The Mantoux reaction or tuberculin test is by far the most common and affordable way checking for the presence of tuberculosis infection in the body. Negative Mantoux in tuberculosis is a good sign, but does not completely exclude the presence dangerous pathogen. That is why timely vaccination and monitoring of the results of its implementation is so important.

To represent the Mantoux test

Tuberculosis is considered to be one of the most widespread and dangerous diseases, which most often affects the fragile children's body. For this reason, vaccination against the disease is done even in the hospital, a few days after the birth of the baby. Thanks to BCG vaccination, the immune system of the baby is activated, antibodies are produced against the infection.

A year later, the first Mantoux test is carried out in order to find out in this way whether the child has developed immunity to infection, and whether the BCG vaccination was effective.

At the core this method is the introduction of tuberculin under the skin - a drug artificial origin, which includes highly purified waste products of the virus. It works on the principle of litmus paper - either a pronounced reaction appears at the injection site, or a Mantoux test for tuberculosis gives negative meaning.

Tuberculin diagnostics is carried out annually to find out whether Mantoux will be negative for tuberculosis, and whether the corresponding antibodies have been developed.

How is a tuberculin test performed?

Tuberculin diagnosis is carried out in a polyclinic, or, if we are talking about organized groups children (kindergarten, school), in a separate room nurse who have received appropriate training.

It is very important to conduct a study before any vaccinations, otherwise the result may be distorted. If at this moment the child is sick, the sample is taken a month after treatment and full recovery. Diagnosis is carried out annually, starting from the first year of life.

• For the Mantoux test, disposable special tuberculin syringes are used.
• Tuberculin injection is injected into the middle third of the forearm, subcutaneously
• At the injection site, an infiltrate or papule should form, outwardly resembling a lemon peel light color, up to 1 cm in diameter. After 20-30 minutes, it disappears from the surface of the skin
• The response of the body is formed after 72 hours, according to which the specialist draws a conclusion about the state of immunity. Papule measurements are carried out with a transparent ruler, placing it perpendicular to the axis of the forearm, and the data in without fail are brought into medical card child or vaccination card.

Test results

In fact, the Mantoux test is a test that has much in common with an allergy test. The reaction to it can be of several types:

If, during the course of the study, the physician suspected possible infection, he gives a referral to a specialized TB dispensary in order to hand over additional tests and consult a narrow specialist - a phthisiatrician.

Negative Mantoux test - dangerous or not?

Despite the fact that it is a negative value that is considered within the normal range when the diameter of the papule is less than 1 mm, in practice this result is far from always unambiguous, and with Mantoux tuberculosis it can be negative.

Such a false negative reaction to a vaccine can be caused by the following factors:

• The infection has happened in the last few weeks. In this case, after 10 weeks, a second vaccination will be required.
• Delayed counter reaction child's body caused by weakened immunity, its instability, beriberi, general exhaustion
• Serious violations immune system, AIDS disease weakens the body, which is not able to resist mycobacteria at the proper level. To obtain a reliable picture, you need additional diagnostics and testing with increased concentration tuberculin.

Mantoux test for tuberculosis backlash does not cause concern if the child has never been vaccinated with BCG before: the body is not infected, but immunity to tuberculosis is completely absent. Such children may be offered to undergo revaccination.

Proper care after the Mantoux test

If you take care of the injection site incorrectly, you can achieve a distortion of the result. Basic rules of conduct after tuberculin test:

• Until the doctor evaluates the reaction of the body, in no case should the injection site be treated with brilliant green, hydrogen peroxide, iodine or any other antiseptic
• Eliminate contacts of papule with water
• You can’t stick a “button” with a band-aid - the skin under it will start to sweat
• It is necessary to ensure that the papule is not scratched and touched as little as possible.

After checking the reaction, you can treat the wound or abscess, if any, with a suitable antiseptic.

When a doctor informs parents that a child has a positive Mantoux reaction, they have a number of questions about how good or bad it is. In order to correctly perceive the words of a health worker, it is worth delving into the principle of determining tuberculosis infection using a tuberculin test.

Which reaction is better: negative or positive

After the test for tuberculosis (Mantoux test), 72 hours must pass before the result can be determined. For evaluation, the measurement of the papule is used - the pineal seal, which forms at the injection site of the drug. What does this score mean and what does the papule look like if the child is positive or negative?

