Mantoux reaction or tuberculin test- This 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 the results of its implementation are so important.

To represent the Mantoux test

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

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

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

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

How is a tuberculin test performed?

Tuberculin diagnostics is carried out in a clinic, or, if we're talking about about organized groups children (kindergarten, school), in a separate office by a nurse who has undergone appropriate training.

It is very important to conduct research before any vaccinations, otherwise the result may be distorted. If the child is sick at this moment, 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 administered into the middle third of the forearm, subcutaneously
• An infiltrate or papule should form at the injection site, resembling a lemon peel in appearance. light color, up to 1 cm in diameter. After 20-30 minutes it disappears from the surface of the skin
• The body’s response is formed after 72 hours, from which the specialist draws a conclusion about the state of immunity. Measurements of the papule are carried out with a transparent ruler, positioning it perpendicular to the axis of the forearm, and the data in mandatory entered 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 examination the doctor has suspicions about possible infection, he gives a referral to a specialized anti-tuberculosis dispensary to test on the spot additional tests and consult a specialist - a phthisiatrician.

Negative Mantoux test - dangerous or not?

Despite the fact that a negative value is considered within normal limits when the diameter of the papule is less than 1 mm, in practice this result is not always unambiguous, and in case of tuberculosis Mantoux can be negative.

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

• The infection occurred in the last few weeks. In this case, repeated vaccination will be required after 10 weeks.
• Slow counter reaction child's body caused by weakened immunity, its instability, vitamin deficiency, general exhaustion
• Serious disorders of the immune system and AIDS weaken the body, which is unable to resist mycobacteria at the proper level. To obtain a reliable picture you will need additional diagnostics and testing with increased concentration tuberculin.

A Mantoux test for tuberculosis with a negative reaction 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 revaccination.

Proper care after the Mantoux test

If you do not properly care for the injection site, you can distort the result. Basic rules of conduct after a tuberculin test:

• Until the doctor assesses the body's reaction, under no circumstances should you treat the injection site with brilliant green, hydrogen peroxide, iodine or any other antiseptic.
• Eliminate contact of the papules with water
• You can’t cover the “button” with a band-aid - the skin underneath 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.

The Mantoux test is one of the most popular methods for diagnosing tuberculosis. The study is carried out on all children 1 year of age and older, and the reaction to the injected drug may be different for each child. Why does a child have a negative reaction? Is this condition dangerous? What should a papule normally be like? Let's figure this out together.

What is the Mantoux test?

The Mantoux test allows you to diagnose tuberculosis. The procedure is carried out in countries where there is an unfavorable situation with this disease (this list includes Russia), and is indicated for:

• diagnostics of patients newly infected with tuberculosis;
• confirmation of the presence of the disease;
• identification of persons infected a year earlier (if the papule grows to 6 cm or more);
• selection of children who are planned to be re-vaccinated with BCG.

The first time tuberculin is administered to a child is 1 year old; doing this earlier is prohibited, since the reaction to the antigen can be unpredictable. The immune system and skin of a newborn are too sensitive to various irritants, so the result may be unreliable.

The test is carried out once a year. More frequent testing may provoke an increase in the sensitivity of the immune system to the drug, as a result of which the result will be incorrect. Tuberculin is administered to children under 14 years of age, regardless of how the body responded to the previous Mantoux. So, children 6-7 and 14 years old are selected for BCG revaccination - they are vaccinated healthy kids, in which the sample has a diameter of less than 1-2 mm.

Test procedure and interpretation of the result

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The Mantoux test is done in hospitals and in medical offices of kindergartens and schools. The sample contains tuberculin, a substance obtained from Koch bacilli (the causative agent of the disease) destroyed by heating.

The principle of action of the drug is to provoke skin inflammation and allergic reaction at the injection site. The injection is given annually in the right or left hand on inside forearms. The zone is divided into three parts, the drug is injected into the middle of the central part of the forearm. The substance is injected subcutaneously with a small syringe, resulting in the formation of a small bubble (see photo).

