They gave me a referral to a phthisiatrician after the injection. Who is a phthisiatrician? When to See a Doctor

Sometimes situations arise that are unpleasant for parents and the child when they receive a referral to a phthisiatrician after Mantoux. It is given in cases where the reaction of the tuberculin test is increased. This may have several causes, so the TB doctor conducts the patient additional examination, allowing to determine the presence or absence of infection in the body. In order to prevent an increase in the reaction, which occurs due to the mistakes of doctors and patients, it is worth familiarizing yourself with the rules for setting up this important test for health in advance.

When can a child be referred to a TB specialist?

Parents can get a referral to see a doctor if:

The result of the tuberculin test is more than 12 mm in comparison with the previous indicators for 4 years and longer after the BCG.
Positive response to vaccination small child who did not receive a BCG injection.
If after vaccination a person has a positive result after a negative one.
Mantoux results are increasing instead of decreasing. It is important to note that immunity from BCG vaccines may not leave the human body for about 7 years, after which the child is revaccinated, which, according to the plan, is carried out after birth, and then upon reaching 7 and 14 years. Immediately after the injection of BCG, the results of the test will be large, but gradually, over 7 years, while immunity from the development of pulmonary tuberculosis is maintained, the reaction gradually decreases.
A person was not vaccinated for a long time, as a result of which the Mantoux test began to show only a positive result. In this case pediatrician unable to independently correctly evaluate the test results and identify the disease, which is why he gives the child a referral to a phthisiatrician.
The child has a hyperergic reaction, in which the papule increases by 15 mm or more.
Suspicion of a bend - over the past few months (from 1 to 6), the dimensions of the Mantoux have increased by more than 6 mm, or the negative test has become positive.

When making a visit to a phthisiatrician, it is important to take with you a referral issued by a pediatrician, where the time of the vaccination, the size of the resulting scar, the results of previous tuberculin tests, as well as the results of tests (urine and blood) passed by the child, which will help determine the presence of tuberculosis in the body, will be written .

Also, a mark on the fluorography of the parents is indicated in the direction in order to completely exclude the disease.

Then the doctor will prescribe an additional examination to establish correct diagnosis or refute it.

Contraindications to Mantu

Non-compliance with contraindications, which include:

epilepsy;
skin diseases;
allergic manifestations;
inflammatory and infectious pathologies detected during vaccination in an acute form;
cancerous tumors;
chronic pathologies internal organs etc.

These contraindications to the injection can lead to false positive results.

Since Mantoux is an allergy test, any skin diseases and allergic manifestations can cause wrong result showing the presence of mycobacteria in the human body.

To avoid this, the doctor, before the introduction of tuberculin, must exclude all contraindications, and if there is an allergy, the patient must start taking it 3 days before the vaccination antihistamines. Also, do not introduce into the child's diet those foods that can quickly cause an allergic reaction.

How to test

This tuberculin test is mandatory every year. diagnostic examination children and adolescents, allowing timely detection of the presence of infection or lack of immunity against it. After the doctor excludes all contraindications, Mantoux is made to the child, which is placed in the right or left hand, insulin syringe with a fine needle. Tuberculin is injected intradermally and after it is placed at the injection site, after some time there is a thickening and redness, which is called a reaction to the injected drug. When taking the results after the injection, which is performed after 72 hours, the doctor determines the presence of a compaction with his fingers, and then measures it with a regular ruler.

The results of the test are divided according to the following indicators:

negative - the absence of the appearance of compaction or its little presence, the dimensions of which reach 0-1 mm;
doubtful - a seal of 2-4 mm, in which redness appears, and there is also no papule;
positive - a large and bright seal, the diameter of which is more than 5 mm;
hyperergic - in children in this case, the seal is more than 17 mm, in an adult - more than 21 mm. In addition, the patient has the formation of pustules on the skin and the necrosis of its upper layer, which does not at all depend on the type and nature of the seal.

A positive result of vaccination is also divided into several types:

low intensity - in this case, the diameter of the papule is no more than 9 mm;
medium intensity - the width of the seal varies between 10-14 mm;
pronounced - the diameter is about 15-16 mm.

