Large sample of mantu. Mantoux reaction: what result is considered normal

Administered for the first time in one year. This procedure is necessary for the rapid detection of tubercle bacilli, a deadly pathogen. 3 days after the manipulation, the Mantoux reaction is studied. The norm in children depends on age. It is assessed visually. The main thing is the size of the papule.

What should be the normal Mantoux reaction in children?

After the first tuberculosis vaccination, immunity from this deadly disease does not disappear for 7 years. How long the protection against a dangerous pathology will last can be judged by the size of the rounded scar remaining on the shoulder after vaccination. The larger this size, the longer a person remains vaccinated against tuberculosis.

The reaction to Mantoux appears after the injection the next day. It looks like a small papule at the sample injection site. 3 days after the injection, the immune system reacts to the “invasion” of tuberculin with maximum force.

The Mantoux norm varies depending on the age of the baby:

Norm Mantoux, made for the first time at 1 year

For the entire year before the second test, almost all children’s reaction to tuberculin can be called questionable or positive. For yearlings with a post-vaccination scar, redness is considered normal if its diameter is in the region of 5-11 mm.

The photo shows what the first Mantoux looks like:

Normal for children from 2 to 6 years old

In the 2nd year, anti-tuberculosis immunity is usually strongest. When the size of the post-vaccination scar exceeds 8 mm (that is, what it should be when the baby is 2 years old), then Mantoux can easily reach as much as 16 mm. When a child is over three years old, immunity to tuberculosis begins to weaken. However, in most cases, a positive or questionable reaction to tuberculin persists at 4, 5, and 6 years of age. During this period, the normal size for a papule is a maximum of 10 mm. To accurately determine which parameters are optimal at this age, you should compare it with the post-vaccination tuberculosis trace.

At 6-7 years old

The reaction to the test performed in the vast majority of cases can be called questionable or negative. This is a sign that immunity to tuberculosis is beginning to disappear. That is why at the age of 7 all children receive a second anti-tuberculosis vaccination.

Normal for 7-14 years old

After revaccination, a new 7-year cycle begins. At the age of 3 to 10 years, the child has good reliable immunity against tuberculosis, and the size of the papule is between 10-17 millimeters.

When the baby becomes more than 10 years old, the immune response to the tuberculin invasion begins to weaken, and the papule decreases to 5.0-6.0 mm. At 13 years old, the absence of any reaction or the presence of a questionable one is already the norm. The papule during this period is maximum 4 mm. By the age of 14, it often disappears completely.

Post-vaccination immunity

Table of differential diagnosis of post-vaccination immunity and infection

Years	Magnitude
	Scar after BCG, mm	Papules, mm
		immunity after vaccination	unknown factor	presence of infection
1	6,0-10,0	5,0-15,0	16,0	17.0 and above
	2,0-5,0	5,0-11,0	12,0-15,0	16.0 and above
	absent	doubtful	5,0-11,0	Above 12.0
2	Doesn't matter	Nothing has changed or there has been a decrease	An increase of 2.0-5.0 in the case of the previous result, which is interpreted as positive	Increase by 6.0 or change to positive
3-5	Doesn't matter	Maximum 5-8. Reduction in size	There is no direction to decrease or there is an increase of 2.0-5.0	Growth by 6.0; 12.0 if the test is done for the first time, or a change to positive. Or change to 2.0-4.0 and reach 12.0
6-7	Doesn't matter	The reaction fades to a dubious interpretation or negative	5,0	6.0 and more

Reasons for distorting the result

A number of different factors can distort the results of an injection (both positively and negatively). The culprits may be:

• chronic functional and organic diseases of internal organs and body systems;
• various infectious pathologies, especially colds with high fever. The Mantoux result can also be distorted in a healthy child who has recently suffered from some infectious disease;
• allergies of various natures. It is especially dangerous to test children who are intolerant to tuberculin;
• dermatitis and other skin diseases;
• liquid entering the place where the Mantoux test was placed. Even a very small amount of water can cause an allergic reaction and distort the result;
• unfavorable environmental situation in the region where the person who received Mantoux lives;
• various diseases whose main symptom is epileptic seizures;
• a period of quarantine due to a pandemic of a virus (for example, a strain of influenza);
• low quality of the drug, use of an expired sample;
• improper storage and transportation of the sample;
• the test was carried out with violations - they used a non-disposable syringe, did not treat the skin where the injection was made with alcohol.

