Pirque test. Pirque test: indications, evaluation of results

The Pirquet test The test is a skin application of dry, purified tuberculin. diluted to a content of 100 thousand TE in 1 ml. Through a drop of this solution of tuberculin, applied to the skin, the skin is scarified. The result is evaluated after 48 hours. The subcutaneous tuberculin test proposed by Koch consists in the introduction of 10-30-50 TU PPD-L under the skin at the lower angle of the scapula. The results of the Koch test are evaluated by local, general and focal reactions. In 48-72 hours, an infiltrate with a diameter of 15-20 mm appears at the injection site of tuberculin. The general rea-i is characterized by an increase in temper. body malaise 6-12 hours after the introduction of tuberculin, and focal - exacerbation of tuberculin. changes (appearance or aggravation of cough, infiltration around foci in the lungs, enlargement of lymph nodes with specific lymphadenitis, soreness and swelling of the joints with specific arthritis). Particularly sensitive is the test with subcutaneous injection tuberculosis with spec. eye damage. Indications. In case of mass tuberculin diagnostics, the Mantoux test with 2 TU is performed for 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 methodology once a year. The Mantoux test can also be used for an individual. tuberculin diagnostics. It is carried out in the conditions of a children's clinic, somatic and infectious diseases hospitals for differential diagnosis tuberculosis and other diseases, in the presence of chronic diseases with a torpid, undulating course, with the ineffectiveness of traditional. methods to lay down. 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 a Mantoux test 2 times a year in a general medical network: diabetes, peptic ulcer stomach and duodenum, blood diseases, systemic diseases. HIV-infected people receiving long-term hormone therapy(more than 1 month); with chronic nonspecific diseases(pneumonia, bronchitis, tonsillitis), low-grade fever unclear etiology; not vaccinated against tuberculosis, regardless of the age of the child; children and adolescents from social risk groups located in institutions (shelters, centers, reception centers) that do not have medical documentation (upon admission to the institution, then 2 times a year for 2 years)

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Tuberculosis Diagnosis

The main organ that is damaged by tuberculosis is the lungs. Other internal organs rarely suffer from such a disease. It is possible to diagnose tuberculosis with the help of fluorography, CT ( computed tomography), radiography, skin tuberculin test(Pirke test) 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 examination of children for tuberculosis is the Pirquet test. This immunological test is able to show whether in a growing organism, even on early stages, tuberculosis infection. The reaction of the body to the appearance of tuberculin is called the Pirque reaction, and it determines the sensitivity of the body to Pirque, the test is also done in patients already an adult age group as a control analysis in evaluating the effectiveness of treatment.

Sample composition

The composition of the sample includes tuberculin - this is a special extract from the 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 after that they began to try to inject tuberculin subcutaneously.

Today, the Pirke test, which consists of a mixture of killed culture filtrates of human and bovine microbacteria, is observed in many people of various age groups. In addition to the active main substance - tuberculin Pirquet, the sample 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 on 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. Notches on the skin are made using a scarifier with a depth of not more than 5 mm. The patient must wait up to 5 minutes until the solution is absorbed, and the remnants are gently 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 introduction of tuberculin, a specific inflammation (papule) occurs at the site of scratches, which is provoked by the accumulation of T-lymphocytes. It is these blood cells that are responsible for anti-tuberculosis immunity. The skin can change color and density in the papule area. This method of diagnosis is used quite rarely due to its low information content and low diagnostic efficiency. After the test has been made and until the results are obtained, it is not recommended:

wet the place where the test was made;
wipe the papule with various medicines or ointments;
seal the papule with a plaster;
scratch or tear.

results

On average, when the Pirquet test is performed, the results are evaluated after 2-3 days, that is, 48-72 hours. At the place where the scratches were made, a focus of irritation appears. His area is measured by doctors. The results are classified as follows when the Pirquet test is performed:

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

Graduated sample

This type of study has been improved and represents the skin application of the drug with the help of 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 an allergy to tuberculin. A skin test is performed by applying to skin tuberculin with 100%, 25%, 5% and 1% concentration. Skin preparation is carried out in the same way as in the traditional Pirquet test. Notches are applied strictly in order, and various marked pipettes are used. Only sterile materials are used for each patient. After the appearance of a "white roller", the remnants of tuberculin can be removed. This type of diagnosis is most often carried out in order to determine the effectiveness of tuberculosis treatment.

Graduated Sample Results

graduated skin test Grinchar and Karpilovsky are evaluated after 48-72 hours after the procedure. There are such reactions of the body to various concentrations tuberculin:

anergic reaction (no reaction to samples);
non-specific reaction (only slight reddening can be noticed on a sample with 100%;
normergic reaction (there is a moderate response of the body to tuberculin, and there are no reactions to samples with a 5% and 1% solution at all);
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 made have the same papules, skin colors and sizes of foci of inflammation);
paradoxical reaction (with a higher concentration of tuberculin in the sample, a more pronounced reaction is observed).