Allocate the following types test result:

1. A negative Mantoux reaction is the absence of induration or redness around the injection site. This usually indicates total absence contact with mycobacteria. But for doctors, such a result can serve as a signal for another vaccination against tuberculosis.
2. A dubious Mantoux reaction is observed with the possible presence of a small number of tubercle bacilli in the body, but sometimes it also occurs when the test is performed incorrectly, the use of low-quality tuberculin, or non-compliance with the rules for caring for the injection site. The papule in this case reaches a size of 1-4 mm. A repeat test may be ordered to clarify the result.
3. A positive reaction to Mantoux is characterized by the formation of a seal of 5-10 mm. If the sample is even larger (17 mm) or there is suppuration, then the reaction is called hyperergic. This is the worst possible outcome. Positive and hyperergic reactions with big share probabilities indicate that a person has been infected with tuberculosis or even the onset of the disease. Bad Mantoux is especially alarming for doctors if before that all tests gave a negative result.

But positive result is not a judgment. In some cases, the appearance of a large papule is considered a variant of the norm.

When not to worry

After vaccination or revaccination (vaccination against tuberculosis), a positive Mantoux reaction in a child can be observed due to the fact that antibodies to a tubercle bacillus are produced in the body. The preparation for the Mantoux test, or tuberculin, contains a certain amount of waste products and cell membranes of mycobacteria. Due to the recognition of the protein of bacteria as pathogens themselves, the child's body begins to direct to the injection site of tuberculin a large number of leukocytes. Protective cells provoke local inflammation and lead to the formation of a seal.

If a positive reaction occurs in the first year after vaccination, then this means that BCG vaccine started to act. The child's body will be protected from tuberculosis, and bacteria that accidentally enter it will receive an adequate response from the immune system.

The question of what to do when the Mantoux reaction is negative and what it means, in such a case, the doctor should decide. For parents, a negative Mantoux result in the first year after vaccination means that for some reason the child has not received immunity and one should be careful about his contacts with relatives and other adults. Mycobacterium tuberculosis can be easily transmitted by airborne droplets, be on household items or in street dust.

But what if the Mantoux test is positive and this is not due to a recent vaccination against tuberculosis? In this case, you should not worry yourself and make the child nervous: if vaccination was not carried out (at the request of the parents or due to other reasons), then a positive reaction only indicates the penetration of microbes into the body. With a strong immune system and good general condition the child may not develop the disease. This means that mycobacteria live in the body in a latent form.

The danger of this condition is that when immunity is weakened due to external cause(stress, infection, etc.) may begin the development of tuberculosis. In order to determine this in time, samples are carried out annually until the age of 18 years (the Mantoux reaction in adults is usually not performed). If necessary, the pediatrician will give a referral to an appointment with a phthisiatrician, in a tuberculosis dispensary. The child will be assigned additional examinations and treatment.

If the Mantoux reaction becomes smaller

Immunity after vaccination lasts for 7-8 years. With the annual Mantoux test, you can notice a gradual decrease in the papule. This indicates that mycobacteria did not enter the body, and the immune response becomes weaker every year. To restore immunity against tuberculosis, the child is given 2 BCG revaccinations: at the age of 7 and 14.

After these vaccinations, an increase in the papule should be observed again after 1 year, and then a gradual decrease in the result at the next test. But the child at school begins to actively contact children and adults, among whom there may be carriers of mycobacteria.

What is a bend in the Mantoux test

If in an organism with immunity obtained as a result BCG vaccinations, the causative agent of tuberculosis enters, then the immune system copes with it on its own. The disease does not develop, but during the next annual test, a positive, or bad, Mantoux reaction appears. Often in such cases, the size of the papule differs from the previous result by 6 mm or more, or the usual negative Mantoux test becomes positive. This result is called the turn of the tuberculin test. What does such a reaction of the body mean?

Virage is a sign of infection with tuberculosis. When immunity is formed, the disease may not begin.

Nevertheless, the pediatrician, upon detection of a turn, gives a referral for examination by a phthisiatrician. The child can be registered in a tuberculosis dispensary and monitored to determine if a local process is developing in the body. If a specialist prescribes medication, then you need to follow his instructions accurately and strictly: treatment helps the body to better cope with mycobacteria on initial stage disease development.