Thus, severe swelling at the site where tuberculin was injected, or, conversely, a complete absence of swelling, is not a guarantee that the child has Koch’s bacillus or not. To find out for sure, more in-depth research and analysis will be required. The Mantoux reaction is just one of the methods by which it is determined whether there is a dangerous pathology in the body.

What to do in case of deviations?

If the papule is larger than the norm in children, the phthisiatrician usually prescribes an additional study using Diaskintest. This method is considered more reliable, accurate and safer than the Mantoux test. It is completely safe for allergy sufferers. In addition to Diaskintest, it is also advisable to do a blood test.

Additional diagnostics are especially important if a hyperergic reaction is observed after the test (when the papule is larger than 17 mm). This is a serious sign that the baby has mycobacterium tuberculosis. A child with a hyperergic reaction will have to be placed in a tuberculosis clinic for an in-depth examination. There, the baby will definitely undergo fluorography and other necessary diagnostics.

If the Mantoux test result is positive, but not clearly expressed, the child, after additional diagnostics, is registered at a tuberculosis dispensary. He is also prescribed Isoniazid.

A phthisiatrician usually prescribes a preventive course of treatment even for those children whose tests are questionable, that is, it is impossible to say for sure whether they have Koch’s bacillus or not.

Conclusion

The Mantoux test measures how the immune system reacts to tuberculin, fragments of tuberculosis bacteria that have been specially treated and sterilized at high temperatures. This test has been effectively used in diagnostics for many decades. It allows you to identify the tuberculosis bacillus at the very first stage of its introduction into the body and prevent the further development of a dangerous disease.

Many parents are interested in the question of what Mantoux reaction is normal in 1-year-old children. Their excitement is understandable, because at this age the first Mantoux is made for children. Why is the Mantoux test needed at 1 year of age? Carrying out this procedure is very important for the baby, as it allows you to control the presence of mycobacteria in the body, which are the causative agents of such a terrible disease as tuberculosis. The features of the Mantoux test for one-year-old children will be discussed further.

The Mantoux test at 1 year of age is not done by chance. The fact is that it is useless to do it at an earlier age. In a child under 1 year of age, the immune system is still very unstable. Accordingly, it is impossible to predict her response to the given test, since the probability of a false reaction is very high. In addition, in the first days of life, the child is vaccinated with BCG. One of the main goals of performing the Mantoux test at 1 year of age is to monitor how the child develops immunity to tuberculosis after vaccination. The first such control is carried out a year after vaccination and then repeated every year.

In addition to the above purpose, the Mantoux test is also performed in order to:

• identify children who do not respond to the test in order to vaccinate them in the future;
• identify cases of pronounced reactions that indicate that the child needs a more in-depth examination for tuberculosis.

If vaccination with BCG has been postponed, then the Mantoux test is performed later and is done every 6 months. In cases where there are people in the baby’s immediate environment who are infected with Koch’s bacillus, the frequency of testing also increases.

How to prepare your baby for Mantoux

The Mantoux vaccination is considered harmless to the child and relatively painless. However, in a child with an unformed psyche, this procedure can cause serious psychological shock. Therefore, you need to make some preparations for Mantu so that everything goes smoothly.

In order to be well prepared for vaccination, it is recommended:

• tell the child about the upcoming procedure in an accessible form, explaining why it is needed;
• play with your child in the hospital, simulating various medical procedures using play medical kits;
• never scare your child with doctors, the hospital and what they can do to him there;
• do not show your excitement to the child, emphasize with all your appearance that this procedure is a completely ordinary event;
• immediately before and during the test, constantly provide the child with all possible psychological support, showing your care for him.

In addition to the psychological aspect, preparation for Mantoux should include ensuring the child’s normal nutrition, walks in the fresh air and a favorable emotional background, so that by the time of the procedure he is absolutely healthy and in a good mood.

Following these rules will help your child overcome his fear of injections, which can greatly simplify visits to medical institutions in the future.

Carrying out Mantoux and caring for the child after it

The Mantoux test is performed by injecting a small amount of tuberculin, a drug containing neutralized fragments of tuberculosis pathogens, under the skin. The injection is made on the inside of the forearm. During the Mantoux procedure, the child should be in a sitting position.

