Pirke test. Pirke test: indications, evaluation of results

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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Diagnosis of tuberculosis

The main organ that is damaged in tuberculosis is the lungs. Other internal organs It is quite rare to suffer from this disease. It is possible to diagnose tuberculosis using fluorography, CT ( computed tomography), radiography, skin tuberculin test(Pirke sample) and other types laboratory research. In order to diagnose the disease, vaccination is carried out once a year.

What is a skin test reaction?

One of the methods of preventive testing of children for tuberculosis is the Pirquet test. This immunological test can show whether a growing organism, even at early stages, tuberculosis infection. The body’s reaction to the appearance of tuberculin is called the Pirquet reaction, and it determines the body’s sensitivity to Pirquet. The test is also done for adult patients age group as a control analysis when assessing the effectiveness of treatment.

Sample composition

The sample contains tuberculin - a special extract from destroyed Koch bacilli, invented back in 1890 by a German doctor. It was this doctor who became the discoverer of such a disease as tuberculosis. The hood began to be used in 1907. Initially, they lubricated the skin with it and monitored the reaction, and only after that they began to try injecting tuberculin subcutaneously.

Today, the Pirquet test, the composition of which includes a mixture of killed filtrates of human and bovine microbacterial cultures, is observed in many people of different age groups. In addition to the active main substance - Pirquet tuberculin, the test includes the following additional substances:

phosphate salts;
sodium chloride.

How does this happen?

The principle of operation of the test, the composition of which is based on tuberculin, is to apply the drug to the skin. The skin of the forearm or shoulder is well disinfected only with carbolic acid, because alcohol-containing substances leave protein on the skin, which is undesirable for the purity of the analysis. Incisions on the skin are made using a scarifier with a depth of no more than 5 mm. The patient must wait up to 5 minutes until the solution is absorbed, and the residue is carefully wiped off paper napkin. After the procedure, the patient is monitored for 48 hours and the reaction to the substance is analyzed.

As a result of the injection of tuberculin, a specific inflammation (papule) occurs at the site of scratches, which is provoked by an accumulation of T-lymphocytes. It is these blood cells that are responsible for anti-tuberculosis immunity. The skin may change color and density in the area of the papule. This diagnostic method is used quite rarely due to its low information content and low diagnostic effectiveness. After the sample has been taken and before the results are obtained, it is not recommended to:

wet the place where the sample was taken;
wipe the papule with various medicines or ointments;
cover the papule with a band-aid;
comb or tear.

Results

On average, when the Pirquet test is performed, the results are assessed after 2-3 days, that is, 48-72 hours. A focus of irritation appears at the site where the scratch was made. Its area is measured by doctors. The results are classified as follows when the Pirquet test is performed:

the norm is observed when minimum indicator measuring papules (on average up to 5 mm);
an indicator of 3 mm indicates the need for re-vaccination and re-analysis of the irritation result;
if a papule measuring from 4 to 10 mm is detected, this means a possible infection with tuberculosis or the person is at risk (that is, constant contact with an infected person);
if the focus of irritation measures from 10 to 15 mm or ulcers are found at the site of vaccination, then this indicator talks about high probability tuberculosis infection.

Graduated sample

This type of study has been improved and consists of skin application of the drug using several scratches. Unlike the traditional version of the study, a graduated test allows you to determine the differential diagnostic value in the process of clarifying the nature of the allergy to tuberculin. A skin test is carried out by applying skin tuberculin with 100%, 25%, 5% and 1% concentration. Skin preparation is carried out in the same way as with the traditional Pirquet test. The notches are applied strictly in order, and various marked pipettes are used. Only sterile materials are used for each patient. After the “white roller” appears, the remaining tuberculin can be removed. This type of diagnosis is most often carried out to determine the effectiveness of tuberculosis treatment.

Calibrated sample results

Graduated skin test Grinchar and Karpilovsky are assessed 48-72 hours after the procedure. There are such reactions of the body to different concentrations tuberculin:

anergic reaction (no reaction to tests);
nonspecific reaction (you can only notice a slight redness on a test with 100%;
normergic reaction (there is a moderate reaction of the body to tuberculin, and there are no reactions at all to samples with 5% and 1% solutions);
hyperergic reaction (this result is characterized by a response to all types of samples; the higher the concentration of tuberculin in the solution, the greater the reaction);
equalizing type of reaction (all samples taken have the same papules, skin colors and sizes of inflammation);
paradoxical reaction (with a higher concentration of tuberculin in the sample, a more pronounced reaction is observed).

