then repeat the test itself;
• A papule of 3-5 mm in diameter indicates the absence of tuberculosis and normal vaccination effectiveness;
• A papule of 4-10 mm indicates that there may be an infection, or there has been contact with an infected person;
• A papule of 10-15 mm, ulcers, etc. indicate the presence of the disease.

Since several papules are formed, it is possible that they can vary quite a lot in size. In this case, they are evaluated together, depending on which area of ​​what concentration the solution was applied to.

Mantoux test with 2TE PPD-L

Tuberculin test Mantoux is held in mandatory all children under 15 years of age. These events are organized at schools and kindergartens. Its purpose is diagnostic and preventive. The advantages are that it is as simple as possible, fast, cheap, and is also well tolerated by patients (and therefore can be put on stream). The disadvantages are that the information content is quite low (compared to other methods), and in addition, it is quite difficult for a child to handle.

Such a test cannot be carried out in case of acute respiratory viral infections, acute respiratory infections, inflammatory and infectious processes in the body. The results are also deciphered by assessing the size of the formed papule. But as a result of an allergic reaction, such a test can quite often give a false positive result.

Conclusion

The reaction to tuberculin is the main way to guess or determine for sure whether a person is infected with tuberculosis. Such timely diagnosis on early stage not only guarantees successful treatment, but also prevents the pathology from spreading. For this reason, a mandatory Mantoux test is performed on all children, starting from the maternity hospital until they reach the age of 15 years, because children are the most vulnerable to this disease. However, an adult can also carry out this test if he wishes - his reaction assessment will follow the same principles.

Pirquet's test is an allergic reaction of the body to the introduction of a certain amount of purified tuberculin. The solution is diluted to contain up to one hundred thousand units (TU) per milliliter. The composition contains tuberculin - a special extract from destroyed Koch bacilli. This type diagnostics became the progenitor of Mantoux, which was later further improved.

Contains:

1. Killed filtrates of cultures of human and bovine microbacteria;
2. Phosphate salts;
3. Sodium chloride.

Indications for use

1. Children under three years old. A positive reaction means that the child is sick and the disease is in the active phase;
2. Teenagers and children over three years of age. Diagnostic detection primary infection, as well as carrying out prevention in medical institutions;
3. Already infected persons. To study the degree of manifestation of allergy to tuberculin.

Execution method

Having previously disinfected the injection site with carbolic acid, the drug is applied cutaneously in the area of ​​the upper arm.

Under no circumstances should you treat the surface of the skin with alcohol. Such disinfection can harm the diagnosis and give a false result, since alcohol leaves traces of protein on the skin.

Before application, shallow incisions are made with a scarifier (no more than five millimeters). Wait five minutes, during which the drug is absorbed into the skin, after which the excess medication is wiped off with a sterile napkin. The reaction appears after two days.

Prohibited events

1. wet the skin;
2. lubricate it with something medicines or alcohol;
3. stick a patch on the wound;
4. scratch and touch the papule with dirty hands.

Evaluation of results

The test is assessed by the size of the papules and the appearance of ulcers around it.

1. Papule no more than five millimeters - the reaction is negative, the child does not have tuberculosis;
2. The papule is less than three millimeters - the diagnosis needs to be done again, since it is not clear whether there was a response to the introduction of tuberculin;
3. A papule of up to ten millimeters means that a person is infected with tuberculosis or is in constant contact with a patient in active form diseases;
4. A papule of ten to fifteen millimeters with the appearance of ulcers means that the likelihood of the disease is very high.

Graduated sample

In addition to the Pirquet test, another similar diagnosis is performed. This assessment of tuberculosis incidence is called a graduated sample. Unlike the Pirquet test this reaction shows differential diagnostic characteristics. It is also called the Grinchar and Karpilovsky test. The techniques are very similar, the only difference is that they make four notches instead of one, after pre-processing skin carbolic acid.

After which tuberculin is applied varying degrees concentrations: one hundred percent, twenty-five percent, five percent and one percentage concentration. The solution is applied with different marked pipettes and only sterile scarifiers are used. The test can be used in both children and adults. It shows how effective the treatment for this disease is.