What can affect the result of Mantoux

For the Mantoux test to give reliable result, it is forbidden to carry it out on the day when they are vaccinated against other diseases. When using vaccines with inactivated microbes and viruses (influenza, tetanus or diphtheria vaccinations), a Mantoux test is allowed only after 30 days. Live vaccines (for hepatitis, measles or rubella) require a test no earlier than 45 days after vaccination.

Before the test, the pediatrician must examine the baby. If the child is sick with ARVI, then the procedure cannot be carried out: the Mantoux reaction in such a case can give a positive result, regardless of the presence of Mycobacterium tuberculosis in the body. The test is rescheduled. Between the recovery of the child and the Mantoux test, at least 30 days must pass.

For the tuberculin test, there are direct contraindications:

• identified allergy to the drug;
• exacerbation seasonal allergies to pollen or the presence of other allergic reactions (to wool, food, etc.);
• infectious diseases in the acute phase;
• dermatological diseases;
• Sokolsky's disease;
• asthma;
• epilepsy.

If the child attends children's institution, then the Mantoux test is not carried out during quarantine and within 1 month after its removal.

The results of the tuberculin test can also be affected by a violation of the rules for caring for the injection site of the drug.

Parents who independently bring the child to the clinic receive information from the local pediatrician. When testing in kindergarten educators are required to notify parents that the children have had a Mantoux test. Within 72 hours after the injection, it is not recommended:

• rub the injection site with a washcloth or towel;
• stick it with a plaster;
• lubricate antiseptic solutions(brilliant green, iodine, etc.);
• wear clothes that press on the skin (sweaters, turtlenecks);
• v summer time should refrain from swimming in open water.

In case of violation of the rules or accidental injury to the injection site, a false positive test Mantoux, which will make the doctor react in the same way as when receiving a positive reaction to the test. Parents should notify the doctor about the factors that distort the result.

If positive result tuberculin test is not a consequence of violations during its implementation, then the phthisiatrician should make a conclusion about the child's condition. To establish the onset of the disease or infection with tuberculosis, fluorography may be prescribed. chest, sputum examination and other tests. All family members should be tested to determine the source of the infection.

V childhood The disease may begin insidiously but progress rapidly to clinical form. Therefore, conducting annual tuberculin tests is a necessity, and not an invention of unknown enemies of the state. The Mantoux test should not be feared, nor should it be treated negatively: there are no live or killed bacteria in the preparation. Tuberculin contains only protein substances by which the body recognizes pathogenic microorganisms.

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A negative Mantoux test means that the body does not react to pathogenic mycobacteria that cause tuberculosis. But such a result does not exclude the presence of infection, and this is not always good. There is an opinion of experts that such a condition indicates a weakened immune system of the child, and he is not able to fight the causative agent of the disease.

A negative Mantoux reaction is determined in the absence of a papule under the skin or its size is not more than 1 mm in diameter. To determine what such a reaction means, it is important to understand why the test is being done.

One of the ways to diagnose tuberculosis is the Mantoux test, a diluted mixture of tuberculin is injected into the hand.

The procedure is carried out for the first time to a child after a year old, this is testing for the presence of a tubercle bacillus in a person. This method will allow diagnosing the disease on early stage. With a violent reaction of the body, there are characteristics. According to the results of vaccination, preventive measures, to prevent serious complications diseases. Mantoux has been the main method for detecting infection in many countries where the problem of infecting the population was too acute.

Before vaccination, newborns still in the maternity hospital must be given BCG, vaccination helps a small body develop immunity against the causative agent of the disease.

A year later, the first test is carried out, according to the Mantoux reaction, it is possible to determine how the immune system reacts when it comes into contact with a tuberculosis infection.

A negative Mantoux reaction in children is considered normal, but it does not show how strong the immunity against the pathogen is. Therefore, an injection is carried out every year for all children under 14 years of age to determine the effectiveness of vaccination, the presence of antibodies in a child to pathogenic mycobacteria.

To obtain correct result after vaccination, not only the size of the button is taken into account, but also other data:

• BCG vaccination in the maternity hospital;
• the result of the previous injection or all vaccinations in dynamics;
• concomitant diseases, allergic deviations.