So, we considered such a diagnostic method 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 indicates only the reaction of the body to the causative agent of tuberculosis. The Pirquet test is its alternative) is considered mandatory for childhood.

PIRKE REACTION(Pirquet), a skin reaction to tuberculin, proposed by Pirquet in 1907. It is used to study tubes. allergies, i.e. hypersensitivity to tuberculin in persons infected with tuberculin. bacilli. The essence of the Pirquet method lies in the fact that tuberculin is applied to the scarified area of the skin, and then after a certain period of time, inflammatory changes in the skin are recorded at this place (see also skin reaction). When studying smallpox vaccinations, Pirquet found that in individuals who had already undergone vaccination, the reaction to re-vaccination appears early, within the next 24 hours. An early reaction therefore serves as proof of a vaccine allergy. Pirquet used skin vaccination to establish a previous infection with tuberculosis. Hypersensitivity 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 show such reactions. Pirquet's original technique. The skin of the forearm is wiped with cotton soaked in ether; then, using an eye dropper, 2 small drops of tuberculin are applied at a distance of 10 hedgehog from one another. Then, with the help of a special platinum-iridium burr calcined on a flame, the skin is drilled in the middle between both 72fr drops (control reaction); in the same way, mechanical traumatization of the skin is performed under both drops of tuberculin. After that, several fibers of sterile fat-free cotton wool are placed on both drops to prevent the drops from dripping. After 5 min. tuberculin is erased, but so. image, so that it does not fall into the control reaction. Parsley (Petruschky, ; 1908) uses a smallpox lancet instead of a borchik, making a superficial incision on the skin. Nastyukov (1922) proposed a platinum scarifier. According to the instructions of the II All-Union Tubercul. congress and the II All-Union Congress of Pediatricians in 1923, the sensitivity of the skin to a series of dilutions of tuberculin is investigated, namely, in addition to whole tuberculin, to 30%, 10% and 3% of its solutions. That. in addition to the degree of intensity of the reaction to whole tuberculin, the lower limit of sensitivity to weak solutions tuberculin. The composition of the liquid for the control reaction: 100 cm 3 fi-ziol. solution, 0.5 carbolic acid and 5.0 glycerol. The same liquid is used to dilute tuberculin. In view of the fact that the meat-peptone glycerin broth, usually used to obtain tuberculin, in some cases in itself causes known reactive phenomena on the skin, it is better to use glycerin meat-peptone broth with an addition of 0.5 % carbolic acid. Measurement of reactions. P.'s results r. trying to quantify as well. To do this, determine the diameter inflammatory infiltrates appearing on scarifications [see separate table. (pp. 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, morfol 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 a 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 size of the diameter of the papules at increasing concentrations of tuberculin. If almost the same papules are observed at all concentrations of tuberculin, at least reaching a size of 5 mm, then the reaction cannot be considered positive. A positive skin reaction to tuberculin is any infiltrate whose diameter is clearly greater than the diameter of the nonspecific infiltrate obtained from the control solution. A number of authors have challenged the strict specificity skin reactions for tuberculin. It has been argued that the reaction is healthy and tube. body on tuberculin represents | only a quantitative difference, that is, tuberculin acts as a stronger irritant on a sick person than on a healthy one. I Dealer (Zieler) insists on the specificity of tuberculin reactions. According to him, tbc-free subjects do not give skin reactions to tuberculin and other drugs from VC (the Dealer recognizes tbc-free subjects that are at doses of 50-1,000 mg old tuberculin Koch under the skin do not give a general and local reaction). On the contrary, a positive reaction to other bacterial preparations (E. coli, dysenteric bacillus, etc.) is equally given by both tuberculosis and non-tuberculous people. Most clinicians believe that a positive tuberculin skin reaction strongly indicates tbc infection. A negative skin reaction to tuberculin cannot be taken as proof 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 by the method of intradermal and subcutaneous tests(method for determining tuberculin titer). Single P.R. almost irrelevant for assessing the flow of 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 transitions to the stages of isolated phthisis, their intensity decreases. Practical value for the diagnosis of tbc P. p. has ch. arr. in childhood. Lit.: Bandelier and Ryopke, Specific Diagnosis and tbc therapy, vol. 1, M.-P., 1923, - V o l f-E ysner A., Early diagnosis and immunity in tbc, St. Petersburg, 1913; Immunobiology, clinic and prevention of tbc in children, Sat. articles, vols. I-III, Y., 1926-32; M e rs o n D., Pirquet reaction, ee diagnostic, prognostic and epidemiological value, Odessa, 1921; Model L. and Sidelnpko-in and 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. Model.