Evaluation of results

The response to tuberculin administration is assessed after two to three days. These diagnostic tests do not show the localization of tuberculosis, but allergic reaction for the administration of tuberculin.

Possible the following types manifestations:

1. Allergic reaction - no response to tuberculin;
2. Nonspecific reaction - redness on the notch where tuberculin was applied with one hundred percent concentration;
3. A normergic reaction is a response only to a one hundred percent and twenty-five percent solution, but to a five and one percent solution there is no reaction;
4. Hyperergic - inflammation to all types of concentration, and the higher the percentage of the reagent, the more pronounced the body’s reaction;
5. Equalizing - all papules are the same, of the same color for all concentrations of solutions;
6. Paradoxical - the skin reacted the most to the highest concentration.

Mantoux reaction - a technique for analyzing the severity of immunity to a pathogen serious illness– tuberculosis. Hence other names: tuberculin diagnostics, tuberculin test. The diagnostic test is carried out annually in kindergartens, clinics and schools.

For many parents, the study raises many questions. Passions are fueled by stories about the optionality of diagnosis and the fashion for refusing vaccination. The material will help parents understand why it is important to conduct a tuberculin test and whether there are contraindications. Find out more about what is normal and pathological in the Mantoux reaction.

General information

A special test confirms or denies the presence of tubercle bacilli in the body. Tuberculin administered intradermally indicates the presence of a pathogen of a serious disease. Analysis of the reaction to the drug gives the answer: whether Koch’s bacillus is in the body or not.

The essence of the method:

• extract based on mycobacterium tuberculosis containing auxiliary components, administered intradermally;
• after carrying out the Pirquet diagnostic test, a papule appears at the injection site - a thickened area of ​​skin, redness appears;
• in some children the reaction is weak, the papule is practically absent or barely noticeable. In some cases, the red, swollen spot grows to 15–17 mm or more;
• 72 hours after the tuberculin test is performed, the doctor monitors the body’s reaction. The doctor examines the injection site, checks the thickness of the epidermis at the injection site, and uses a transparent ruler to measure the size of the papule. In the absence of compaction, the diameter of the reddened area matters;
• Based on the results of the diagnostic test, the doctor writes down the size of the papule and the nature of the reaction in the young patient’s card. If the norms are violated, the doctor writes a referral for examination to an anti-tuberculosis dispensary.

Why is a sample needed?

In countries where tuberculosis is a national problem, a tuberculin test is mandatory. The technique allows you to effectively control dangerous infection, monitor the dynamics of the spread of the disease.

The Pirquet reaction is needed to solve certain problems:

• active identification of primary infected patients;
• diagnosis of tuberculosis in patients in whom Koch's bacillus is detected, but not visible signs serious illness;
• confirmation of diagnosis for suspected tuberculosis;
• identification of patients who were infected a year ago or more. An enlarged papule and active redness were noted;
• selection of children aged 6–7, adolescents aged 14–15 years for mandatory revaccination against dangerous disease– tuberculosis.

Mantoux reaction: vaccination or not

Many parents call the tuberculin test a vaccination, but in fact it is not:

• Vaccination produces immunity against a specific pathogen. After vaccination, the child receives protection for a certain period of time. Revaccination is often required to maintain specific immunity for a longer period of time;
• The Mantoux test is a diagnostic test with the help of which the body’s reaction to the lysate from Mycobacterium tuberculosis is visible. The more active the redness is, the larger size papules, the higher the likelihood of having a tuberculosis bacillus in the body.

Norm and deviations

The nature of the reaction during a diagnostic test:

• negative. There is no infiltration, the injection site is marked with a dot up to 1 mm;
• doubtful. With this form, the papule grows from 2 to 4 mm. The second option is that with redness of any size there is no seal;
• positive Mantoux. The injection site turns into a papule with a diameter of 5 mm or more. Manifestations can be weakly positive - the papule reaches 9 mm, medium intensity - 14 mm, well-defined - diameter from 15 to 16 mm;
• strongly expressed– in this case, the infiltrate reaches 17 mm or more;
• dangerous, vesicular-necrotic. Dead areas appear at the injection site, daughter dropouts and pustules appear nearby, and nearby lymph nodes become enlarged.

