During the Soviet Union, such a terrible disease as tuberculosis was considered almost defeated. When the country collapsed, many republics again found themselves under the threat of the spread of infection. Infection in childhood can lead to the fact that a person will remain disabled for life. But at the same time, many parents have recently refused to vaccinate and conduct tests, not taking into account the fact that the Mantoux reaction is a diagnostic method that everyone needs to help avoid the development of severe and dangerous pathology.
History of the origin of the Mantoux test
For the first time, a substance called tuberculin was used at the beginning of the twentieth century by Charles Mantoux. With its help, a Mantoux test was carried out. It is used to this day, carried out every year for children from 12 months. Doctors say that the Mantoux reaction is the most reliable, safe anda simple method to prevent the spread of such a formidable disease as tuberculosis.
After the discovery of the tubercle bacillus by Robert Koch, attempts began to be made to find a remedy for this terrible disease, including by the microbiologist himself. He managed to create a substance called tuberculin. According to Robert Koch, it was able to protect humanity from pathology. Since that time, tuberculin has been tested on humans, but as it turned out, it is not able to get rid of the disease.
At the same time, thanks to the French doctor Charles Mantoux, the substance was tried as a diagnostic test for the presence of the disease. In the course of research, a French physician noticed that the organisms of a he althy and infected person react differently to the introduction of the drug.
After a while, the diagnostic study was called the Mantoux test. It is not a vaccine, as some parents believe, but a safe and beneficial allergy test that is used all over the world.
Mantoux reaction and BCG
After the birth of a baby who has just been born, BCG is vaccinated against tuberculosis. This usually happens in the maternity hospital, on the 3rd-7th day of the child's life.
The purpose of this procedure is to develop antibodies to tuberculosis bacteria in the body of the newborn. And the first Mantoux test is carried out in order to understand whether this has been achieved. The reaction must be positive, otherwise it becomes clear that the production of antibodies has not occurred, the reactionthe baby's body did not respond to the introduction of the substance. These children are revaccinated when they are six years old. Also, children with a negative reaction to the initial introduction of tuberculin need to have a Mantoux test twice a year.
How it works
The mechanism of action of the sample is simple. When a substance is introduced, a corresponding reaction occurs. If in the past there was contact with a tubercle bacillus, then in the body of the researcher there are immune cells in a certain amount that “remembered” the pathogen and are ready to meet him again. Re-encountering the virus triggers a strong response to destroy it.
The results of the test will show the state of the patient's defenses. Perhaps the lack of immunity, its excessive activity, or everything will be within the normal range.
If there was contact with the infection in the past, the human immunity works normally, when the organism re-encounters with the pathogen, the body will react with moderate inflammation in the area of tuberculin injection. If there was no contact, there will be no reaction.
When and how is the Mantoux test done
The first test is done when the baby is one year old. This allows you to check whether the BCG vaccine is working. In the future, this procedure is carried out every year. In adolescence, the test is carried out less often, for adults it is necessary in exceptional cases, when outbreaks of the disease are registered in the region, and other diagnostic methods are not available.
The drug is administered subcutaneously. At the same time, hands alternate: one year - right, the other - left. This creates a small bubble. After the Mantoux reaction in a child, the norms and deviations are assessed after 72 hours.
How measurements are taken
In three days, there will be redness with a dense papule at the injection site. In the measurement process, the diameter of the redness is not taken into account, only the size of the papule matters. During the study, transparent rulers are used, which are applied across the arm. To make the result as accurate as possible, sometimes the papule is circled with a pen, after which measurements are taken.
Mantoux reaction in a child: norms and deviations
Reaction to the introduction of tuberculin can be:
- Positive. It is characterized by the appearance of a seal. Indicates that there are no active bacteria, but there are antibodies. In turn, such a reaction is divided into mild (seal with a diameter of 5-9 mm), medium (papule size 10-14 mm), intense (diameter 15-16 mm), sharply positive (more than 17 mm or with signs of an inflammatory process on the skin, swollen lymph nodes, edema). It is a reason to contact a phthisiatrician and conduct additional studies in order to get ahead of whether there are causative agents of tuberculosis in the body in an active state.
- Negative. There are no reactions whatsoever. This is evidence that there are no active pathogens in the body, however, as well as immunity. When is the Mantoux reaction done again if such a deviation is found? In this case, it is recommended to conduct a test twice a year andcarefully control the likelihood of infection.
- Doubtful. With such a reaction, redness may be present, but without a papule, or it will not exceed 4 mm in diameter. Such a result is equated to negative.
Tuberculin test twist
In this situation, the result of the just performed test changes dramatically compared to the previous one, and there are no obvious reasons for such a violation. The reaction, which was negative, changes to positive, which indicates the presence of a pathogen in the body. This almost always indicates infection with tuberculosis.
What indicators indicate infection
On the Mantoux reaction alone, it is impossible to judge the presence or absence of a disease. The reaction is recommended to be evaluated over several years.
You can guess the infection by:
- turning tuberculin test;
- presence of a sharply positive reaction;
- seal diameter over 12mm for 4 years.
Such manifestations are a reason for a thorough diagnosis.
Is tuberculin so dangerous
Today, many doubt whether to do the Mantoux reaction? Parents, refusing to study, motivate this by the fact that the tuberculin solution contains phenol, which is considered a toxic substance, although in reality it is a natural metabolic product present in our body. In tuberculin solution, it is used as a preservative. But the amount is so small thatpoisoning is simply not capable of leading.
How to prepare your child for the procedure
Carrying out a mantoux reaction in a child at a year old and at an older age is possible only if he is completely he althy and feels good. It is important that the baby does not have a cold, allergic reactions on the skin in the form of rashes and irritation.