History of tuberculin diagnosis

tuberculin in his classical form was invented in 1890 by the famous German physician Robert Koch, after whom the causative agent of tuberculosis, Koch's wand, is named.
The authorship of the method of tuberculin diagnostics, that is, the use of Koch's tuberculin for the purpose of diagnosis, 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. Approximately in this form, the Pirquet test has reached the present day.
Somewhat later, the French physician Mantoux proposed another modification of the test - intradermal administration of tuberculin. The Mantoux test has been used in Russia since 1965.

What is tuberculin?

The meaning of tuberculin is to “indicate” the presence of a tubercle bacillus in the body so that it is possible to assess the reaction of the body (qualitatively and quantitatively) to this “presence”. In this sense, tuberculin copes with its task perfectly - it is for this reason that the drug has not been 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 Mycobacterium tuberculosis, inactivated by heating. The classic drug, in addition to the tuberculin itself, contained many impurities - the remains growth medium on which bacteria, salts and other substances were grown that affected the purity of the reaction and made it difficult to evaluate the result of the samples. Since the late 60s of the 20th century, purer tuberculin preparations, the so-called PPD (Purified Protein Derivate - purified protein derivative), 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 phosphate buffer salts, sodium chloride, Tween-80 stabilizer, and phenol as a preservative. Basically, the drug is free from ballast impurities, however, it may contain them in trace amounts, which can affect the result of the reaction.
However, the exact mechanism of the interaction of tuberculin with the immune system is still unknown to the end. On the one hand, a protein lysate (peptides, amino acids) cannot be a complete antigen. Indeed, tuberculin does not cause the formation of immunity. But this point of view does not explain the amplification, 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, a specific inflammation occurs caused by infiltration by T-lymphocytes - specific blood cells responsible for cellular immunity(in contrast to the antibody immune response, in which antibody proteins play the main role). Fragments of mycobacteria, as it were, 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 Koch's wand.
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 is more intense, and the reaction will be "positive" (there is 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 (an inflammatory “plaque” or “button”) with a ruler, one can assess the intensity of immunity to a tubercle bacillus.

Strictly speaking, the reaction of the body to tuberculin is one of the varieties of allergy (because 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 the available allergic diseases, recently past infections, chronic pathology, immunity to nontuberculous mycobacteria, age. Others also play a role contributing factors- phase menstrual cycle in girls; individual characteristics of skin sensitivity; balanced nutrition of the child, etc. A pronounced effect on the results of mass tuberculin diagnostics is environmental factors: elevated radiation background, the presence of harmful emissions from chemical industries, etc. The results of tuberculin diagnosis can also be influenced by various violations in the method of its implementation: transportation and storage of tuberculin, when using non-standard and low-quality tools, with errors in the technique of setting 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 the connection with BCG vaccination, fluorography chest, microbiological culture of sputum and a number of others. In its turn negative result does not give a 100% guarantee of the absence of Koch's sticks in the body.

Why is the Mantoux test needed?

Or rather, is a Mantoux test needed at all? On this score, WHO answers in the affirmative - yes, for countries with a high relevance of tuberculosis (this is exactly what Russia and most of the CIS countries in this moment) this test is one of the most 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 those infected with tuberculosis in groups high risk.

Reaction (test) Mantoux is needed for:

Identification of primary-infected, that is, those who for the first time have been diagnosed with the fact of infection with a tubercle bacillus;
identification of those infected for more than one year with hyperergic reactions to tuberculin;
infected for more than one year with an increase in infiltration by 6 mm or more;
diagnosis of tuberculosis in individuals who are infected with Koch's bacillus, but do not show, in this moment, symptoms of the disease; confirmation of the diagnosis of tuberculosis;
selection of contingents of children subject to revaccination against tuberculosis.
The selection of children and adolescents for revaccination is carried out according to 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. BCG revaccination healthy persons only with a negative reaction to tuberculin are subject.

Contraindications for Mantoux test

It should be 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 applied dosage of 2 TU (0.1 ml) 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 result of the test 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 adequately respond to the Mantoux test.

Contraindications to tuberculin test are:

skin diseases,
acute and chronic infectious and somatic diseases in the acute stage (Mantoux test is performed 1 month after the disappearance of all clinical symptoms or immediately after the quarantine is lifted)
allergic conditions,
epilepsy.
It is not allowed to conduct a 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 the removal of quarantine.