Parents should monitor the baby, especially if he is 1-2 years old, so that nothing can affect the result. The resulting “button” should not be treated with antiseptics or allowed to get wet. The papule must not be covered with adhesive tape or scratched. After three days, the specialist evaluates the result by measuring the compaction with a ruler. Its value will tell you about the body’s reaction:

• A compaction of less than 1 mm indicates that Mantoux is negative - there are no mycobacteria or immunity to them in the body. BCG vaccination is indicated for children.
• “Button” 5-16 mm indicates positive result. It confirms the fact of infection or contact of the patient with an infected person.
• A papule with a diameter of less than 4 mm or a large red mark without compaction indicates a questionable reaction.
• If there is an infiltrate of more than 17 mm, the reaction is considered severe. Little patient should visit a phthisiatrician - the result may indicate both an illness and hypersensitivity to the drug, or appear against the background of a recently completed BCG vaccination.

There is also such a thing as a test turn, when the reaction to an injected substance changes sharply in the opposite direction compared to previous injections. This phenomenon indicates infection, but only if BCG vaccination has not recently been carried out.

In children of different ages The response to the Mantoux test is different:

• when a child is given tuberculin for the first time, the reaction to it cannot be negative (this is acceptable if there is no scar left from the BCG vaccination);
• at 2 years the size of the papule reaches 16 mm;
• at 3 years of age, the reaction to tuberculin weakens, some children have a negative result;
• at 4–5 years old, the number of children with a negative result increases, the average norm is weak positive reaction;
• at 6 years old dubious result detected in most babies;
• after repeated BCG vaccination, the body’s response remains positive for 5 years;
• by 13–14 years of age, a negative response to tuberculin is considered normal.

Thus, in vaccinated children, the reaction to Mantoux changes depending on how long ago the BCG vaccination was performed - the longer the period, the smaller the “button”.

The result must be compared with last year. In addition, the response to tuberculin depends on the correctness of the manipulation, the characteristics of the body and sensitivity to the drug.

What does a negative body reaction look like?

A negative Mantoux reaction is the absence of redness of the skin area around the injection and swelling. In this case, a papule with a diameter of up to 1 mm is observed, or there is none at all. Slight redness in a child (especially one vaccinated with BCG) and a “button” of up to 2 mm are also equivalent to a negative result. feeling good and the absence of symptoms of the disease.

Most often, this reaction means that the baby is completely healthy, but there are exceptions. Sometimes such a result indicates a lack of immune response to the pathogen or the cessation of action BCG vaccines. What does a papule look like when negative result, can be seen in the photo.

Is it good or bad if the reaction is negative?

If a child does not have a reaction to Mantoux, this indicates that BCG vaccination was ineffective, or he already has immunity to the disease. Often the baby is sent for examination and re-vaccinated with BCG.

If a child has a negative Mantoux reaction, this may mean that his body is weakened and therefore unable to respond to the administered drug. It is impossible to say unequivocally whether this is good or bad - the result may indicate either good health child, and about the presence of problems. There are several reasons why no trace remains on the skin after an injection:

• infection has occurred, so the test must be repeated after 10 days;
• the child is too small – children under 3 years of age often get a questionable, false-positive or negative result;
• the baby is a carrier of HIV infection - you can increase the dose of tuberculin or do Diaskintest.

Lack of reaction to the Mantoux test is possible for other reasons:

Should a child have a Mantoux test?

Parents often think about whether it is necessary to do a Mantoux test, worrying about undesirable consequences from the administration of tuberculin. Active substance harmless during diagnosis and does not affect immune cells, but in lately there are many children with hypersensitivity to him. Some kids quickly forget about the injection, while others get sick for a long time and complain of being unwell.

Often parents in medical institutions are afraid that the child will not be accepted into kindergarten or school if he doesn't will undergo diagnostics tuberculosis, but this is not the case. The legislation secures the right of children who fail the test to attend an educational institution - no one can force adults to give their child Mantoux. Parents can write a refusal to take the test at the clinic.

