Mantoux test is carried out in every clinic, kindergarten or school. Once a year, children meet with a he alth worker to provide their hand to inject some substance under the skin. Do you know what this procedure is and for what purpose it is carried out? Some mistakenly believe that this is a vaccine, but it is not. Mantoux is a test for the detection of tubercle bacilli in the human body. What should be the reaction to Mantoux in children, what precautions should be taken and how to prepare for the test, you will learn further from this article.
Contribution to the history of Robert Koch
The famous microbiologist Robert Koch in 1882 discovered the existence of a bacillus that led to the emergence of a terrible disease - tuberculosis. After some time, such a concept as “Koch's wand” or “mycobacterium tuberculosis” appeared in medicine. All the scientists of the world have takenfind a cure for this disease. Robert Koch was among the first to advance in this direction.
He tried various methods of killing bacteria: he boiled them, exposed them to chemical reagents, combined them with other bacteria, etc. After some time, Koch synthesized a substance that he called tuberculin. With his help, the scientist intended to save the world from a terrible disease - tuberculosis. Tuberculin began to be tested on humans, but it turned out that there was no particular benefit from it.
Contribution to the history of Charles Mantou
In 1908, an unknown French scientist Charles Mantoux first suggested using tuberculin as a diagnostic test that would determine the presence of Koch's bacillus in the human body. Charles's medical background allowed him to notice distinctive reactions to tuberculin samples. That is, he althy people and those suffering from tuberculosis reacted differently to the injected substance.
Over time, the name of Charles Mantoux already appeared in the name of the test itself - the Mantoux test. Since most doctors do not go into details and do not talk about the purpose of this test, many people believe that this is such an annual vaccination. Some parents even write a refusal of a certain “Mantoux vaccination”, but this is just an allergy test, absolutely safe and extremely useful.
For several decades, the Mantoux test has been carried out all over the world, usually once a year. Particular attention is drawn to the degree of reaction in children. What should be the reaction to Mantoux in the normin children? In certain periods of age, there are subtleties and nuances, it is also worth considering the genetic predisposition and much more in order to reliably determine the reaction of the body. We will consider these issues in more detail below.
What is the relationship between BCG vaccination and Mantoux test?
The connection between these procedures is quite close. So, even in the maternity hospital, the baby is vaccinated against tuberculosis - BCG vaccination. The purpose of this vaccine is to develop antibodies in the child's immune system against TB infection. A year after vaccination, a Mantoux test is performed in order to ensure the successful formation of antibodies after vaccination. What should be the reaction to the “vaccination” of Mantoux? The human body can react in different ways, but we'll talk about that later.
A positive reaction to the Mantoux test is the best possible reaction of the body. Sometimes the child's immune system does not respond to the BCG vaccination and does not form protective antibodies against the disease, in such cases the reaction will be negative. Before entering school, at about 6 years old, the child is sent for a re-vaccination of BCG. Such children who have not responded to the primary vaccination should be closely monitored and the Mantoux test should be performed twice a year so as not to miss a possible infection with dangerous tubercle bacilli.
Mechanism of action of the Mantoux test
Tuberculin contains tiny remnants of live tuberculosis bacteria. If the human body met (fought) with a tubercle bacillus, there will be a reaction to the sample. If there are no “memories” in the “memory” of the immune systemabout a meeting with these mycobacteria, then she will not react in any way to the introduction of tuberculin. In other words, the Mantoux test is an allergy test. If there is a tubercle bacillus in the child's body, then he will give an allergic reaction to the introduction of the substance tuberculin.
By the type of reaction to the sample, the presence of active bacteria that infect the child's body is judged. Which Mantoux reaction is considered normal? Through vaccination (BCG), the child's immune system is infected with weakened tuberculosis bacteria, so the test should be positive? In short, yes, but more on that later.
How and where are Mantoux samples administered?