So, we looked at a diagnostic method such as the Pirquet test. Its result does not indicate the localization of the disease in the body or the ability of a person to infect healthy people. It only indicates the body’s reaction to the causative agent of tuberculosis. Pirquet's test - its alternative) is considered mandatory for carrying out in childhood.

PIRKE REACTION(Pirquet), a skin reaction to tuberculin, proposed by Pirquet in 1907. Used to study tuberculin. allergies, i.e. increased sensitivity to tuberculin in persons infected with tuberculosis. batsi-lami. The essence of the Pirquet method is that tuberculin is applied to a scarified area of skin, and then after a certain period of time, inflammatory changes in the skin are recorded in this area (see also Skin reaction). When studying smallpox vaccinations, Pirquet found that people who had already undergone vaccination reacted to re-vaccination appears early, within the next 24 hours. An early reaction therefore serves as evidence of a vaccine allergy. Pirquet used skin vaccination to establish previous infection with tuberculosis. Increased sensitivity tuberculosis organism to tuberculin is manifested in the fact that the skin of such an organism responds to tuberculin penetrating into it with characteristic inflammatory phenomena, while the skin healthy person does not detect such reactions. Pirquet's original technique. The skin of the forearm is wiped with cotton wool soaked in ether; then, using an eye dropper, apply 2 small drops of tuberculin at a distance of 10 hedgehogs from one another. Then, using a special platinum-iridium burr calcined in a flame, the skin is drilled in the middle between both 72fr drops (control reaction); In the same way, mechanical trauma to the skin under both drops of tuberculin is performed. After this, several fibers of sterile, grease-free cotton wool are placed on both drops to prevent the drops from draining. After 5 min. tuberculin is erased, but that’s how it is. image so that it does not fall into the control reaction. Parsley (Petruschky, ; 1908) uses a smallpox vaccination lancet instead of a borchik, making a superficial incision across the skin. Nastyukov (1922) proposed a platinum scarifier. According to the instructions of the II All-Union Tuberk. Congress and the II All-Union Congress of Children's Doctors in 1923, the sensitivity of the skin to a series of dilutions of tuberculin was studied, namely, in addition to whole tuberculin, to 30%, 10% and 3% solutions. That. In addition to the degree of intensity of the reaction to whole tuberculin, the lower limit of sensitivity to weak solutions tuberculin. Composition of the liquid for the control reaction: 100 cm 3 phy-ziol. solution, 0.5 carbolic acid and 5.0 glycerol. The same liquid is used to dilute tuberculin. In view of the fact that meat-peptone glycerin broth, usually used to obtain tuberculin, in some cases itself causes known reactive phenomena on the skin, it is better to use glycerin meat-peptone broth with the addition of 0.5 as a “control” liquid % carbolic acid. Measuring reactions. Results of P. r. they are also trying to measure quantitatively. For this purpose, the diameter is determined inflammatory infiltrates appearing on scarifications [see. separate table (Art. 223-224), Figure 2]. If an infiltrate appears from the control solution, it is also measured. In addition to the size of the infiltrate in millimeters, morphol should also be noted in the protocol. features of local reactive inflammation, such as the presence of serous exudate (large and small vesicles), diffuse hyperemia, the appearance of crusts, necrosis, peeling, pigmentation. General temperature and focal reactions are rarely observed with the Pirquet method. It is convenient to record the results of a skin reaction after 48 hours; in case of a negative reaction, it should be resumed immediately. Taking into account the results of the second study after 48 hours, the results of the first study should be checked at the same time. The main criterion for a positive reaction to tuberculin is the diameter of the papules at increasing concentrations of tuberculin. If almost identical papules are observed at all tuberculin concentrations, at least reaching size 5 mm, then the reaction cannot be considered positive. A positive skin reaction to tuberculin is any infiltrate whose diameter clearly exceeds the diameter of the nonspecific infiltrate resulting from the control solution. A number of authors have disputed the strict specificity skin reactions for tuberculin. The opinion was expressed that the reaction of healthy and tub. organism for tuberculin represents | only a quantitative difference, i.e., tuberculin acts as a stronger irritant on a patient than on a healthy person. I The dealer (Zieler) insists on the specificity of tuberculin reactions. According to his data, subjects free from TBC do not give skin reactions to tuberculin and other drugs from VK (the Dealer recognizes those free from TBC, which are at doses of 50-1,000 mg old Koch tuberculin under the skin is not given general and local reaction). On the contrary, both tuberculous and non-tuberculous people give a positive reaction to other bacterial drugs (Escherichia coli, dysentery bacillus, etc.). Most clinicians believe that a positive skin reaction to tuberculin reliably indicates TBC infection. A negative skin reaction to tuberculin cannot be considered evidence of the absence of tuberculin. infections in the body. To finally determine the degree of tuberculin allergy in the presence of negative skin reactions, it is necessary to resort to tuberculin diagnostics using the intradermal and subcutaneous samples(method for determining tuberculin titer). Single P.r. is almost irrelevant for assessing the course of the tubes. process; Much more valuable in this sense is their repeated observation. In children, for example. more intense reactions to tuberculin correspond to fresh and acute manifestations process ( allergic stages), as the process moves into the stages of isolated phthisis, their intensity decreases. Practical significance for diagnosing tbc P. r. has ch. arr. in childhood. Lit.: Bandelier and Röpke, Specific diagnostics and tbc therapy, vol. 1, M.-P., 1923, -Volf-Eisner A., Early diagnosis and immunity in tbc, St. Petersburg, 1913; Immunobiology, clinic and prevention of TBC in children, Sat. articles, vol. I-III, Y., 1926-32; M e rson D., Pirquet reaction diagnostic, prognostic and epidemiological significance, Odessa, 1921; M odel L. and Sidelnko-va E., Tuberculin diagnostics, study of tuberculin titer in children, M., 1928; About g "e 1 N., Allgemeine Diagnostic, Prognostik, Prophylaxe und T.herapie (Hndb. d. Kindertuberkulose, nrsg. v. St. Engel u. Cl. Pirquet, B. II, Lpz., 1930, lit.) ; Pirquet C, Klimsohe-Studien iiber Vakzination und vakzinale Allergie, Lpz.-Wien, 1907..L.