However, it is worth remembering that tuberculosis is one of the most dangerous diseases that can lead to fatal outcome. The BCG vaccination cannot protect against infection, but it does prevent serious complications. Many experts consider Manta to be the only method that in almost 100% of cases helps to identify tuberculosis and problems with the immune system in time. By refusing the test, parents risk their child's life.

If the baby has inherited immunity to Koch's bacillus, he is one of the lucky 2% whose immune cells instantly destroy the pathogen as soon as it enters the body.

However, most children are still at risk of the disease. The test is not carried out if:

• allergies to tuberculin;
• asthma;
• epilepsy;
• availability chronic disease V acute form or quarantine in an educational institution are (temporary obstacle).

Alternatives

Today there are several alternative methods Mantoux test, including PCR analysis, blood and urine tests, as well as Diaskintest. However, none of the methods gives a 100% guarantee of detecting the disease. Diaskintest works only when infection has already occurred, and a negative result will be visible in the absence of infection or after complete recovery from tuberculosis. It does not respond to the BCG vaccine, so the need for re-vaccination cannot be determined using it.

The Mantoux test is one of the most common methods for diagnosing tuberculosis. It is first performed when the child is one year old. In the future this examination carried out every twelve months. It allows you to identify the disease early stages its development, when serious adverse symptoms that threaten the life and health of the patient have not yet arisen. Test results can vary greatly, so it is important to know what they mean. This also applies to those cases where a negative Mantoux reaction is diagnosed.

When is the Mantoux test done?

World organization Health Protection Authority (WHO) has determined that the Mantoux test should be carried out in those countries where there is an increased threat of the spread of such dangerous disease like tuberculosis. According to statistics, almost all states Eastern Europe still couldn't get to the state low level infection of citizens with Koch's wand. At the same time, even Western countries still consider the risk of spreading tuberculosis to be very high. Therefore, for example, in the USA and France, the Mantoux test is also used to detect new cases of infection, both adults and children.

Thus, vaccination is done in all the following cases:

1. The need to identify people newly infected with the virus that causes tuberculosis.
2. Identification of sick people who have a hyperergic reaction to the introduction of tuberculin under the skin.
3. Detection of patients infected with Koch's bacillus more than a year ago, but with a significant increase in infiltrate - more than 6 millimeters.
4. Confirmation that a person has a disease such as tuberculosis.
5. Selection of children who need to be re-administered the BCG vaccine.

This disease can affect many internal organs human, symptoms of tuberculosis genitourinary system and lungs can be very diverse, if no action is taken to treat it, there can be disastrous consequences.

Due to the fact that tuberculosis is a current problem in a large number of countries, parents of children need to know literally everything about the Mantoux test.

Reaction to tuberculin

In order to understand the results of the examination, you need to know what the reaction to tuberculin is. There are 4 main types, but first it is necessary to consider the features of BCG vaccination. The possibility of examining a person using the Mantoux test depends on the latter.

BCG vaccination in accordance with the rules is carried out on the 10th day of a child’s life. This vaccine is a weakened tuberculosis virus. It is necessary for the patient’s immunity to encounter the pathogen for the first time and learn to fight it, launching its own mechanisms aimed at this process.

Thus, when a Mantoux test is given to a baby at the age of 1, a peculiar allergic reaction, by analysis of which it is possible to determine whether the child became infected during the previous period of time or not.

Signs of a positive and negative reaction are as follows:

• papule size;
• the appearance of redness;
• enlargement of nearby lymph nodes;
• the appearance of itching, burning or pain.

All of the above factors are analyzed by a doctor 72 hours after the Mantoux test to assess what kind of reaction has occurred. Only after evaluating the result is an appropriate conclusion made.

The following results are available:

1. Negative reaction. It means that the body does not have Koch's bacillus, the causative agent of tuberculosis.
2. Questionable reaction. It can occur both due to the presence of a pathogen in the body, and due to the influence of many other factors.
3. Positive reaction. In most cases, it indicates that the patient is infected.
4. Hyperergic reaction. In such cases, you need to understand that the person being examined is probably going through active process tuberculosis.