Each student, without hesitation, will be able to show the place where the papule usually appears after the mantoux, although during the procedure itself, most children turn away and do not look at how the injection is given. But after that, the medical worker points to the so-called "button" that has formed on the patient's arm.
Traditionally, the sample is placed on the inside of the forearm, approximately in its central part. The needle slightly pierces the skin and tuberculin is injected with a syringe, which is collected in a small ball. After three days, you need to check the result (doctors say: “Make a record”).
How to understand which Mantoux reaction is considered normal? Using a ruler, the circumference of the resulting button is measured, and based on the results of the data obtained, one can judge the degree of reaction. Allocate a positive, sharply positive and negative reaction.
Variants of possible reactions to the “vaccination”Mantu
Types of reaction to the Mantoux test are as follows:
- Positive. A seal has formed at the injection site, which is additionally examined and its physical characteristics are studied (weak - the diameter of the "button" is 5-10 mm, the average is the diameter of the papule is 10-15 mm, the strong is the diameter of the seal is 15-17 mm). That is, the norm of papules on Mantoux in children is no more than 16-17 mm in diameter.
- Sharply positive. The diameter of the papule with such a reaction is more than 17 mm, there may also be inflammation on the skin, swelling or enlargement of the lymph nodes.
- Negative. Three days later, there are no traces at the site of the Mantoux test - no induration, no redness.
- Doubtful. Inflammation of the skin is present, but the diameter of such a papule is less than 4 mm. Often such a reaction is not taken into account and equated to a negative one.
Severe inflammation of the papule, more than 17 mm, is the reason for contacting a phthisiatrician to check the body for the presence of active Mycobacterium tuberculosis. The optimal response is considered positive (medium and mild). Such a response of the immune system indicates that it has developed antibodies, and the presence of active tuberculosis bacteria in the body has not been detected.
Doubtful and negative reactions indicate that active bacteria are not present in the body, but there are also no antibodies to the disease, immunity has not been developed. This reaction is a reason for close attention to a potential patient, and the Mantoux test should be doubled, that is, not 1, but 2 times a day.year.
Mantoux twist
This medical concept should be known to all parents. The turn of the tuberculin test shows the opposite result compared to last year's tests, although there should be no reason for this. If the last test showed a negative reaction, and after a while the reaction changed sharply to a positive one, then most likely the body is infected with a tuberculosis infection (the child is sick and has no immunity to this disease). Such statements are relevant only if the child was not revaccinated at age 6.
Indicators of TB infection
A medical worker is obliged to analyze not only the real reaction to the Mantoux test. With the help of this test, the presence or absence of tuberculosis bacillus in the body is determined, and it is possible to evaluate the reaction after a few years. So, what should be the reaction to Mantoux, if we assume infection with tuberculosis:
- tuberculin test turn;
- the presence of a sharply positive (hyperergic) reaction;
- if for 4 years the diameter of the papule exceeds 12 mm.
Situations like this are a sure sign that he alth professionals should monitor the child more carefully and refer him for additional testing for tuberculosis.
Preparation for the Mantoux test
Sane parents know that on the eve of any vaccination, special attention is paid to the he alth of the baby. It is important to monitor the condition of the child so that he is nothad a cold and showed no signs of allergy (rash and skin irritation). To avoid side effects, pediatricians advise taking all sorts of preventive measures, such as taking antihistamines a few days before the test and antipyretics at the first sign of fever.
This strategy is correct and prudent, but only before vaccination, and the Mantoux test is not such, so the actions of parents should be slightly different. In any case, the child must be he althy, without allergic and infectious manifestations. Antipyretics and antihistamines should not be given, because the Mantoux test is an allergy test. If you give an antihistamine, then the results will be distorted. That is why it is so important for parents to know what the reaction to Mantoux should be, because it is by this factor that the condition of the child is determined. In no case should anything be changed, otherwise doctors will not be able to detect the presence of antibodies in the child's body.
When can't a Mantoux test?