History of tuberculin diagnostics

Tuberculin in it classic look was invented in 1890 by the famous German doctor Robert Koch, after whom the causative agent of tuberculosis, Koch’s bacillus, is also named.
The authorship of the tuberculin diagnostic method, that is, the use of Koch tuberculin for diagnostic purposes, belongs to Pirke, who in 1907 first proposed the use of tuberculin for the diagnosis of tuberculosis. Tuberculin was applied to the skin damaged by a special borik. Later, this method was modified and skin damage (scarification) began to be performed with a special lancet. It is approximately in this form that Pirquet’s test has survived to this day.
Somewhat later, the French doctor Mantoux proposed another modification of the test - intradermal injection of tuberculin. The Mantoux modification test has been used in Russia since 1965.

What is tuberculin?

The meaning of tuberculin is to “indicate” the presence of a tuberculosis bacillus in the body so that the body’s response (qualitatively and quantitatively) to this “presence” can be assessed. In this sense, tuberculin copes with its task perfectly - it is for this reason that the drug was never subjected to radical processing and for more than 100 years, to this day, it has been one of the main means of diagnosing tuberculosis.
And again a little history. Tuberculin (the exact name is “alttuberculin”, AT) Koch is an “extract”, a lysate from heat-inactivated Mycobacterium tuberculosis. The classic preparation, in addition to tuberculin itself, contained many impurities - residues nutrient medium, on which bacteria, salts and other substances were grown, which affected the purity of the reaction and made it difficult to assess the result of the samples. Since the late 60s of the 20th century, purer tuberculin preparations, the so-called PPD (Purified Protein Derivate), have been developed, which are still used today. In Russia, the drug PPD-L is used, i.e. purified tuberculin obtained by the Russian scientist Linnikova in 1965. Modern drug tuberculin, in addition to tuberculin itself, contains salts of phosphate buffer solution, sodium chloride, Tween-80 stabilizer, and phenol as a preservative. Basically, the drug is free of ballast impurities, but it may contain them in trace amounts, which can affect the result of the reaction.
However, the exact mechanism of interaction of tuberculin with the immune system is still not completely known. On the one hand, a lysate of proteins (peptides, amino acids) cannot be a full-fledged antigen. Indeed, tuberculin does not induce the formation of immunity. But this point of view does not explain the intensification, as with vaccination, of the reaction with frequent testing - the so-called. "booster effect" of the Mantoux test. So what is tuberculin? Most likely, tuberculin can be characterized as a heterogeneous mixture of organic matter varying degrees complexity derived from mycobacteria.

What is the Mantoux reaction?