Since vaccinations can also affect the results of the vaccination, the tuberculin test is carried out at least 3 days before the scheduled vaccination.

After the dimensions of Mantoux are taken, you can be vaccinated. If vaccination was carried out before Mantoux, then this tuberculin test can be done a month after vaccination.

It is not enough just to conduct a Mantoux test correctly, in addition, it is necessary to follow some rules in order not to negative impact to the results.

Do not rub or scratch the area where the injection was given. It is especially important to control this in young children, who are always interested in redness and slight swelling of the skin that appears imperceptibly on the arm.
Bathing a child is not recommended. This ban is explained not so much by the effect of water on the skin, but by the fact that it cannot be rubbed, and some people, after getting water, immediately begin to touch the injection site. Therefore, if water gets in, it is enough just to blot this place with a towel.
Do not allow contact with cosmetic, perfumery and detergents at the injection site.

When to See a Doctor

Sometimes, in the presence of a hyperergic reaction after Mantoux in children, the temperature may rise sharply, which occurs on the 3rd day. In addition, at this time on the body of the child appears severe itching and ulcers.

This reaction may indicate both infection and the presence of an allergy that is dangerous to health. In the second case, it is imperative to consult a doctor about the advisability of setting up Mantoux in subsequent years, as well as replacing it with Diaskintest.

Parents should always remember certain moments, which say about the danger to the health of the child:

The presence in the family of people suffering from tuberculosis.
Temporary or permanent contact with patients open form tuberculosis.
The annual increasing result of sensitivity to drug administration.
A sharp increase in the results of the injection, which can be 6 mm or more.
Long stay in the region heightened danger to infection with tuberculosis.

All these cases are the basis for referring the child to a phthisiatrician, who, after an examination, will be able to understand whether he is infected with pulmonary tuberculosis or not.

Timely diagnosis infectious diseases plays important role to prevent infection of others and the development dangerous complications. If a person was referred to a phthisiatrician after Mantoux, there is no need to panic ahead of time. Consultation with profile specialist usually associated with a number of additional research methods that are aimed at setting accurate diagnosis.

The Mantoux reaction is a mass method for the study of tuberculosis, which is often used to detect mycobacteria of the pathogen in children under the age of sixteen. The main component of the drug is tuberculin. It is made from an extract of the protein of dead mycobacteria.

Tuberculin is not a toxin or antibody, and does not activate their production. Most phthisiatricians give it the role of a specific antigen. Responses to the administration of a substance develop only in those people who have an increased susceptibility to the disease.

This substance is standard dilution is not a vaccine, therefore, after its introduction in humans, the development of immunological protection against the disease is not activated. The substance consists of a protein extract of Koch sticks.

Additionally, the drug contains sodium and potassium chloride, phenol, Tween-80, and phosphate salts. Usually it does not contain components that adversely affect the result of the study.

The agent is injected into middle third forearm. After some time, at the injection site develop inflammatory processes. They are activated as a result of exposure to lymphocytes, which are components of cellular immunity.

One of the main components in the discovery childhood tuberculosis using the tuberculin test are proteins-antibodies. Their level fluctuates as a result of the presence of a lesion in the body.

The structures of Koch's sticks are able to connect with lymphocytes from adjacent vessels. However, only some of them enter the active phase.

The reaction is able to show whether the body of the person under study met with mycobacteria. In this case, after the injection of the drug, the size of the seal significantly exceeds the norm. This is due to the response of the defense system, which was familiar with the pathogen.

Complications after the procedure are rare.

Basically, they can be associated with a number of factors, among which the most common are:

violation of the technique of the procedure;
individual intolerance to the components of the drug;
the lack of a clear interaction of tuberculin with immunity, which forms an idea of the reaction;
poor quality of the drug.

After a tuberculin test, there is a possibility of developing severe consequences even in the absence of disease.

These include the following complications:

pathological formations on the skin;
decreased efficiency of the stomach, intestines and other digestive organs;
an increase in temperature indicators above 38 degrees Celsius;
mental changes;
allergic reactions.