If you figured out what the reaction to the "vaccination" of Mantoux should be, then you perfectly understand that it is impossible to conduct a test immediately after an illness. For at least a month before the test, the child should not encounter the following diseases and situations:
- acute viral or infectious disease;
- skin irritation and rash;
- exacerbation of any chronic disease;
- allergic reaction;
- bronchial asthma;
- epidemic or quarantine in an educational institution (school, kindergarten, nursery).
A month after the test, the child should not experience the above situations, and only then can the results of the reaction be judged with confidence.
To wet or not to wet?
Immediately after the Mantoux test, the nurse warns the child and his parents about the precautions to not wet or scratch the injection site. But it is difficult to explain the reason for such requirements to the medical staff, because these rules have been preserved since Soviet times, and now this is not at all relevant. Parents and children often ask, what should be the reaction to the Mantoux “vaccination” if we wet the injection site? Not every he alth worker can answer this question.
It turns out that the earliest tests for tuberculosis were carried out by injecting tuberculin not under the skin, but on its surface (a small scratch was made on the skin, and tuberculin was placed in it). Naturally, such conditions could not guarantee the reliability of the results after the Mantoux test, because the ingress of water greatly distorted the indicators.
The last Mantoux skin scraping tests were done some 15 years ago, and most he alth workers use the “old” rules. However, for a long time, tests have been done exclusively subcutaneously, which means that you need to follow the rules of modern medicine.
You can wet the injection site, wash it as much as you like and even swim in the pool - nothing from the outside can enter the body.
How does TB get infected?
As a rule, a person is infected with mycobacteria directly from a patient with active tuberculosis. When an infected person talks, coughs or sneezes, he spreads Koch's wand for a long distance around him. If you eat the dairy products of a sick animal, you can also become infected with tuberculosis. The disease develops with the following factors:
- Malnutrition.
- Unfavorable environmental and social living conditions.
- Smoking, alcoholism and other addictions that lead to reduced immunity.
- Emotional tension and stress.
- Presence of lung diseases, stomach ulcers, diabetes, duodenal ulcers.
If at least one of the above factors is present, you need to consult a specialist about what the reaction to Mantoux should be in this case, and follow the doctor's further recommendations. Some factors can impair the he alth and immune system, so you should not smoke or drink alcohol, thereby crippling yourself.
Adverse reactions from the Mantoux test
A positive reaction to the Mantoux test for tuberculosis or the norm according to the physical characteristics of the papule is not all that awaits the child and his parents. There are also adverse reactions, most of which are not recognized by world medicine and pediatricians from government agencies. However, doctors from private institutions who do not report to the state confirm the possibility of adverse reactions.
If the first reaction to the Mantoux test ontuberculosis in children is normal, this does not mean that there will be no complications in subsequent years. Here are the most common reactions:
- lethargy and apathy;
- temperature increase;
- skin rash;
- indigestion;
- cough (one week after test).
The above reactions of the body indicate that the Mantoux test contains toxic substances. And although their number is scanty, some children are affected by the toxin, and they may experience an adverse reaction to Mantoux. In children at 5 years of age, the norm is the transfer of the sample without any reactions.
Normal reaction to Mantoux in children of different ages
The response of the body after the test should be studied with knowledge of the age of the child. After all, the rate of reaction to Mantoux in children at 2 years old and 10 years old is somewhat different. In adults, the Mantoux test should be negative. There are the following papule diameter norms:
- The normal reaction to Mantoux in children at 4 years old looks like a papule 10-14 mm in size.
- Children at 5 years old have a “button” less than 10 mm.
- Children at the age of 7 are characterized by the presence of a dubious or negative reaction.
- The normal size of a papule in children 8-10 years old is 16 mm.
At 3 years old, the rate of reaction to Mantoux in children is approximately equal to the test readings at an older age, parents should not worry if the diameter of their child's papule does not match the indicators. The main thing is that the measurement of the “button” is carried out qualitatively.