For the result to be reliable, it is important to adhere to the recommendations of experts:

• do not lubricate the injection site with ointments, brilliant green, and other means;
• it is forbidden to glue the patch;
• forbid the child to wet his hand, scratch the tuberculin test;
• before the procedure, do not include new products in the child's diet that cause allergies.

If you do not follow these rules, the result will be false. When an injection brings great anxiety, a doctor should be consulted.

The Mantoux reaction in a child is carried out in a clinic or by a nurse in a preschool institution, school. Before the procedure, the doctor necessarily examines the child, clarifies the reaction of the previous vaccination, establishes the presence of contraindications to the tuberculin test.

The injection is made under the skin with a thin syringe, the seal is observed after two days.

Worker medical institution measures the button with a special ruler, the result of vaccination depends on the size of the seal:

• If the Mantoux reaction does not exceed one millimeter, this is a negative reaction;
• A positive reaction is the size of a button up to 16 mm;
• If the vaccine turned red without a seal about 4 mm in size, this means a dubious reaction;
• There is a pronounced condition on Mantoux, when the button is more than 17 mm.

A positive result does not always mean bad, it does not establish the presence of pathogenic mycobacteria in a child. Sometimes excessive redness indicates an allergy to the drug. The button becomes big size due to personality skin when the baby has recently been ill infectious disease, there are worms.

Contraindications

Many parents are against vaccination for fear severe consequences and complications, but without vaccinations, an epidemic of various infectious diseases that threatens all of humanity.

This means that the Mantoux test must be carried out with the exception of contraindications in a child:

• colds, runny nose;
• exacerbation of the disease;
• individual intolerance active substance drug;
• serious pathological disorders.

It is impossible to conduct a test simultaneously with other vaccinations, which means the introduction of preparations of different composition, this will cause false positive result may adversely affect health.

A tuberculin test is done no earlier than a month after another preventive vaccination.

Any result causes excitement among parents, but show the child to a phthisiatrician and conduct additional diagnostic examination necessary if:

• hyper allergic reaction for an injection;
• there is a bubble at the injection site;
• each time a negative result on the sample;
• constantly the size of the button becomes large over the years.

An accurate diagnosis will help determine the x-ray, this additional type of study will allow the phthisiatrician to establish an adequate picture of the patient's condition with a dubious reaction.

There is no need to abandon the tuberculin test, it will determine the resistance of the immune system against pathogenic mycobacteria. The drug stimulates protective function organism. With any deviation, it is important to consult an experienced doctor in order to prevent serious consequences.

The Mantoux test is a test of the body's response to a small dose of tuberculin. Some mistakenly consider it a vaccine, but this diagnostic procedure. According to the condition of the skin at the injection site, the doctor sees how lymphocytes react to foreign cells, and draws a conclusion about the health of the child: is it possible to vaccinate him against tuberculosis or is there already a prerequisite for the development of the disease.

The main method of preventive examination of children for tuberculosis is the Mantoux reaction.

Who gets tested and when?

The first Mantoux test is carried out at the age of 1 year, because. earlier, the baby's immunity has not yet been fully formed, and the result may be unreliable. Further, the procedure is repeated once a year until the child reaches the age of 14, regardless of the results of the last test. According to the reaction of the body, a decision is made to revaccinate BCG at the age of 6-7 years and 14 years. If for some reason the child did not receive a BCG vaccination in the maternity hospital, then Mantoux is carried out every 6 months until the moment of vaccination.

What should be the normal Mantoux reaction, and how does it look on the skin?

This article talks about typical ways to solve your questions, but each case is unique! If you want to know from me how to solve exactly your problem - ask your question. It's fast and free!

The reaction to the Mantoux test manifests itself in the form of a red seal, "buttons" on the skin - in fact, this is a local allergic reaction to tuberculin. Lymphocytes try to localize the penetration of a foreign substance, so a small focus of infiltration occurs. The photo shows an example of a reaction - redness and a tubercle.

A normal reaction to Mantoux is evaluated only in dynamics. There is no single indicator of the norm for all. The phthisiatrician fixes the size of the papule (the degree of redness does not matter) three days after the procedure itself, and in comparison with the results of tests from previous years, draws a conclusion about the state of the child's anti-tuberculosis immunity.