Among the common complications of a drug that contains tuberculin, it is worth highlighting severe headaches. They are observed in combination with changes in body temperature, fever and disorders in the digestive tract.

Much less often, among the complications, doctors note skin manifestations, swelling, as well as a feeling of itching around the injection wound. In most cases, these conditions are due to the development of allergic reactions to the components of the administered drug.

If you notice any side effects, you should immediately seek help from a doctor. This will make it possible to prevent the development of dangerous complications, which will make anti-tuberculosis diagnostics comfortable and safe for the health of the child.

The Mantoux test allows you to determine how prone the child's body is to infection with Mycobacterium tuberculosis. Similar procedures provide an opportunity to identify children at risk and monitor their health status.

Tuberculin diagnosis is carried out on different stages children's lives. This is due to the assessment of the dynamics of previous samples, as well as timely detection diseases on early stages development.

Anti-tuberculosis research is carried out:

At the end of the first year of life.
Annually for children under 16.
With daily contact of the child with patients who have tuberculosis.

Direction to Manta is not needed. The introduction of the drug is carried out in the middle third of the forearm. The hand changes every year. These data are entered into the medical record of the person undergoing the examination.

For diagnostics, a special tuberculin syringe is used. After the injection, a papule appears on the skin, which is observed by the doctor.

Correctly carried out reaction consists of several stages:

before diagnosis, other vaccinations and certain medications should not be administered;
it is allowed to administer other drugs a month before or after the Mantoux test;
when using live vaccinations, the difference between the test and the introduction of the vaccine must be at least six weeks.

After the injection, parents should observe the wound. Doctors also recommend not to use bandages, plasters, ointments, creams, as well as shower gels.

On final result research may be influenced by a number of other factors that adversely affect the determination of the diagnosis.

Among them are:

Also, the result of the Mantoux reaction is affected by compliance with the rules for transporting and storing the product. If they are violated, it is impossible to guarantee the correctness of the conclusion of the doctor.

One of the most common side effects after the administration of a tuberculin preparation is an allergy to the constituents of the drug. It is manifested by edema of the organs respiratory system dysfunction of the liver, kidneys and blood vessels baby.

Among the others serious consequences after diagnosis, it is worth highlighting:

development of inflammatory processes;
itching, skin changes;
temperature fluctuations;
acute insufficiency of various organs.

Tuberculin reaction should not be used if the child has:

acute and chronic pathologies during exacerbation;
skin and venereal diseases;
bronchial asthma;
rheumatism;
epilepsy.

In the absence of the possibility of carrying out this diagnostic method, the phthisiatrician as alternative method diagnostics recommends using diaskintest. You can also use polymerase chain reaction, linked immunosorbent assay, as well as the quantiferon test. These methods are on the list of examination methods that the phthisiatrician prescribes if the child has an enlarged Mantoux.

Failure to comply with the rules directly affects the final result of the study. As a result, the physician cannot adequately assess the injection site. Also, children can develop consequences that will harm his health.

The result of the tuberculin test is obtained on the third day after the administration of the drug. The pediatrician takes measurements of the papule, and also evaluates its shape, color and other components. After that, appropriate notes are entered in the child's medical record.

The assessment of the results of the study directly depends on the size of the seal.

Based on this, experts identify several possible responses of the body after the Mantoux test:

Negative. At the same time, there are no specific papule and redness at the injection site, which indicates the absence of contact between the child's body and the pathogen. Pediatricians do not exclude the possibility that he was in the past, after which protective systems suppressed the activity of mycobacteria, as well as their adverse effects.
Positive. In this case, the formed seal is of considerable size, which is the result of the contact of the child's body with Koch's sticks. Compaction develops due to the accumulation of specific lymphocytes, which are aimed at combating pathology.
Doubtful. The diameter of the papule is in the range of 3-5 mm. At the same time, redness of the skin is observed around the injection site. In such cases, the doctor may prescribe additional procedure a month later to get a clearer picture.