Thus, if a child has a negative Mantoux reaction, this means that he does not have a dangerous pathogen in his body. Therefore, for a certain period of time you can be completely calm about the state of your baby’s health. A negative reaction cannot negatively affect the patient’s condition.

It is important to understand what the examination may indicate if there is no reaction to Mantoux. Most people think that this is a good thing and therefore there is no need to worry about anything. Experts agree with this opinion, but not always.

Negative reaction

Negative Mantoux test medical practice in most cases it is considered normal. It is characterized little education papules up to 1 millimeter. At the same time, such a result may also indicate not entirely favorable processes in the patient’s body.

Human immunity can be both active and passive. In the first case, it reacts to the introduction of bacteria into the body, and in the second, to the vaccine. The latter option is only possible when the child has been vaccinated with BCG. If it was not there, the lack of reaction to Mantoux is a completely predictable result. He says that the patient does not have the disease, but at the same time he also does not have immunity capable of fighting it.

Thus, if the Mantoux test is negative in cases where there was a previous BCG vaccination, this means that the patient has not created immune mechanisms, allowing you to deal with the problem.

The Mantoux reaction of a child can be negative and positive. However, to determine how bad it is, it is necessary to know the patient's medical history. In the case where he was vaccinated with BCG immediately after birth, the absence of a reaction to Mantoux at one year is considered unfavorable factor. It indicates a lack of immunity to Koch's bacillus.

To determine what a negative Mantoux reaction means - a better or a bad result - you need to know what vaccinations the child was given in childhood.

The longer the time has passed since the BCG vaccine, the less pronounced the consequences of the introduction of tuberculin under the skin will be.

Positive reaction

Positive sample, like the negative reaction to Mantoux, cannot be interpreted in any unambiguous way. In most cases, the appearance of a large papule is a sign of an infection in the body. However, it is worth paying attention to the following:

• if in early childhood you have been vaccinated with BCG, the reaction to Mantoux should be positive or doubtful for several years;
• If a negative reaction to Mantoux is detected after BCG vaccination, the child must undergo revaccination.

Thus, a positive reaction to Mantoux is not always a good or bad result. This depends on how much time has passed since the last BCG vaccination.

Hyperpositive sample

In some cases, after the Mantoux test, a too strong reaction occurs, which means the following:

• the child has genetic predisposition to tuberculosis;
• the quality of the drug used is low.

In some cases, a hyperpositive reaction occurs in children preschool age, if they have dermatological diseases. In such situations, specialists diagnose tuberculosis in other ways. Among them, it is first of all worth highlighting.

What does redness after vaccination mean?

The size of the button and the redness are those external factors, which many parents pay attention to when their children have had the Mantoux test done. In fact, when analyzing the results, doctors pay attention only to the diameter of the papule. They are not interested in other indicators if they do not go beyond the norm.

A negative reaction to Mantoux can occur even with quite extensive hyperemia skin. Redness in such cases does not indicate the presence of a disease. It may arise due to completely various factors.

Some patients believe that redness after the Mantoux reaction means that they have some kind of allergy. In fact, hyperemia in most cases is only evidence of the penetration of third-party substances under the human skin. This way the body lets you know that it has recognized the drug.

Many people have a question about what to do if Mantu is not visible. This should only be decided by a doctor after analyzing the results obtained. In some cases, an additional visit to the doctor is indicated, in others, revaccination is indicated. BCG vaccination, thirdly - waiting next year carrying out diagnostics.

Additional examinations for redness of the skin after Mantoux are not required. After a few days, this hyperemia completely disappears without any consequences.

Cases for referral to a tuberculosis clinic

Having done the Mantoux test, you need to understand what the resulting reaction means in a particular case. First of all, it is important to know when to see a doctor for additional examination.

Experts advise taking your child to a TB doctor after Mantoux in the following situations:

1. A hyperergic reaction to manipulation appeared.
2. A large papule with fluid has formed at the injection site.
3. A negative reaction to the drug continues for more than 3 years in a row.
4. The size of the seal increases every year.