After Mantoux is performed on a child, to ensure maximum accuracy of the result, the following rules must be followed:

1. The injection site should not be wet. This is the main thing that should not be done after the injection. You are also prohibited from bathing, showering or visiting a sauna. But this does not mean that you do not need to follow the rules of personal hygiene at all.
2. Do not bandage or cover the injection site with a band-aid.
3. There is no need to let the child scratch in the place where the test was taken and in the surrounding area. It is necessary to divert his attention from this in every possible way.
4. Children should not be allowed to come into contact with pets.
5. Do not give your baby citrus fruits, as well as red-colored vegetables and fruits.

These restrictions must be in effect for three days from the date of the test. This is exactly the period of time that must pass before its results can be assessed. After the doctor fixes it, the sample site can be treated with hydrogen peroxide or covered with brilliant green.

Evaluation of the Mantoux result in children 1 year old

The result of the Mantoux test is determined by examining the injection site. Usually there is redness and a papule that resembles a button forms. The doctors' conclusion depends on its size. The more immune cells are familiar with the causative agent of the disease, the more pronounced the reaction will be. The diameter of the papule should only be measured with a transparent ruler with a centimeter scale. The redness that occurs around the papule is usually ignored. It is taken into account only in cases where the papule is absent.

There are such types of Mantoux reaction:

• negative - there is no redness or papule at the injection site;
• doubtful - there is redness, but no papule. The diameter of redness is from 2 to 4 mm;
• positive - there is both redness and a papule. The seal size is from 5 to 10 mm.

There is also a type of Mantoux reaction, which is called a false positive, when the test gives positive results, but in fact there is no pathogen in the body. This reaction occurs in cases where there is infection with a mycobacterium of another species, or when the rules for testing are not followed.

To understand what the Mantoux reaction should be in 1 year, the size of the papule is also compared with the size of the scar that appears on the skin after BCG vaccination.

Options for interpreting such a comparison for children aged one year are shown in the table below:

BCG scar size	Papule diameter from Mantoux
	Reaction to the vaccine	Unclear reason	The child is infected
From 6 to 10 mm	From 5 to 15 mm	16 mm	Over 17 mm
From 2 to 5 mm	From 5 to 11 mm	From 12 to 15 mm	Over 16 mm
No scar	From 2 to 4 mm	From 5 to 11 mm	Over 12 mm

Thus, the Mantoux norm in children is displayed in the second column. With the indicators displayed in the last column of the table, the patient is referred for a more in-depth examination for tuberculosis.

It should be borne in mind that a negative reaction in a one-year-old child does not mean that Mantoux is normal. If it is observed in a previously vaccinated baby, then the vaccination did not give results and there is still no immunity to the tuberculosis pathogen. A negative reaction becomes the norm only after 4 years.

You can find out in more detail what Mantoux should be per year by contacting a phthisiatrician. He can talk about this taking into account the individual characteristics of the baby.

What you need to know about the effects of Mantoux in children 1 year old

Despite the fact that Mantu is considered a safe event, its implementation can have certain negative consequences.

These include:

1. Low accuracy of the sample result. Because of this, the patient may be prescribed additional procedures, in particular, fluorography, which does not have the best effect on the child’s body. In addition, due to a distorted test result, therapy may be prescribed that is actually not necessary.
2. Poor quality of the drug. It is primarily affected by storage and transportation conditions. The manufacturer of the medicine also plays an important role. The use of such a remedy also leads to a distortion of the result with all the negative consequences. If there are any doubts about its quality, three days after administration, the test must be repeated in another medical institution. This will avoid unnecessary treatment.
3. Individual intolerance to the components of the drug. It can cause allergies, which can also be misinterpreted as a positive test result.

Children as young as one year of age are very sensitive to various chemical compounds and additives. Many parents are concerned about phenol, which is used in the tuberculin preparation as a preservative. Sodium chloride is also not tolerated equally by everyone.

Therefore, the Mantoux test is not performed on one-year-old children in the following cases:

• in the presence of skin diseases;
• in cases of infectious diseases, especially in the acute stage, or if the child suffered them less than two weeks before the procedure;
• proneness to allergies;
• for rheumatism, asthma and epilepsy;
• for problems with immunity.