The Mantoux reaction is the body’s reaction to the introduction of tuberculin. At the site of injection of the drug into the skin, specific inflammation occurs caused by infiltration of T-Lymphocytes - specific blood cells responsible for cellular immunity(as opposed to the antibody immune response, in which antibody proteins play a major role). Fragments of mycobacteria seem to attract lymphocytes from nearby blood vessels skin. But not all T-lymphocytes come into play, but only those that are already fully or partially “familiar” with the Koch bacillus.
If the body has already had a chance to “get acquainted” with the real Mycobacterium tuberculosis, then there will be more such lymphocytes, the inflammation will be more intense, and the reaction will be “positive” (there is an infection with Koch’s bacillus). Naturally, a positive reaction means that the inflammation exceeds that caused by the injection itself and a certain diagnostic threshold. By measuring the diameter of a papule (inflammatory “plaque” or “button”) with a ruler, you can assess the strength of immunity to the tuberculosis bacillus.

Strictly speaking, the body’s reaction to tuberculin is one of the types of allergies (for tuberculin itself is not a full-fledged antigen, but rather an allergen). That is why existing allergic diseases can affect the result of the Mantoux test.
Above is a somewhat simplified biological mechanism Mantoux reactions. It should be remembered that the result of the reaction can be influenced in addition to existing allergic diseases, recently previous infections, chronic pathology, immunity to non-tuberculous mycobacteria, age. Others also play an important role associated factors- phase menstrual cycle in girls; individual characteristics of skin sensitivity; balanced nutrition of the child, etc. The results of mass tuberculin diagnostics have an unfavorable impact environmental factors: elevated background radiation, the presence of harmful emissions from chemical production, etc. The results of tuberculin diagnostics can also be influenced by various disorders in the methodology of its implementation: transportation and storage of tuberculin, when using non-standard and low-quality instruments, in case of errors in the technique of performing and reading Mantoux reactions.
Taking into account the above factors, in isolation, a positive Mantoux test in itself is not 100% proof of infection with tuberculosis. To confirm the diagnosis, a number of other studies are required to exclude a connection with BCG vaccination, fluorography chest, microbiological culture of sputum and a number of others. In turn negative result does not provide a 100% guarantee of the absence of Koch's bacillus in the body.

Why is the Mantoux test needed?

Or rather, is the Mantoux test necessary at all? On this score, WHO answers in the affirmative - yes, for countries with a high relevance of tuberculosis (which are Russia and most CIS countries in present moment) this test is one of the effective infection control measures. Even in those countries where the relevance of tuberculosis is low, for example in the USA and France, the Mantoux test is used quite actively - to identify groups infected with tuberculosis high risk.

Reaction (test) Mantoux is needed for:

Identification of primary infected people, that is, those who have been diagnosed with tubercle bacilli for the first time;
identifying those infected for more than one year with hyperergic reactions to tuberculin;
infected for more than one year with an increase in infiltrate by 6 mm or more;
diagnosis of tuberculosis in persons who are infected with Koch's bacillus, but do not manifest, in at the moment, symptoms of the disease; confirmation of the diagnosis of tuberculosis;
selection of children subject to revaccination against tuberculosis.
The selection of children and adolescents for revaccination is carried out based on the results of the Mantoux test at 6-7 and at 14-15 years. In areas where the epidemiological situation for tuberculosis is unfavorable, revaccination is carried out at 6-7, 11-12 and 16-17 years of age. BCG revaccinations Healthy individuals only with a negative reaction to tuberculin are subject to treatment.

Contraindications to the Mantoux test

It should be especially emphasized that the Mantoux test is harmless both for healthy children and adolescents, and for children with various somatic diseases. Tuberculin does not contain living microorganisms, and in the used dosage of 2 TU (0.1 ml) it does not affect either the body’s immune system or the entire body as a whole.
Testing does not make sense in children under 12 months, because the test result will be unreliable or inaccurate due to age characteristics development immune system– the reaction may be false negative. Children under 6 months of age are unable to respond adequately to the Mantoux test.

Contraindications to performing a tuberculin test are:

skin diseases,
acute and chronic infectious and somatic diseases in the acute stage (the Mantoux test is performed 1 month after the disappearance of all clinical symptoms or immediately after quarantine is lifted),
allergic conditions,
epilepsy.
It is not allowed to carry out the test in those groups where there is a quarantine for childhood infections. The Mantoux test is performed 1 month after the disappearance of all clinical symptoms or immediately after quarantine is lifted.

Mantoux reaction and vaccinations

Due to the fact that the immunity developed as a result of vaccinations can affect the result of the Mantoux test, it should not be performed on the same day as any vaccinations. Otherwise, the risk of false-positive reactions increases.
At the same time, immediately after assessing the test results, on the same day or later, vaccinations can be carried out without restrictions.
If vaccinations are carried out before the test, then to avoid interference, the interval between the administration of inactivated (killed) vaccines, such as against influenza, diphtheria and tetanus, etc., and the Mantoux test should be at least 4 weeks. This is in equally This also applies to the administration of serums and immunoglobulins. In case of vaccination with live vaccines (measles, mumps, rubella, OPV, etc.), it is advisable to increase this interval to 6 weeks.