Contacting a physiatrist is necessary to confirm or rule out tuberculosis. This doctor with the help additional methods diagnostics is able to determine the presence of infection in the body and prescribe appropriate therapy.

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In most cases it should be perceived very positively. Most often, this means that the child is doing well and is not infected with Mycobacterium tuberculosis. Moreover, in some cases, such a result may indicate the presence of sufficient dangerous pathology. Neither option should be overlooked.

When do we talk about a negative test reaction?

After the administration of highly diluted tuberculin, which is neutralized microorganisms, a certain reaction develops, which may indicate the presence/absence of the disease in a person. It is injected under the skin inner surface forearm with a syringe. A few days later the child is examined nurse. She should measure the size of the red area at the injection site using a flexible ruler.

A negative result is diagnosed in cases where there is no spot at the site of tuberculin injection at all. There is only a trace from the injection, which does not exceed 0.1 mm in diameter.

If the Mantoux reaction is negative, what does this mean? Experts disagree on whether this is good or bad, or whether it is always true. The reasons for this result may be the following situations:

In order to assess what specific cause was decisive in the development of negative Mantoux, if symptoms of the disease are present, an additional medical examination is carried out.

If the Mantoux reaction is negative, then most often this indicates that the baby has never had contact with the tuberculosis pathogen. Among other things, this test result indicates that the child has not been vaccinated with BCG or its validity period has expired.

That is, a negative Mantoux test means that the child is not infected and is completely safe at the time of the examination. However, this also means that the baby does not have immunity from Mycobacterium tuberculosis.

That is, he has increased risk encounter a disease caused by this pathogenic microorganism. This factor is taken into account by specialists and therefore they try to carry out BCG vaccination to this child.

What should parents and child do?

First of all, it should be understood that negative Mantoux is not a pathological sign. In the vast majority of cases, it occurs in children who either have not been vaccinated or are simply characterized by reduced susceptibility to the causative agent of tuberculosis. All other options are quite rare, and most often parents know about the presence of such additional factors in advance.

If there are any doubts about the baby’s health, you can refer him to a pediatrician for consultation. This specialist will prescribe certain research methods that will exclude the presence of diseases.

If the reaction to Mantoux turns out to be negative, then parents should think about vaccinating their child. She will help young body fight Mycobacterium tuberculosis in cases where it gets inside. You should not hope that the baby may never encounter such an infection. According to doctors, this pathogen occurs in 90-95% of children aged 10-12 years. So it’s better to play it safe and get vaccinated.

Many people today refuse to carry it out because they are afraid of their children becoming infected with tuberculosis during vaccination. Such fears are unfounded for the following reasons:

So there is no point in being afraid of vaccination after a child’s Mantoux test turns out to be negative.

It is worth remembering that acute infectious diseases are a contraindication to Mantoux. This test should be postponed until the child has fully recovered. The fact is that any sharp infectious diseases capable of producing false negative results. As a result, this leads doctors down the wrong path, which means possibly prescribing additional vaccinations for the child, which he absolutely does not need.

In order to exclude the presence of acute infectious diseases, occurring without severe symptoms, before performing the Mantoux test, it is recommended to perform a general examination of patients, as well as measure their body temperature in the axillary region. If the indicators are exceeded, it is necessary to postpone the test indefinitely until complete recovery.

It is recommended to perform Manta for children in winter period. This is due to the fact that in spring and autumn, children develop vitamin deficiencies much more often, which can cause a lack of response to the administration of tuberculin. In summer, the skin sweats faster, and during the study it is strongly not recommended to wet the tuberculin injection site. In winter, it is much easier to avoid getting the tuberculin injection area wet, and vitamin deficiencies during this period are much less common.

Negative test results should not alert the child’s parents. However, if the child’s health deteriorates, it is better to consult a doctor.

They will help identify violations and figure out whether the child’s immunity is strong enough to fight against the causative agent of tuberculosis.