When a child is sent for examination to a tuberculosis clinic

You should not panic if you have a questionable or mild (moderate) reaction to tuberculin. When assessing the results, doctors take into account the time that has passed since the last BCG vaccination.

Landmarks:

• a year after BCG vaccination. Acceptable values ​​are from 5 to 15 mm. Induration, redness are manifestations of post-vaccination immunity;
• two years after vaccination. The infiltrate during the Mantoux reaction should be smaller or remain at the same level. If the papular formation increases by more than 5 mm, severe redness requires additional examination to exclude infection with Koch's bacillus;
• three to five years after introduction BCG vaccines. After this period, the maximum permissible papule size is no more than 8 mm, optimally up to 5 mm. At good immunity Many children experience a negative reaction: after a couple of days, only a dot is visible at the injection site. Swelling and redness are practically absent. If the infiltration increases, the doctor will write a referral for examination to an anti-tuberculosis dispensary.

What factors influence the final result?

The following factors often distort the response to tuberculin administration:

• hemodialysis;
• real immunodeficiency;
• chemotherapy for various tumors;
• errors when performing a diagnostic test;
• use of low-quality tools;
• violation of tuberculin transportation/storage parameters.

You should not panic if there is a positive Mantoux reaction. Doctors never diagnose tuberculosis based solely on a tuberculin test. Wanted additional research: sputum collection, radiography chest, finding out the timing of BCG vaccination.

Indications

The Mantoux test is required for all children aged 1 to 17 years. It is important to consider absolute and relative contraindications.

Doctors recommend doing a tuberculin test for all children who have no restrictions for the test. The Pirquet reaction is the most reliable method for identifying the body’s reaction to the presence of the tuberculosis bacillus. For this reason, over a hundred years the drug (tuberculin) has not undergone fundamental changes.

Contraindications

Tuberculin is safe for children: no living microorganisms, minimal dosage, no effect on immunity. Despite this fact, there are limitations to the study.

Important point! The child recently suffered from an acute respiratory viral infection, a cold, etc. infectious disease? Has a group or class been quarantined due to a contagious disease? A diagnostic test for identifying tuberculosis pathogens is permitted one month after the quarantine is lifted/the disappearance of all clinical signs pathology.

Please note the contraindications:

• allergic reactions in children, especially 4–6 years old, with a weak immune system;
• epilepsy;
• infectious, somatic diseases (acute plus chronic form) with pronounced clinical symptoms;
• dermatological diseases;
• age under 1 year (distorted reactions, inaccurate/unreliable answer).

This is a list that all parents should know: performing the Pirquet test at the wrong time, in the presence of restrictions, often gives wrong result. Parents and their child are forced to visit the tuberculosis clinic at certain intervals, conduct repeated examinations, and the reaction, in fact, is false positive. For example, not everyone knows that allergies + weak immunity In children, the size of papules on the arm often increases.

There is a page written about massage for dacryocystitis in newborns.

At the address, read about the rules of use and dosage of Orvirem for children.

Vaccinations and Mantoux: how to combine

Parents should know certain rules and monitor whether doctors observe the interval between vaccination and tuberculin test. A certain period is needed to restore immunity sufficient to combat microdoses of inactivated and live vaccines. Intervals are needed to eliminate the mutual influence of two stimuli.

Basic rules:

• It is prohibited to perform the Pirquet test and vaccinate. At high load on immune system False-positive reactions are often observed;
• after assessing the results of the Mantoux reaction (in the absence of indications for referral to a tuberculosis dispensary), vaccination is allowed the next day;
• deadline is approaching routine vaccination? After vaccination against tetanus, influenza, diphtheria using killed vaccines, the interval until the next Pirquet test is 4 weeks or more;
• After vaccination with live vaccines (rubella, mumps, measles, OPV), wait 6 weeks or more with a tuberculin test.