How is the Mantoux test performed?

In accordance with the Order of the Ministry of Health of the Russian Federation dated November 22, 1995 No. 324 in Russia, the Mantoux test is performed once a year, starting at the age of 12 months, regardless of the results of the previous test.
Using a special tuberculin syringe intradermally ( middle third inner surface forearm) tuberculin is administered in terms of 2 tuberculosis units (TU). The volume of the administered dose is 0.1 ml. The needle is inserted with the bevel upward, to a depth sufficient for the outlet to be completely immersed in the skin. In order to make sure that the needle has not penetrated the skin and to ensure intradermal administration itself, the needle is slightly raised, stretching the skin. After the introduction of tuberculin, a specific bulge of the upper layer of skin, better known as a “button,” is formed.

How to care for the “button”?

The simplest answer is no. At least until the results are assessed. There is no need to smear the sample site with brilliant green or peroxide. There is no need to cover the wound with an adhesive plaster - the skin under it may sweat. Do not let your child scratch the button. Remember that improper care behind the injection site of tuberculin can affect the test result, and this is not necessary for either the patient or the doctor.
After assessing the results, if an abscess or ulcer has formed, it can be treated like any other wound, using all traditional means.

How are results assessed?

“It doesn’t matter how they voted, it’s important how they counted” - the authorship of this common saying about elections is attributed to Stalin. One cannot but agree with the leader - the most important thing in the Mantoux test is not the performance, but the evaluation of its results, and even more important - the conclusions from the result of the evaluation of the sample.
After the administration of tuberculin, on the 2-3rd day a specific skin thickening is formed - the so-called. “papule” (infiltrate, compaction). In appearance, it is a slightly raised rounded area of skin above the skin. When you press lightly on it with a transparent ruler (or if you press and release with your finger), it should turn slightly white. Unlike simple redness, to the touch (although this cannot always be detected with your fingers), the papule differs from the surrounding skin in its consistency - it is denser.

From an anatomical point of view, this papule is the result of a kind of saturation of the skin with cells, namely lymphocytes, sensitized (that is, sensitive) to Koch's bacillus. Naturally, the more lymphocytes that “know” about mycobacteria in the body, the larger the infiltrate (papule) will be.
The size of the papule is measured in sufficient light with a transparent ruler (so that the maximum diameter of the infiltrate is visible) on the 3rd day (48-72 hours) after tuberculin administration. The ruler should be positioned transverse to the longitudinal axis of the forearm. It is not allowed to use a thermometer and other “improved materials” such as graph paper and homemade rulers made from x-ray film. Only the seal size is measured. Redness around the lump is not a sign of immunity to tuberculosis or infection, but it is recorded when there is no papule.
There are several “versions” of setting up and evaluating the results of the Mantoux test. Strictly speaking, tuberculin can be administered in several ways - cutaneously (Pirquet reaction), intradermally (ordinary Mantoux) and using plastic applicators, on the pointed ends of which tuberculin is applied (in addition, other substances can be applied to simultaneously perform other tests).
We will focus on two approaches to assessing results - Russian and American. It should immediately be emphasized that in addition to the assessment methods, the production methods also differ. Thus, in domestic practice, the Mantoux test is performed with 2 TE, while in the USA the test is performed with 5 TE. The American assessment method differs by taking into account the degree of risk of infection with tuberculosis of a given patient; depending on this, the size of the infiltrate is interpreted.

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:

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

Indications for use

Children under three years old. A positive reaction means that the child is sick and the disease is in the active phase;
Teenagers and children over three years of age. Diagnostic detection primary infection, as well as carrying out prevention in medical institutions;
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

wet the skin;
lubricate it with any medicines or alcohol;
stick a patch on the wound;
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.

Papule no more than five millimeters - the reaction is negative, the child does not have tuberculosis;
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;
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;
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 four cuts are made instead of one, after pre-treating the skin with carbolic acid.

After which tuberculin is applied to varying degrees of concentration: 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:

Allergic reaction - no response to tuberculin;
Nonspecific reaction - redness on the notch where tuberculin was applied with one hundred percent concentration;
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;
Hyperergic - inflammation to all types of concentration, and the higher the percentage of the reagent, the more pronounced the body’s reaction;
Equalizing - all papules are the same, of the same color for all concentrations of solutions;
Paradoxical - the skin reacted the most to the highest concentration.