If, after receiving the size of Mantoux 13 cm, they were sent for a consultation with a phthisiatrician, then it is necessary to prepare for a thorough diagnosis. Often, such a manifestation of the reaction is associated with a violation of the rules for caring for the papule, so you should not worry ahead of time. At the same time, at the time of the examination, the child is not recommended to attend kindergarten or school.

When receiving a positive response of the body to the tuberculin drug, do not panic. In most cases, the child is a carrier of mycobacteria and does not pose a danger to outsiders.

To confirm this fact, the phthisiatrician may prescribe additional methods research, including:

fluorography for all family members;
bacteriological examination of biological materials;
radiographic diagnosis.

The first three months after receiving a positive response of the immune system, the doctor may recommend preventive treatment with Isoniazid. After achieving the desired effect and confirming the absence of any manifestations of the disease, the child is removed from the dispensary observation after visiting the phthisiatrician's office and becomes registered with the pediatrician. He annually controls the results of the tuberculin study.

If infection is detected within 12 months, the patient is placed in a tuberculosis dispensary for a course of therapy, taking into account individual features diseases. Special attention deserve children with a papule larger than 17 mm.

The parents of the baby are allowed to sign a waiver of the tuberculin test and inpatient treatment in the presence of a disease. But it is worth remembering that the lack of timely adequate therapy for tuberculosis usually leads to the development of dangerous complications, leading to the death of the patient.

Often, after a tuberculin diagnosis, the child is sent to see a doctor.

If he was sent to a phthisiatrician after Mantoux, do not panic, because there must be certain indications for this.

Among which:

a positive immune response to the administration of the drug;
exceeding the size several times higher than normal;
an increase in the size of the seal compared to the previous study by more than 6 mm or the so-called tuberculin fold.

The physician must obtain all information medical documentation and research results to establish a more accurate diagnosis.

This list includes:

information about the child's contact with infected people if available;
vaccination certificates;
data on the results of Mantoux reactions that were carried out earlier;
fluorographic conclusions;
entries in medical card about transferred acute viral diseases, the presence of chronic pathologies, as well as allergic factors;
results of general and biochemical analyzes blood;
consultations of narrow specialists.

When establishing the etiology of an increase in the size of the seal after tuberculin reaction The doctor must take into account several factors.

Among them it is worth highlighting:

Setting the intensity of the manifestations of the sample with entering data into a special medical form.
Determination of the number of BCG vaccinations administered, as well as their results.
Data on the measurement of the size of scars after vaccination.
The appointment of an examination of the child, aimed at detecting symptoms of the disease.

Phthisiologists identify a number of cases in which it is possible to make a diagnosis of infection with Mycobacterium tuberculosis.

Among them, the most common are:

the presence of a papule larger than 5 mm, provided that the Mantoux test is performed for the first time without previous vaccination using BCG;
detection of a positive response to a tuberculin drug for more than three years contract;
gradual increase in seal size over 4-5 years.

Increased susceptibility of the body of children to the tuberculin drug with the development of allergies, infectious pathologies And skin manifestations usually unrelated to research. If the Mantoux reaction is increased, then what threatens a visit to a phthisiatrician can be found out from the local pediatrician. In such cases, the doctor has a basis for differential diagnosis with the establishment of the causes of the appearance of pathological symptoms.

Such children are registered with the local pediatrician. They need to be examined at least once every three months. This will detect the activation of pathogenic processes in the early stages.

At-risk groups

The main factor that is the reason for consulting a phthisiatrician for people with a negative diagnostic result is their attitude to risk groups.

These include citizens who are subject to one or more factors, including:

poor social and living conditions;
lack of regular rational nutrition;
acute respiratory viral infections, as well as chronic pathologies that are in the acute stage;
residual effects after the disease;
daily contact with infected people;
people with a positive tuberculin test.

The phthisiatrician chooses the tactics of managing the patient after conducting the methods for diagnosing tuberculosis. In the presence of initial forms the disease of the patient is registered in the TB dispensary. This will allow timely detection of the activation of pathogenic processes and begin the treatment of pathology.