As a prevention of side effects, the child is usually given antipyretic and antiallergic drugs before vaccinations. But before conducting the Mantoux test, on the contrary, the intake of such medications should be excluded. This is an allergy test, and an antihistamine taken before the procedure will distort the result.
Contraindications
Mantoux reaction is not carried out at:
- acute infectious diseases;
- exacerbation of chronic pathological processes;
- skin rashes;
- allergic;
- bronchial asthma;
- in case of quarantine in a child care facility.
The procedure is possible if during the month the baby did not experience any of the above. In addition, at least 30 days must have elapsed since the last vaccination. Only under these conditions can the result be considered reliable.
Do's and Don'ts
The child should not be allowed to scratch the injection site, and the skin should not be lubricated with medications or cosmetics, glue or bandage.
Contrary to popular belief, wet the injection siteallowed, you can take a bath or visit the pool. This misconception arose due to the fact that earlier the drug was applied over the skin, making a small scratch, but now it is injected subcutaneously.
Side effects and complications after the procedure
After the Mantoux reaction in the first days, various side effects may develop, although many doctors do not recognize this. Violations can be manifested by skin problems, constipation, changes in behavior. Often, children suffer from headaches and dizziness, fever, the temperature after the Mantoux reaction can reach 40 degrees, vomiting, allergic skin rashes, swelling, asthma attacks, itching at the injection site.
In some cases, local reactions are accompanied by lymphangitis, lymphadenitis, micronecrosis.
Currently, there is a drug "Diaskintest", it is officially registered and used to diagnose tuberculosis. The principle of application is the same - it is injected under the skin, then measurements are taken. But unlike tuberculin, the drug reacts only to the active pathogen. That is, positive test results indicate infection with tuberculosis.
Is it possible to judge the presence of tuberculosis only by the results of the test
If a child has a positive Mantoux, what to do in this case? This question torments many parents. But the final diagnosis cannot be made only on the basis of the results of the test. Other diagnostic methods must also be taken into account. This test is indicative, intended forso that the doctor can determine if further testing is needed. Various circumstances and conditions can affect the result of the test, so a positive result is not a reason to panic.
A positive reaction in children 2-3 years old may indicate a post-vaccination allergy. A year and a half after BCG vaccination, depending on individual characteristics, the test result may be negative, doubtful, and in 60% of cases - positive.
A positive response of the body as a manifestation of post-vaccination allergy is observed approximately 8 weeks after the vaccine is given, the highest intensity is achieved by 1-2 years. This is explained by the fact that during this period, post-vaccination immunity is most pronounced. Therefore, during the first two years of life after vaccination, the size of the papule after the Mantoux test can be in the range of 5-16 mm. If the scar size is from 2 to 4 mm, then post-vaccination immunity will last for 3 years. In these babies, the test should be accompanied by taking desensitizing drugs for five days before the procedure, and two after.
If the result is positive, the pediatrician will give a referral to a phthisiatrician for registration. How often do the Mantoux reaction in this case? The procedure will have to be repeated after six months. If the size of the papule is the same or increased, this indicates the presence of an allergy of an infectious nature. With a decrease in sensitivity to the drug, it is considered that the allergy is post-vaccination.
An important feature that helps to distinguish post-vaccination immunity from infection ispigmentation (the area of compaction becomes brown) 7-14 days after the test. Seal after vaccination does not have clear boundaries, has a pale pink tint, no pigmentation. The post-infectious papule has a brighter color, clear boundaries, pigmentation is present, which decreases after 2 weeks.
What can affect test results
It is important to consider that the Mantoux reaction is a test, the result of which can be distorted by various circumstances and diseases:
- pathologies of an allergic nature;
- infections the patient has recently had;
- chronic diseases;
- age.
Other contributing factors may be:
- individual skin sensitivity;
- phases of the female cycle;
- features of human nutrition;
- worm infestations.
The result may be distorted under the influence of adverse environmental factors:
- increased background radiation;
- harmful emissions from chemical industries.
Also, unreliable data can be obtained if the sampling procedure was violated, for example,
- transportation and storage of the drug was incorrect;
- non-standard and low-quality tools were used;
- violated the technique of setting the Mantoux reaction and deciphering the results.
In addition, individual intolerance to tuberculin is possible, which will be manifested by an increase in temperature, a violation of the general condition,lethargy, poor he alth, disorders of the gastrointestinal tract. According to what has been said, a positive test result alone cannot be 100% proof of the presence of tuberculosis.
Isoniazid prophylaxis necessary if test results are not satisfactory
Studies show that taking isoniazid as a preventive measure reduces the risk of developing the disease. If it concerns a child, then it is better to insure yourself and not abandon the preventive course. In addition, prevention is important for those who have had close contact or lived with an infected person.
This may cause adverse reactions to the drug. Most often, these are headaches, the appearance of problems with sensitivity, the occurrence of neuritis.
But such reactions can be avoided. Vitamin B6 will protect against the occurrence of negative manifestations. In the event that the trace element is supplied with food in sufficient quantities, side effects may not even occur. Regarding the negative effect of the drug on the condition of the liver, we can say that when taken in a dosage that is calculated according to weight, there is no reason for concern.
According to WHO, more than one and a half million patients die of tuberculosis every year, mostly from developing countries. Doctors are worried about the emergence of drug-resistant forms of the disease, the number of which is increasing from year to year. Questions concerning the he alth of children, of course, are decided by parents. Buta sane adult should understand that the Mantoux reaction is a necessary study in our time, when the disease is gaining momentum, and many people are infected. Timely diagnosis will prevent the development of pathology, and the results of the test can even be preliminarily deciphered by yourself.