Parents should also keep in mind that Mantoux can also cause side effects. The possibility of developing allergies has already been mentioned above.

In addition, the following may occur:

• temperature increase;
• general weakness;
• skin rash;
• digestive disorders;
• cough.

Knowledge of contraindications and possible side effects is mandatory for every parent. If available, the Mantoux test can be abandoned. Currently, there are a number of alternative methods for diagnosing tuberculosis. Instead of the Mantoux reaction, you can do a Diaskintest or a blood test for tuberculosis.

The Mantoux test has become an important part of pediatric diagnostics - almost everyone is required to undergo a test to assess the level of immunity to tuberculosis. After the Mantoux test is performed, it is evaluated - and on the basis of all this, certain conclusions are drawn. But what is the norm, what size should you focus on? Which is better, 7, 10 or 12 mm? It’s worth understanding this - although the child’s reaction is assessed by a professional doctor, it will never be superfluous to at least roughly navigate this.

How to behave?

In order for a child’s Mantoux size to be objective 72 hours after placement, it is necessary to adhere to a number of specific rules:

• Contrary to rumors, it is possible to wet Mantu, but you should refrain from going to baths and swimming pools.
• The injection site should not be scratched, rubbed, or physically affected by any other method.
• Do not cover the injection site with adhesive tape.
• Do not smear the injection site with brilliant green, iodine or peroxide.

If these criteria are met, the indicators will be quite objective, reflecting the real situation .

How is the sample taken?

To measure the Mantoux test readings in a child, do the following:

1. They examine the injection site to assess how the child’s reaction is proceeding, whether there is hyperemia and swelling.
2. The skin is felt at the injection site to assess its thickness.
3. Next, they move on to directly assessing the size of Mantoux by measuring the compaction with a transparent ruler. If there is no seal, then the redness present at the injection site is measured instead.

Norms

What size is considered normal? The first injection of tuberculin is given as early as a year; if done earlier, the final result will be distorted, the reaction will not give a sufficiently objective understanding of whether there is immunity to the disease or not. But after this, when the child is already one, two or more years old, conclusions can be drawn by changing the size of the area. And there can be three results.

• Negative is when only the injection site is visible in the child, or nothing is visible at all, basically not visible, or when only the injection site is visible, approximately the diameter of a dot, no more.
• Doubtful - when the papule that appears at the injection site has a diameter of 2-4 mm or when there is only redness, but there is no dense formation in the form of papules at all. In this case, the result is uncertain.
• Positive - in this case, the papule and/or other reaction varies between 5-17 mm.

A positive result in a child can be divided into several subcategories:

• Medium - when the reaction is 5-7 mm, the maximum size will be 9-10 mm.
• Intense – when the reaction is 10-12, maximum 14 mm.
• Pronounced - when the reaction is more than 15 mm.

In some cases, the Mantoux reaction in a child exceeds 17 mm (or 21 after 18 years/at any adult age), and characteristic blisters appear in its area, lymph nodes enlarge, or a necrotic zone appears. This is called a hyperergic reaction, it is maximally pronounced, and is no longer the normal course of events.

Criteria for evaluation

It is not enough just to know what the actual sample size is; it is also necessary to understand what evaluation criteria are available in principle. Remember that a negative test is only available in cases where there is no immunity to tuberculosis. If your baby has already been vaccinated with BCG, but the reaction to tuberculin has not manifested itself, it is recommended to vaccinate again.

The first Mantoux test can be quite large, comparatively more significant than a regular sample. After two years from the date of vaccination, it must certainly be positive, for example, 12 mm, this is the norm, which indicates that the baby’s body responded normally. Please note that there must be a small scar at the injection site. If it is absent, although the Mantoux reaction is generally positive, this indicates that the body is seriously infected.

Gradually, over the years, the size of the infiltrate at the injection site should decrease slightly - the first decrease (for example, from 12 to 10 or more) is noted after two years. By the age of seven, it gradually disappears entirely - and just at seven years they re-vaccinate. But if the papule completely disappears, this indicates that an infection has occurred, which is a negative sign that people pay attention to.

In general, if a year has passed since the tuberculosis vaccination, and the size of the seal is still 5, 10, 12 or even 15 millimeters, this is the norm. The problem only arises when the indicators over the course of years become more than 17.