If the child has big mantou and he was sent to a phthisiatrician, do not panic ahead of time. Experienced specialist will appoint necessary methods research taking into account the individual characteristics of the baby's body, which will safely confirm or refute a dangerous diagnosis for his health.

the child was referred for a consultation with a phthisiatrician - this does not mean that the child has tuberculosis. The child was referred for a consultation, just as they are referred to other specialists.

Currently, the phthisiatric service is trying to organize the reception of children by a phthisiatrician in children's polyclinics at the place of residence on certain days 1-2 times a month. Preference is given to children under 3 years old. It would not be superfluous to inquire about this in your clinic before going to tube with your child. dispensary.

It is advisable to show the child to a phthisiatrician as soon as possible. It is recommended within 6 days from the date of the Mantoux, so that the phthisiatrician has the opportunity to see the papule. Papule at infectious allergy it differs from the papule in the post-vaccination (after), it differs in color, leaves behind pigmentation, etc. (the phthisiatrician should understand these subtleties, but he must be given this opportunity).

Extract from form 112 ( outpatient card child) indicating information about the BCG vaccination, the presence of a scar and its size, information about all the Mantoux reactions performed by the child with an indication of the size in mm, information about previous consultations with a phthisiatrician (if any), information about chronic diseases if the child is sick.
Result general analysis baby's blood and urine.
If a child has had X-rays of organs for a year chest: Take the photo with you.
The results of fluorography of parents and other adult (over 14 years old) family members living with the child.

What examination will the child have?

Inspection

The phthisiatrician will take a history. What did the child get sick during his life, in what conditions does he live, how does he eat. Could he have contacts with tuberculosis patients. Evaluate the results of all Mantoux of the child, analyzes, fluorography of the parents.

Examine the child: a trace from Mantoux, BCG scar. Performs peripheral examination lymph nodes, listen to the lungs.

In some cases, the phthisiatrician then diagnoses a post-vaccination allergy. This concludes the examination for the child and he is allowed to go home with recommendations to repeat Mantoux in 1 year.

In some cases, the doctor and parents doubt the correctness of the Mantoux. Then the treatment of other diseases of the child is indicated: sanitation of foci of infection, deworming, achieving remission chronic diseases, allergy treatment, compliance hypoallergenic diet And re-holding R. Mantoux in 1-2 months (if necessary, against the background of antihistamines).

X-ray examination

Most children are scheduled for x-rays. To exclude tuberculosis of the respiratory organs - the most common form tuberculosis. This form of tuberculosis is subdivided into tuberculosis of the lungs, bronchi and intrathoracic lymph nodes.

In children, compared with adults, much more often (about 1/3 of all cases of tuberculosis of the respiratory organs) tuberculosis of the intrathoracic lymph nodes occurs without changes in the lungs. This is the so-called "small form of tuberculosis." Its prevalence in children is currently associated with protective effect BCG vaccination, as a result of which the child's body limits the spread of infection. Intrathoracic lymph nodes are located in the area lung root. On standard chest x-rays in direct projection, the roots of the lungs are partially covered by the shadow of the heart. At the onset of the disease radiological signs may not be obvious, but indirect: a slight expansion of the lung root, increased vascular pattern, etc.

Therefore, X-ray tomography is also used to diagnose this and other forms of tuberculosis: an image of a section of the lung at the depth that interests the doctor. In order for the X-ray examination to be the most useful and informative, a specific type of examination is prescribed (plain radiography, X-ray tomography, or a combination of them) and it is the phthisiatrician who evaluates the results, and not the pediatrician in the children's clinic at the place of residence.

If X-ray pictures without pathology, this means that the child is not sick with tuberculosis of the respiratory system.

Diagnostic minimum

Thus, the diagnostic minimum for answering the question is sick or not on this moment a specific child (and adult) with TB today includes:

Mantoux reaction,
general analysis of blood and urine,
inspection data,
x-ray examination.

Most often, children are diagnosed with bend tubes. samples or primary tubinfection. This means that tuberculosis bacilli environment got into the body, as evidenced by an increase in the Mantoux test, but the child has not yet become ill with tuberculosis, they say this normal results examination of the child. That is, the diagnosis is a tube bend. samples means the child is allowed in children's team and is not contagious to others.