How is the diagnosis carried out?

Carrying out a test for tuberculosis takes little time and does not require special preparation from children and parents:

• tuberculin is injected with a special syringe into a specific area - middle third forearms, from the inside;
• the needle is inserted intradermally to a minimum depth;
• dose volume for intradermal administration is 0.1 ml, which is 2 TU (tuberculosis units);
• after the injection, a lump appears under the skin - a papule. The test site turns slightly red, the compacted area rises slightly above the skin.

What you can do after the test and what you can’t do

The child and parents must follow certain rules:

• Before testing, you should not wet the area where the sample was placed. Did the child forget about the warning and accidentally wet his hand? Be sure to tell your doctor about this, especially if the spot has increased sharply after the incident;
• It is forbidden to rub, comb, scratch the infiltrate;
• Do not heat or smear brilliant green or hydrogen peroxide on the papule and the hyperemic (reddened) area;
• It is forbidden to cover the injection area with an adhesive plaster or bandage it;
• It is important to wear clothes made from natural fabrics that do not irritate the skin of the forearm. Be sure to wear a flannel, knitted or cotton blouse under a woolen sweater for your child;
• Do not press or frequently touch the papule and the hyperemic area.

Do not be afraid of performing the Pirquet test on a child: the drug is safe for a growing organism. Annual tests show full picture about the presence of tuberculosis bacillus, reflect the dynamics, speak about the strength of the immune system. In case of deviations from the norm, strictly follow the doctor’s instructions, and be sure to conduct an additional examination in a specialized institution.

Timely visit to the TB dispensary for diagnosis dangerous disease will prevent serious consequences. Remember: It is easier to identify and prevent the development of pathology than to treat the complications that patients face with advanced tuberculosis.

More interesting information about Mantoux in a child in the following video:

The annual Mantoux test is a common procedure for all children. This injection is not a vaccination; it serves completely different purposes. Mantoux is a test that tells the doctor how the child’s body reacts to the antigen of the pathogen. The procedure also helps diagnose tuberculosis or evaluate the results of treatment. How to properly prepare for the test, and what is included in the preparation? Let's consider what rules exist for assessing the results of a tuberculin test, and in what cases a consultation with a pulmonologist or phthisiatrician is necessary.

Why is the Mantoux test needed and when is it performed on children?

Every newborn in the maternity hospital is vaccinated against tuberculosis - the vaccination is called BCG (more details in the article:). In the absence of contraindications, the child is revaccinated at 7 and 14 years of age. However, there is no 100% guarantee that a vaccinated baby will not become infected with tuberculosis. This insidious disease It is best to stop it at an early stage; therefore, children need to undergo a preventive test once a year - the Mantoux test, which will help identify the disease. The injection is given one year after vaccination and is repeated regularly every 12 months until age 15.

You should not refuse this research - it does not pose a threat to the child’s health. For examination of children over 15 years of age and adults, Mantoux is not used, but fluorography of the lungs is indicated. This procedure helps to identify foci of tuberculosis in the respiratory organs, since it is in them that the first signs of the disease are most often found (we recommend reading:). Unlike Mantoux, fluorography is not so harmless, since it gives a certain radiation load to the body.

Sample composition

The drug contains several components and the main one is tuberculin. This substance was obtained by the German physician and bacteriologist Robert Koch at the end of the 19th century. Old tuberculin (or alttuberculin) contains an extract (lysate) of two types of mycobacteria, which are the causative agents of tuberculosis. These microorganisms are pre-inactivated by heat treatment.

However, in addition to the lysate, this substance contains a lot of foreign impurities. Today ATK is almost never used; instead, Seibert's tuberculin is used in Europe, and Linnikova's tuberculin is used in our country.

IN modern analogues a minimum of foreign impurities due to additional purification of proteins from the environment in which the bacteria were cultivated, so it is easier for the doctor to correctly assess the body’s reaction to this drug. It includes:

• tuberculin;
• phosphate buffer solution;
• sodium chloride;
• polysorbate 8;
• carbolic acid.