Turn

While the actual Mantoux test numbers are important, what is also important is how they change over the years. In some cases, Mantoux may perform a so-called turn during the years. These are situations when:

• Previously, the results were a maximum of 5 mm - and suddenly the Mantoux test suddenly became positive.
• Over the course of a year, there was an increase or decrease in the sample by more than 6 mm.
• More than 4 years have passed since BCG, but the size of the papule still exceeds 10-12 mm.
• The diameter of the general infiltration zone is quite large; the size of the reaction is more than 17 mm.

If this occurs, then it is imperative to draw the attention of your attending physician to this fact. There is a possibility that you may need to visit an anti-tuberculosis dispensary. so that the child’s problem is resolved in an effective manner.

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Mantoux vaccination– very important in determining the child’s health status. It should not be carried out until one year of age, since the baby’s skin is still too sensitive. When a Mantoux vaccination is given, the body’s reaction is checked by looking at the area of ​​redness around the injection.

In small children under one year old, the skin may react too strongly to the injection of tuberculin and give the wrong result. Therefore, children under one year of age are not given Mantoux vaccinations; it simply does not make sense.

What is Mantoux and how often does it need to be vaccinated?

In the future, this vaccination is given every year until the age of 14. In fact, injection of tuberculin is not a vaccine against the disease. This is a test that shows whether the child’s body has developed antibodies to the causative agent of the disease - Koch’s bacillus.

By vaccination, Mantoux checks the state of the bacillus in the body, which can begin to develop when immunity falls and develop into an open form of tuberculosis, as well as the state of immunity in general. If the reaction is within normal limits, parents do not have to worry about the child’s health.

Let's look further at how many centimeters are considered normal, and whether it is possible to understand at home that the child does not have the disease.

The introduction of the vaccine, that is, the real vaccination, is BCG, which is given in the forearm. 1 year after the vaccine is administered, Mantoux is given to find out what the body’s reaction is to the BCG vaccination. And so on until the period of growing up every year.

If for some reason BCG was postponed, then the Mantoux test is done every 6 months to monitor the formation of immunity.

By the age of four, the number of tests per year increases to 3 times. If there are people around the child who can infect him, Mantoux can be done more often so as not to miss the onset of the development of the disease. If the baby has to undergo examination and treatment, Mantoux can be done as many times as the doctor prescribes. This may be more than twice a year.

If the child’s parents think that this is a vaccination, then such a quantity of Mantoux may make them want to refuse the administration of tuberculin. Adults will assume that the child’s body will be overloaded with bacteria.

In fact, mantu is considered not a vaccination, but a test, and if the doctor has prescribed it frequently, then it is necessary. You cannot miss the next Mantu and refuse it yourself. Only the attending physician will determine how many times it needs to be done and when to stop frequent tests and switch to the standard option once a year.

Nature and process of grafting

The test is administered by injecting a disposable syringe shallowly under the skin from the palm to the elbow from the inside on the surface of the child’s arm. Typically, such an injection is not too painful, so you need to talk to a child of a conscious age in advance so that he does not feel afraid of the vaccination.

After some time, a papule forms at the puncture site. After 72 hours, its diameter is measured with a ruler, and the obtained figures are used to determine the state of immunity and the activity of Koch’s bacillus in the body.

In order for the doctor to make a correct diagnosis, it is necessary to take certain precautions after the injection.

The injection site must be protected so that the size of the mantoux is true. Under no circumstances should it be wet. Therefore, showers and baths are canceled while waiting for the Mantoux reaction in a one-year-old child. You can wash your face, wash your legs and other parts of the body, but you need to be careful not to let water get into the grafting site.

You also need to avoid dirt and dust, so vigorous games in the sandbox are canceled for three days.

You should not scratch the papule or the area around it; you should avoid playing with pets so that their claws, tongue and fur do not get dirt into the skin puncture site. During these three days, until the doctor measures the red spot that represents the reaction, you need to take care of the child.

You should also not eat red vegetables and fruits, so as not to cause excessive redness, but you should not change your diet too much, so that this does not become a shock to the body and cause an unusual reaction to the vaccine.

Somewhere during the month when the vaccination should occur, there is no need to change the baby’s usual menu much. You just have to limit meat and dairy products a little. The rest of the menu should be in its normal state without sudden changes. Also, you should not put a band-aid on the injection site or apply anything on it.