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 the assessment of the results of the test, on the same day or later, vaccinations can be carried out without restrictions.
If vaccinations are carried out before the test is performed, then in order to exclude interference, the interval between the administration of inactivated (killed) vaccines, such as against influenza, diphtheria and tetanus, etc., and the production of the Mantoux reaction should be at least 4 weeks. It's in equally also concerns the introduction of sera and immunoglobulins. In the case of vaccinations with live vaccines (measles, mumps, rubella, OPV, etc.), it is desirable to increase this interval to 6 weeks.

How is the Mantoux test done?

In accordance with the Order of the Ministry of Health of the Russian Federation of November 22, 1995 No. 324 in Russia, the Mantoux test is performed once a year, starting from the age of 12 months, regardless of the results of the previous test.
With a special tuberculin syringe intradermally ( middle third inner surface forearms) tuberculin is injected in terms of 2 tuberculosis units (TU). The volume of the administered dose is 0.1 ml. The needle is inserted with the cut upwards, to a depth sufficient to ensure that the outlet is completely immersed in the skin. In order to make sure that the needle has not penetrated the skin and ensure the intradermal injection itself, the needle is slightly raised, pulling the skin. After the introduction of tuberculin, a specific bulging of the upper layer of the skin, better known as a "button", is formed.

How to care for the "button"?

The simplest answer is no. In any case, until the evaluation of the results. It is not necessary to smear the place where the sample was placed with brilliant green, peroxide. No need to seal the wound with adhesive tape - under it the skin can sweat. Do not allow the child to comb the "button". remember, that improper care at the injection site of tuberculin can affect the result of the test, and this is not necessary for either the patient or the doctor.
After evaluating the results, if an abscess or sore has formed, it can be treated like any other wound, using all traditional means.

How are the results evaluated?

“It doesn't matter how they voted, it's important how they counted” - the authorship of this commonplace statement about the elections is attributed to Stalin. One cannot but agree with the leader - the most important thing in the Mantoux test is not the setting, but the evaluation of its results, and even more important - the conclusions from the result of the test evaluation.
After the introduction of tuberculin, on the 2-3rd day a specific thickening of the skin is formed - the so-called. "papule" (infiltration, compaction). In appearance, this is a rounded area of \u200b\u200bthe skin that rises slightly above the skin. When you lightly press it with a transparent ruler (or if you press and release it with your finger), it should turn slightly white. Unlike simple redness, to the touch (although this is not always possible to catch with your fingers), the papule differs from the surrounding skin in its consistency - it is denser.

From the point of view of anatomy, this papule is the result of a kind of saturation of the skin with cells, namely lymphocytes, sensitized (that is, sensitive) to the Koch stick. Naturally, the more lymphocytes “knowing” about mycobacteria in the body, the greater the infiltrate (papule) will be.
The size of the papule is measured under sufficient illumination with a transparent (so that the maximum diameter of the infiltrate is visible) ruler on the 3rd day (48-72 hours) after the introduction of tuberculin. The ruler should be transverse to the longitudinal axis of the forearm. It is not allowed to use a thermometer and other “improvised materials” for measurement, such as graph paper and homemade X-ray film rulers. Only the size of the seal 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 and evaluating the results of the Mantoux test. Strictly speaking, tuberculin can be administered in several ways - cutaneous (Pirquet reaction), intradermal (normal Mantoux) and using plastic applicators, on the pointed ends of which tuberculin is applied (in addition, other substances can be applied to simultaneously set up other samples).
We will focus on two approaches to evaluating results - Russian and American. It should be immediately emphasized that in addition to the methods of assessment, the methods of setting also differ. So in domestic practice, the Mantoux test is set with 2 TU, while in the USA they put a test with 5 TU. The American method of assessment differs in taking into account the degree of risk of infection with tuberculosis in a given patient, depending on this, the size of the infiltrate is also interpreted.

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

The composition contains:

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

Indications for carrying out

Children up to 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 to the skin in the area of the upper arm.

In no case 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 cuts 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 drugs or alcohol;
stick a plaster on the wound;
scratching and touching the papule with dirty hands.

Evaluation of results

The test is evaluated by the size of the papule 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 must be carried out again, since it is not clear whether there was a response to the introduction of tuberculin;
A papule 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 from 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 carried out. This assessment of the incidence of tuberculosis is called a graduated test. Unlike the Pirquet test this reaction shows the differential diagnostic characteristic. It is also called the Grinchar and Karpilovsky test. The execution techniques are very similar, the only difference is that four notches are made, instead of one, having previously treated the skin with carbolic acid.

After that, tuberculin of varying degrees of concentration is applied: 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 the introduction of tuberculin is evaluated after two to three days. These diagnostic tests do not show the localization of tuberculosis, but allergic reaction for the introduction 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 100% and a 25% solution, and to a 5% and a 1% solution there is no reaction;
Hyperergic - inflammation for all types of concentration, and the greater the percentage of the reagent, the more pronounced the reaction of the body;
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.