But the likelihood of developing the disease exists, and what younger child, the greater the risk (). So the child is taken dispensary observation phthisiatrician. In order to prevent the transition of the state of infection to the disease, children were always prescribed isoniazid in the past. Now, in order to make sure that this treatment is necessary, a diaskintest () is performed.

At present, with a negative result of the diaskintest, by order No. 109 M.Z. “On the improvement of anti-tuberculosis measures in Russian Federation» children with a diagnosis: Virazh tub. samples according to the Mantoux result and a negative result of diaskintest, prophylactic treatment with isoniazid is not prescribed, but it is recommended to repeat the test in dynamics after 2 months. A negative test result does not remove the diagnosis of a turn, it means that at the moment the child's body is coping with the infection without treatment.

A positive diaskintest result means that mycobacteria in the child's body are in a state of active reproduction, which means there is a possibility of developing the disease. When positive result Isoniazid is prescribed.

Isoniazid given to a child or not?

Treatment with isoniazid - prophylactic - is aimed at preventing the development of tuberculosis in a child. Doctor's appointments in this case are advisory, not mandatory.

Isoniazid reduces the risk of developing the disease in a child in case of primary infection with tuberculosis by 8 times.

This drug belongs to the group antibacterial drugs, mycobacterium tuberculosis is sensitive to it in the stage of reproduction, acts on intracellular and extracellular pathogens, penetrates into all tissues of the body. Most effective in recent infections. On other bacteria (causative agents of other diseases and normal microflora person) has no pronounced effect.

Has contraindications:

epilepsy,
transferred poliomyelitis,
dysfunction of the liver and kidneys

In these diseases, the drug is not prescribed.

Side effect

Skin allergic reactions - the drug is canceled.
Nausea, vomiting, dry mouth, rare cases drug-induced hepatitis. These side effects due to the fact that isoniazid is metabolized in the liver (cleaved and then excreted from the body, as a result of its breakdown, a hepatotoxic substance (monoacetylhydrazine) is formed. In order to minimize this side effect children are always prescribed hepatoprotectors together with isoniazid - drugs that protect liver cells from toxic effects, for example - karsil.
Headache, dizziness, irritability, worsening sleep. To reduce the effect of isoniazid on the central and peripheral nervous system along with it, vitamins of group B (B1 and B6) are prescribed.

The side effect of isoniazid is large doses drug, combinations with other anti-tuberculosis drugs and long-term use.

For preventive treatment, it is prescribed in minimum dose: 5 mg/kg, short course for 3 months. For comparison: its therapeutic dose is up to 15 mg / kg, the course of treatment is from 6 to 12 months.

Isoniazid is given to parents free of charge.

The doctor can only recommend preventive treatment. The final decision to conduct it or not is made by the parents. Parents have the right to issue a written refusal of treatment. But in this case, the child is at risk of developing tuberculosis.

Observation

In any case, the child needs further observation by a phthisiatrician. Most often, children referred for a consultation with a phthisiatrician about the Mantoux turn end up in following groups dispensary observation:

Group 0: children who final diagnosis not yet established, i.e., under examination. The duration of observation in this group is up to 3 months, then a diagnosis should be made and the child is either removed from the register by a phthisiatrician or transferred to another observation group.
Group IV: children who have contact with a patient with bacterial excretion of tuberculosis. The entire period of contact is observed and at least 1 year after its termination, in case of contact with a person who died of tuberculosis - 2 years. They undergo a comprehensive examination 2 times a year: Mantoux reaction, diaskintest, blood and urine tests. X-ray examination and sputum examination - according to indications.
Group VI - children with increased risk tuberculosis: children in early period infections (turns), children with increasing tuberculin sensitivity, children with hyperergic reactions to tuberculin. Comprehensive examination take place 2 times a year (see paragraph above). The duration of observation in this group is no more than 1 year, in case of presence of medical and social risk factors (lack of BCG vaccination, the presence of chronic diseases, low-income and large families, refugees) - 2 years.