If water accidentally gets on the papule, you need to honestly tell the doctor about it. If the red spot is large enough, the doctor may send you to a tuberculosis clinic for additional tests. To prevent this from happening, you must warn the doctor that it was not possible to protect the injection site. And then he will calculate the body’s reaction based on the diameter of the spot, taking into account the ingress of water.

After the doctor has examined, measured the spot and made conclusions, you can lubricate the hole from the injection with brilliant green, wait a little until it heals and then continue to lead a normal life for the baby. The Mantoux vaccination will not seriously affect his health.

Mantoux results

What size should a baby have for a negative reaction to tuberculosis? The Mantoux test and BCG vaccination are related to each other.

There may or may not be a scar at the site of the BCG vaccination. In medicine, they believe that if a scar appears, then the first one should show a positive result. In general, the first Mantoux vaccinations show the body’s reaction to BCG. Some time after vaccination, the vaccine takes root and the body produces a sufficient amount of antibodies.

If a scar does not remain at the BCG site, this means that the vaccine has not taken root in the child’s body.

In this case, Mantoux should not give results. And if it shows a positive result, it is necessary to inform the doctor about this, because such a situation may indicate infection of the body with Koch's bacillus.

In general, the Mantoux test at 1 and 4 years is very important, and special attention should be paid to its results.

The normal Mantoux reaction at 1-2 years of age is the absence of redness and thickening at all. If redness is present, then the normal mantu in children should not exceed a diameter of 1 mm.

A questionable reaction manifests itself in the form of clearly defined redness and swelling; the papule should not exceed 2-4 millimeters. Such a reaction may indicate an infectious attack on a child from an environment of infected adults. With such a reaction, they may be referred for examination to a phthisiatrician.

A positive reaction manifests itself in the form of redness and swelling of more than 12 mm. This manifestation of the body is beginning to be considered in conjunction with the BCG vaccination. If such a reaction manifests itself, a repeat Mantoux reaction may be prescribed after some time.

A hyperergic reaction manifests itself in the presence of ulcers or suppuration and may indicate that the child is infected. With such a reaction you need to go to the doctor.

A false positive mantoux reaction may also occur in a child if the injection site was dirty or water got on it. It is imperative to warn the doctor about such things so that he does not mistake the redness for a manifestation of infection of the body.

Thus, the reaction is divided into three categories: mildly expressed - in the form of redness up to 10 mm, moderately expressed - up to 13 mm, strongly expressed - in a red spot more than 16 mm.

If there is no reaction at all, the lump can be felt under the skin, especially in children under 3 years of age due to the characteristics of their skin.

In centimeters, the reaction indicator should not exceed one; all other indicators should be considered a deviation. A severe reaction is an indication to consult a doctor.

Possible consequences of Mantoux

Like any vaccinations and treatments, the test has its contraindications.

As a result of the administration of tuberculin, a very severe allergy and even anaphylactic shock can occur. To prevent this from happening, parents need to know the contraindications in order to warn the doctor if there is a need to do Mantoux. And then, if the vaccination is contraindicated, he will be prescribed other tests to find out the state of immunity.

So, the contraindications are:

1. skin diseases,
2. cold
3. infectious diseases
4. bronchial asthma
5. rheumatism
6. allergic reactions
7. epilepsy.

High background radiation, medications and individual susceptibility to the vaccine can enhance the reaction of the baby’s body.

As a result of an overly pronounced reaction to the test, the child may be sent for unnecessary treatment or fluorography, which, like X-rays, cause harm to the body. Therefore, parents, for their part, must do everything to ensure that the result is true.

There is also the possibility that the free Mantoux vaccination might not be of the highest quality due to improper transportation and storage of the drug. In this case, three days after vaccination, you can go to another medical institution, where Mantoux will be given again using a vaccine from another batch.

If the second result shows the same violent reaction as the first, this is an important signal that you need to go to the doctor for examination.

Thus, Mantoux should be abandoned only if it is really necessary. But you shouldn’t avoid vaccination just because of prejudice, because you might miss the onset of a serious illness.

In this article:

The Mantoux test is a diagnostic test that is aimed at determining the body’s sensitivity to introduced mycobacterial antigens. Antigenic complexes of the pathogen are contained in specific tuberculin. This substance is made synthetically and therefore is not capable of causing the development of tuberculosis. The Mantoux reaction, the rate of which depends on the age of the patient, should be carried out in accordance with the classic schedule.