Rules for conducting the Mantoux test

In children's clinics there are regulations according to which the test is performed. As a rule, in vaccination room a schedule has been worked out according to which the injection can be given. For example, on Monday all patients are given a test, and on Thursday the Mantoux results are assessed. The test is given to children who, from the moment last sample a year has passed, as well as for those who need BCG vaccination or revaccination.

However, the tuberculin test has contraindications - Mantu is not given to children:

• during acute infectious diseases;
• during exacerbation of chronic diseases;
• in the presence of skin ailments;
• for allergic conditions;
• with bronchial asthma.

The Mantoux test has its contraindications, so the child should be examined by a pediatrician

Is preparation necessary for a tuberculin test and how is the vaccine given?

No preparation is required for the procedure - it is performed healthy child, who has permission from the pediatrician. The doctor examines the patient, asks the parents about how long the baby has been sick, and whether he has been vaccinated during last month. If the answer is yes, you should wait a while with Mantoux - tuberculin can cause atypical reaction body. If there are no obstacles to the procedure, the doctor indicates this in the baby’s card and sends the patient to the manipulation room.

To carry out the procedure, only 1 ml of the drug is required, which includes two tuberculin units (2 TU - designation standard dose). Next, in the vaccination room, the nurse draws the drug into a disposable syringe and injects it subcutaneously in the area inner surface forearms. After this, the patient can lead a normal life.

What is a papule and how is it cared for?

Normally, after the injection, there remains visible point from the injection, and only the next day may skin hyperemia and thickening appear. A round, slightly convex mark at the site of Mantoux injection is called a papule, popularly called “button” (see photo). In order for the results to be assessed correctly, the following rules must be followed for several days after the procedure:

• you should not scratch the “button” so as not to increase the area of ​​hyperemia;
• It is not recommended to treat the sample with antiseptics;
• tape or bandage, thereby depriving air access;
• Previously, it was believed that the injection site should not be wet, but today pediatricians are not so categorical, many of them recommend not to refuse bathing after the test.

Doubtful Mantoux reaction in a child

What is the difference between Mantoux and Pirquet's test?

The analysis developed by Clemens Pirquet has the same goal as Mantoux - early detection infection with tuberculosis bacillus. However, Pirquet is carried out using a different technology. This test, unlike the Mantoux reaction, is not subcutaneous, but cutaneous, and evaluation of the results has its own nuances. Due to the fact that the skin is damaged, it is not recommended to wet the area on which the tuberculin composition is applied. The procedure has the following features:

• the patient’s forearm needs to be prepared and treated with a special mixture – phenol with carbolic acid;
• then miniature incisions are made on the skin (0.5 mm deep), into which a drop of ATK (Koch's alttuberculin) is applied;
• the result is assessed after 48-72 hours, focusing on the size of the skin swelling at the incision sites.

How and when is the size of a papule measured?

The results after the tuberculin test are assessed after 72 hours (3 days). If the child was not examined by a specialist in time, this can be done within a week after the injection - the readings will be close to reality. Determination of the diameter of the papule or hyperemia is performed by a nurse (doctor) using a transparent ruler, and the results are recorded in the child’s card.

It is very important to keep an annual Mantoux record, according to which the doctor can see the dynamics of the results and judge possible infection.

Variants of reaction to the sample in the table

Mantoux results may be as follows:

If there is a papule on the forearm, measure its width - the diameter perpendicular to the axis of the arm. If there is only redness of the skin (without thickening in the center), measure the size of the hyperemia. Sometimes Mantoux looks different - a papule appears on the forearm, around which there is a circle of larger diameter reddened skin. In this case, only the inner diameter of the ring is measured, that is, the width of the “button” is taken into account.