A child diagnosed with a Virazh tube test is required

Establish a daily routine - diet, provide time for good rest, walks.
Provide good nutrition. IN daily diet the child must have meat or fish, milk or dairy products, cottage cheese, cheese, fresh vegetables and fruits - in the amount recommended for children of this age.
The child must walk at least 2 hours a day.
The child must have sufficient physical activity(playing sports or just active games).
It is necessary to sanitize the foci of infection (treat the teeth, consult the child at the ENT) and treat chronic diseases.
Sanatorium-resort treatment is recommended for children from the high-risk group for tuberculosis from the age of 4, without a shift climate zone and prolonged exposure to the sun.

Specialized Kindergarten

For children preschool age there is a network of specialized kindergartens for children at high risk of TB. A referral for registration in such a kindergarten is given by a phthisiatrician only to children registered in a tuberculosis dispensary. It is impossible to get infected with tuberculosis in such a kindergarten, since children in the active stage of tuberculosis are not allowed there. On the contrary, here all the children are very carefully examined.

A phthisiatrician can offer parents to place a child in such a kindergarten - the decision remains with the parents. Having agreed to place the child in such a kindergarten, the parents must agree to the preventive treatment of the child if it was recommended by the doctor.

These kindergartens are considered to be sanatorium-type institutions. The child goes to such a kindergarten, just like in a regular one - every day. The stay of a child in them is free for parents. Food is fortified, equates to a sanatorium.

Medical supervision of children in such a kindergarten is carried out by a phthisiatrician: he controls preventive treatment with isoniazid, conducts Mantoux, makes additional appointments if the child needs them: physiotherapy, massage. All these procedures are performed on the child right in kindergarten. In such kindergartens, children are also engaged physical therapy and breathing exercises.

This concludes a series of articles about tuberculosis, vaccinations and examinations related to it.

Sources of information are the same as in previous articles.

The Mantoux reaction for many children and adults is a real medical "horror story". At the same time, tuberculosis is constantly gaining strength, affecting everything more people. The Mantoux test is not a vaccine. But as a diagnosis, it can protect against the development of a terrible disease.

Mantoux reaction: appointment and conduct

The Mantoux reaction allows you to determine the level of susceptibility of the child to Mycobacterium tuberculosis. This diagnosis can not only identify the sick, but also control the condition of children at risk.

The Mantoux test is carried out annually, from 12 months (according to the last order in Ukraine from 4 years) to 14 years in without fail. If the child has not been vaccinated with BCG, then the Mantoux reaction is prescribed twice a year. If the child lives in a family where there is a patient with tuberculosis, then the Mantoux reaction can be prescribed 3-4 times a year.

The Mantoux test is placed on the arm (forearm). Two times in a row on one hand, the test is not done. In odd years, it is done on the left hand, and in even years - on the right. Tuberculin is injected intradermally with a tuberculin syringe. After that, swelling of the upper layer of the skin appears. It is because of this reaction that the Mantoux test is called the "button". For 2-3 days, the raised area of the skin will have a rounded character. Such a seal is called a "papule".

The Mantoux reaction is never carried out on the same day as other vaccinations. Vaccinations before the Mantoux test are best done 4 weeks in advance. If live vaccinations are carried out, then the break is extended to 6 weeks.

Mantoux test care

Before checking the Mantoux test, it should not be touched. You need to make sure that the child does not comb it. Do not stick it with a plaster, smear with iodine or brilliant green. Wrong care for Mantoux can change the results, which will harm the child. But after checking the sample, you can take care of the wound, as usual.

Evaluation of the Mantoux reaction

72 hours after the Mantoux test, its results are evaluated. For measurement, we take only the seal. Redness around the seal has nothing to do with the result. The only exception is the presence of redness in the absence of papule. Then such reddening is certainly noted in medical documents child.