The result of the study may vary depending on the individual characteristics of the organism. Therefore, there is no single answer for all age groups to the question of what Mantoux size is considered normal for children.

When is Mantoux made?

The reaction should be carried out in strict accordance with the schedule. Additional administration of tuberculin is resorted to only in case of special indications. Timely implementation is aimed at early determination of normality or pathology. It is very important to promptly screen children, since this category of the population is the most susceptible to tuberculosis.

Schedule for diagnostic tuberculin test:

1. The first test is carried out at 12 months. Tuberculin should not be administered earlier because the child’s immune system is not sufficiently developed and false-positive results are often observed.
2. Further, according to the vaccination calendar, the Mantoux test should be performed every year until the age of fourteen.

A special group consists of patients who were not given BCG according to indications, or who have a family member with tuberculosis. In the first case, the Mantoux test should be done 2 times a year. In case of contact with a patient with tuberculosis, diagnosis should be carried out 3 to 4 times a year.

It should be noted that at the age of over 18 years, this type of diagnosis is not very informative, so fluorography is included in the screening.

The tuberculin test is contraindicated in combination with vaccinations, as the results may be distorted. Often the Mantoux size is not normal in children due to the development of cross immunity to two or more vaccines given at the same time.

Is mantou harmless?

The test is based on the introduction of tuberculin, which by its structure is an antigen foreign to the human body. In this regard, as a result of this study, undesirable reactions from the immune system may be observed, as well as the development of an allergic reaction or deterioration in health.

In most cases, undesirable effects after tuberculin administration develop as a result of using a low-quality drug.

The risk of complications should not be a reason to refuse the test, since anyone can experience tuberculosis. This is why vaccination in childhood is so important.

Are there any contraindications?

This diagnostic method is not suitable for everyone.

The Mantoux test is contraindicated in the following cases:

• Inflammatory and purulent diseases of the skin.
• Acute or chronic diseases in decompensated form.
• Individual intolerance to the components of the drug.
• Respiratory diseases.
• Rhinitis.

After the elimination of an acute disease or compensation for a chronic form, vaccination can be carried out only 30 days after complete recovery.

At-risk groups

Who is most likely to have a positive Mantoux test?

The high-risk group includes:

• People who frequently come into contact with tuberculosis patients.
• Patients who have had this disease, but tuberculous changes are observed in the lung parenchyma or intrathoracic lymph nodes.
• Patients who have a pathological reaction to the introduction of the Mantoux test.
• Patients with chronic diseases of the respiratory system (chronic obstructive disease, asthma).
• Persons who do not have a permanent place of residence.
• Children aged 1 year whose Mantoux result is not normal .

Proper care

A normal Mantoux size in children can only be observed if the patient follows all the rules for caring for the papule.

1. It is contraindicated to moisten the injection site with water until healing (that is, within 1 hour from the moment the test is performed).
2. Do not rub the injection site.
3. Limit consumption of highly allergenic foods.
4. If a lump has formed, you should start taking antihistamines.
5. Do not cover the surface of the papule with a plaster, bandage or other means of protecting the skin.
6. Do not apply tanning products or creams to the surface of the papules.

Reaction

The reaction itself occurs due to an immune response to the introduction of an antigen into the child’s body. This process is ensured by T-lymphocytes that reach the site of the tuberculin test. As a result of their exposure, a skin reaction occurs in the form of slight hyperemia or papules.

A papule is a small lump that protrudes above the surrounding skin and is not accompanied by pain. The formation itself can have a different appearance: the papule can be of normal color or become hyperemic.

Such manifestations do not appear immediately. On the first day, only hyperemia can be observed. As a rule, the papule appears on the second or third day. The size of this manifestation directly depends on the presence of cells infected with Mycobacterium tuberculosis.

Not in all cases it is possible to focus on what the Mantoux reaction should be normally, since the immune system of each patient is individual.

Norms

Regardless of the presence or absence of Mycobacterium tuberculosis in the child’s body, during tuberculin diagnostics, redness and a papule appear on the skin. It is on their size that the results of the Mantoux norm depend. The permissible limits of their diameter when testing with tuberculin depend on the age of the child.