Normally, the size of the infiltrate spot should decrease by 1-2 mm every year, and by the age of 6-7 years, with the next sample, the papule does not appear at all. In this case, the reaction is classified as negative, and the child is given BCG revaccination.

Is it good or bad that the child has a negative Mantoux?

The absence of a button, i.e. infiltration and redness at the injection site of tuberculin is considered a negative Mantoux reaction. At this stage, many people have a question, is it good or bad? Why is there no reaction? Does this mean that the child is protected from tuberculosis or, conversely, defenseless against this disease? An exact answer can only be given by a specialist, having studied the history of all past tests and vaccinations of the child.

A negative Mantoux reaction indicates that there are no active Koch sticks in the blood, but there are no antibodies either. That is, the child's body either never came into contact with the causative agent of tuberculosis at all, or encountered it a long time ago and managed to completely overcome it.

What can affect the reliability of the results?

The situation when the button is missing (how it looks like is shown in the photo: no redness and papule, only a prick mark) is usually recognized negative result, that is, a variant of the norm. The difficulty of an accurate assessment is as follows: when Mantoux is interpreted as negative, this can mean both strong immunity against tuberculosis, and vice versa, its absence due to the ineffectiveness of the vaccine. So the decision on the assessment is made by the phthisiatrician based on the study of the results of past samples.

Reasons for the lack of response to the Mantoux test

A null Mantoux reaction means no immune response to tuberculin. Possible explanations for this situation are:

1. Inefficiency last vaccination BCG (spoiled vaccine, go for other reasons), therefore - lack of resistance to Koch's sticks.
2. Expressed immunity, formed as a result of previous BCG vaccinations.
3. Innate immunity to tuberculosis. Some people have a genetic resistance to Koch's wand. In this case, the child's body will not react to tuberculin at all, regardless of age and number of samples. You can additionally check this option by examining the scars from BCG vaccination in the baby's next of kin - if they are absent or almost invisible, it is most likely that innate immunity takes place.
4. Tuberculosis infection. If at the time of the test the child is already sick, the reaction will be weak or negative. The same thing happens with a decrease in immunity - the body may not react with tuberculin if its defenses are weakened by any disease.
5. Poor-quality drug tuberculin. If during the next test there is no reaction or too weak (no papule, no redness, only a trace of a skin puncture), errors may have been made during storage, transportation or administration of the drug. In such a situation, re-vaccination is prescribed within 10 days.
6. Conducting a test with the known presence of contraindications: recent vaccinations, colds, exacerbation of chronic diseases, etc.

Is it possible for a baby not to do a tuberculin test?

Parents have the right to refuse the diagnosis of tuberculosis by Mantoux test. No restrictions on further admission to schools for the child will not, and if such problems arise, the parents will have the right to demand a written explanation of such a decision, which can be applied to the court.

In order to correctly argue their position, it is useful for parents to study the documents regulating the actions of any public institutions in the aspect of medical (including anti-tuberculosis) care or refusal of it.

This moment is described in the following regulatory documents:

• order of the Ministry of Health of the Russian Federation No. 109 dated March 21, 2003;
• FZ-77 "On Preventing the Spread of Tuberculosis in the Russian Federation";
• sanitary and epidemiological rules SP 3.1.2.3114-13 "Prevention of tuberculosis";
• Decree of the Government of the Russian Federation No. 892 dated December 25, 2001;
• Decree of the Government of the Russian Federation No. 62 dated April 22, 2003;
• Decree of the Chief State Sanitary Doctor of the Russian Federation dated October 22, 2013 No.

When deciding whether to do a Mantoux test or not, parents need to consider the issue carefully. The tuberculin test stimulates the immune system and at the same time allows you to determine the level defensive forces organism in the fight against mycobacteria. In addition, it helps to identify tuberculosis, even if the infection has occurred recently and symptoms have not yet appeared.

If there are any contraindications for the health of the child (chronic or acute illnesses, organic pathologies, allergies, etc.), the decision on the appropriateness of the test is made by the doctor. Subject to the above conditions and the absence of contraindications, the Mantoux test will not harm the child's body. In any case, when making this or that decision regarding the tuberculin test, parents are not obliged to explain their motives to anyone.