Evaluation of Mantoux results

If the child negative result- there is no hyperemia and papules, which means his body is not familiar with mycobacteria that cause tuberculosis. This happens if the baby is not given BCG for some reason. However, such a response from the body also indicates that the child will not be able to defeat the infection that enters the body. In this regard, children with a negative reaction are subject to observation; they are shown another Mantoux test after six months to a year. Then you need to do BCG or revaccination.

A positive reaction of the body to the injection (if redness of the skin and papule appears) means that the child has already had contact with mycobacteria. However, this does not mean that he has tuberculosis. If the size of the redness around the injection site falls within the normal range, this is good sign- this indicates that the immune system is formed and is able to fight infection that may enter the body.

When interpreting the results special attention is given to children who have developed too much strong reaction for injection – “hyperergic”. These include patients with a “button” size of more than 17 mm, as well as those who have developed blisters, ulcers, or enlarged inguinal lymph nodes. This eloquently indicates the tension of anti-tuberculosis immunity, which means it may be a consequence of the presence of the disease or the systematic entry of infection into the body. If the test results do not fit within the normal range, the child should be examined by a TB specialist.

If the Mantoux test result is not negative, the child should be examined by a TB specialist.

Acceptable sample values ​​for children of different ages in the table

When analyzing the Mantoux results, the diameter of the papule and the age of the child, or more precisely the period elapsed after BCG vaccination, are important. To find out in more detail the acceptable parameters of the tuberculin test in children of different ages, All possible options and we summarized their decoding in a table:

Age, years	Normal papule diameter, mm	The result is questionable, mm	High likelihood of contracting tuberculosis
1	5-15	15-17	17 and over
2	Reduced or same diameter	Increasing the diameter of the “button” by 1-5 mm	Increase in size by 5 mm or more
3-5	Downsizing. Diameter no more than 8 mm	Increase by 3-5 mm	Increase in size by 6 mm. Reaching 12mm diameter
5-7	Decay of the body's reaction to 1-5 mm	Seal size 5-6 mm	Seal diameter more than 6 mm

From 7 to 14 years, after the second BCG vaccination, disease control continues. At 8 years old, parents should not worry if the diameter of the seal is 10 mm, at 9 years old - 16 mm.

From 10 to 14 years of age, the size of the “button” gradually decreases. At the age of 15 the only normal reaction becomes negative.

What can affect the Mantoux reaction?

Not always large size skin hyperemia indicates tuberculosis, enhance skin manifestations there may be other factors. Distortion of results is possible in the following cases:

• the patient has recently had close contact with a person who secretes tubercle bacilli;
• the day before the papules were measured, the child ate allergenic foods that could cause increased sensitivity the body to any pathogens;
• if the papule is combed, soaped and rubbed with a washcloth, its size may be greatly increased.

To a lesser extent, the following factors can influence the Mantoux result:

• improper storage of the drug or violation of transportation conditions;
• errors in measuring Mantoux papule;
• some chronic diseases;
• exposure to skin allergens ( washing powder, fabrics with the addition of synthetics);
• humidity and high temperature indoors;
• some medicines;
• violation of injection technology.

If the button is not properly cared for, the sample evaluation may give false results.

If there is a suspicion that one or more of these factors has occurred, a repeat injection is given. It is best to give the injection in the other hand so that the result is correct. Some experts recommend preparing for the procedure by purchasing antihistamine- it must be taken within three days after the injection in case the child is allergic to Mantoux.

Sample turn principle

Doctors have a term - “Mantoux turn”. It means that the test result has changed for the worse, which is one of the obvious signs presence of disease. The following options are possible:

• the patient had a negative reaction to the test, and a year later – a positive reaction;
• the size of the papule has increased by more than 6 mm compared to the previous sample;
• the diameter of the papule is 12 millimeters or more, if more than 3 years have passed since vaccination.

Such patients are sent for consultation to a TB specialist. The doctor carries out a set of measures that will help identify the disease - listens to the child, prescribes a chest x-ray, and gives directions for a number of tests. If the examination does not show the presence of the disease, the phthisiatrician may suggest taking a course preventive treatment– take Isoniazid or other drugs intended for the treatment of tuberculosis for a month.