Mantoux norms in children by year:

• 12 months. At this age, a child's reaction can vary from 5 to 11 mm in diameter. This is because children are still exposed to the previously administered BCG vaccine. What the normal Mantoux should be per year is also determined by maternal immunity.
• When conducting a test on a child aged 2-3-4 years, Mantoux norms should correspond to a size of 5 to 10 mm.
• If all vaccines are administered as planned and the patient has an uncomplicated medical history at the age of four, the size of the post-vaccination papule does not exceed 8 mm.
• The Mantoux norm in children aged 5 years corresponds to sizes from 5 to 6 mm. The annual decrease in the diameter of the infiltrate is associated with an increase in resistance to the disease.
• From 7 to 13 years the reaction becomes doubtful or negative.

These options for papule size after tuberculin administration are considered ideal. But often the body of an absolutely healthy patient can lead to the development of atypical forms of papules. Such results require additional diagnostics.

You should not worry if in the second year of life the diameter of the infiltrate has not changed compared to last year's result. The Mantoux norm at two years corresponds to the indicators for children at 12 months, which is associated with the peculiarities of the tension of immunity in this age category.

How to determine the result yourself?

What Mantoux reaction is considered normal in a child should be decided by an experienced specialist, but if doubt arises, it can be assessed at home.

As mentioned above, intradermal injection of tuberculin leads to the formation of a specific papule that looks like a compaction. The outside of the papule is hyperemic. The size of this formation depends on how many antibodies there are to Mycobacterium tuberculosis antigens.

The first assessment of the sample should be carried out 72 hours after it was taken. First of all, you should carefully examine the injection site of the drug and make a conclusion about its appearance. The reaction may manifest itself in the form of an infiltrate, a hyperemic area of ​​the skin, or be completely absent. A distinctive criterion for differential diagnosis of hyperemia from infiltrate is that the infiltrate is denser, raised above the surface of the skin and has clear edges.

The next step is to measure the size of the infiltrate. It is recommended to carry out this manipulation using a colorless ruler. Only the seal should be measured. If redness or scratching has formed around it, then they should not be taken into account.

Evaluation of reaction results:

• Negative. This reaction result is indicated by the complete absence of compaction or the option when its size is up to 1 mm.
• Doubtful. The reaction is considered questionable if the infiltrate size is from 2 to 4 mm or if there is an area of ​​hyperemia without the compaction itself.
• Positive. The diameter of the seal is 5 mm or more. This type of reaction to the introduction of tuberculin is classified into weakly positive (from 5 to 9 mm), moderate (from 10 to 14 mm) and pronounced (15-16 mm).
• Strongly expressed. This result can be established when the seal diameter is 17 mm or more.

In some cases, it is impossible to evaluate the sample yourself due to the development of an allergic reaction. The development of allergies is indicated by a history of vaccination, the same size of the papule and scar after the vaccine, the size of the infiltrate more than 11 mm at the age of 1 to 2 years, and an annual decrease in the size of the papule in diameter.

When should you see a doctor?

If a child’s Mantoux result does not correspond to the norm, then this is not yet a sign of tuberculosis infection. But it’s still worth contacting a specialist.

Indications for consultation with a phthisiatrician:

• Annual increase in papule size.
• The Mantoux test of other children in the family does not correspond to the norm.
• A sharp increase in infiltration volume compared to last year's results.
• Contact with patients with tuberculosis (especially those with open form).
• Detection of this disease in family members or close relatives.

The phthisiatrician evaluates not only whether the Mantoux size corresponds to the norm, but also the results of additional studies such as chest X-ray and microscopic examination of sputum. In some cases, additional computed tomography is required.

If the doctor suspects tuberculosis of another location (tuberculosis of bones, kidneys, tuberculous meningitis), then examination methods such as bone scintigraphy, ultrasound, spinal puncture, cytological examination, etc. may be prescribed.

Thus, the Mantoux test for tuberculosis is a diagnostic method for examining patients of different ages, so the concept of normal in children may have age-related differences. It has been proven that after the administration of tuberculin, adverse reactions may develop, but there is no risk of infection from the test.

There are clear criteria for assessing the result of a reaction. With the help of simple measurements you can find out whether the size of Mantoux in children corresponds to the norm or not.

Useful video about the Mantoux test