There are 4 main evaluations of the sample:

1. A very pronounced (hyperergic) Mantoux reaction - the diameter of the papule is from 17 mm or noticeable necrosis, the formation of pustules, regardless of the size of the papule: the child is referred for a consultation with a phthisiatrician, and such a test is especially alarming with a previous negative, doubtful test; the child may have a very high susceptibility to the causative agent of tuberculosis, or already have the disease;

2. Positive Mantoux reaction - papule diameter from 5 to 16 mm: referral to a phthisiatrician is necessary to control the degree of susceptibility of the child to the causative agent of tuberculosis, its changes over several years; the child is healthy, but tuberculosis bacteria have already penetrated into the body;

3. Doubtful Mantoux reaction - there is only redness or papule diameter - up to 4 mm: the Mantoux test can be repeated; doubtfulness lies in the absence of a result that guarantees that the child is protected from tuberculosis, a small amount of pathogenic bacteria could enter the body;

4. Negative Mantoux reaction - a reaction from an injection to 1 mm, there is no compaction and redness: either bacteria did not penetrate the body, or BCG no longer protects and it is necessary to carry out BCG vaccination again.

"Turn" of the Mantoux test - a change (increase) in the result of the test (papule diameter) compared to the last year's result. Is very valuable diagnostic sign. The turn criteria are:

the appearance of a positive reaction for the first time (papule 5 mm or more) after a previously negative or doubtful one;
gain previous reaction 6 mm or more;
hyperergic reaction (more than 17 mm), regardless of the duration of vaccination;
reaction more than 12 mm 3-4 years after BCG vaccination.

It is the turn that makes the doctor think about what happened during last year infection. For example, if the test result for the last three years looked like 12, 12, 12, and in the fourth year a result of 17 mm was obtained, then with a high degree of probability we can talk about the infection that has occurred. Naturally, in this case, it is necessary to exclude all influencing factors - an allergy to the components of tuberculin, an allergy to other substances, recently past infection, the fact of recent vaccination with BCG or other vaccine, etc.

If the Mantoux reaction is positive

A positive Mantoux reaction is a signal for action, not panic. Increased susceptibility to tuberculosis is not yet a disease. It is important to clarify the diagnosis during examination by a phthisiatrician, in an anti-tuberculosis dispensary. After the examination, the child will be registered as belonging to the zero group of dispensary observation.

Tubinfected means that mycobacteria have entered the body, and they will remain there. Immunity will suppress the reproduction of tubercle bacillus, but the danger of getting sick occurs when immunity is disrupted.

To check for infection, a microbiological sputum culture is performed to determine Mycobacterium tuberculosis and an X-ray of the chest organs. At negative results In this diagnosis, a hyperergic or positive Mantoux reaction can be regarded as an allergy.

Recall that the tuberculosis vaccine is BCG, which is carried out in the first days in the maternity hospital. Enough of it for 5-7 years.

Be vigilant, if necessary, do not avoid consulting a phthisiatrician - this envy the health and life of the child.

Judging by nutrition, you absolutely do not care about immunity and your body. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start getting better. It is urgent to adjust your diet, to minimize fatty, floury, sweet and alcohol. Eat more vegetables and fruits, dairy products. Nourish the body by taking vitamins, drink more water(precisely purified, mineral). Harden the body and reduce the amount of stress in life.

You are prone to lung diseases at an average level.

So far, it’s good, but if you don’t start taking care of it more carefully, then diseases of the lungs and other organs will not keep you waiting (if there were no prerequisites yet). And frequent colds, problems with the intestines and other "charms" of life and accompany weak immunity. You should think about your diet, minimize fatty, starchy foods, sweets and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, do not forget that you need to drink plenty of water (purified, mineral). Harden your body, reduce the amount of stress in life, think more positively and your immune system will be strong for many years to come.

Congratulations! Keep it up!

Do you care about your nutrition, health and immune system. Keep up the good work and problems with the lungs and health in general long years will not disturb you. Do not forget that this is mainly due to the fact that you eat right and lead healthy lifestyle life. Eat healthy and nutritious foods (fruits, vegetables, dairy products), don't forget to use a large number of purified water, harden your body, think positively. Just love yourself and your body, take care of it and it will definitely reciprocate.