In our country, the Mantoux test is given to all children older than a year: many young mothers and fathers remember a small "button" on their hand from their own childhood. Why is this test needed, what can it tell about and how can it help?

Tuberculosis and its manifestations

The Mantoux test (its other names are the Pirquet test, tuberculin test, tuberculin diagnostics, tuberculin skin-test, PPD test) is an immunological test for the presence of tuberculosis infection in the body.

Tuberculosis is a chronic bacterial infection that causes the highest number of deaths worldwide. The causative agent of the disease, Mycobacterium tuberculosis (Koch's bacillus, Koch's bacillus), spreads by airborne droplets - when sneezing, coughing, talking. Initially, the dangerous bacillus infects the lungs, but other organs can also become infected. Most people who are infected never develop TB on their own. This happens only in people with a weakened immune system (especially HIV-infected), when the bacillus overcomes all the protective barriers of the body, multiplies and causes active disease.

Only those patients in whom tuberculosis is in the active stage are contagious. However, patients who receive adequate treatment for tuberculosis for at least 2 weeks are no longer dangerous.

In the active stage of the disease, the following symptoms may be observed:

  1. strong lasting 3 weeks or more (when tuberculosis is localized in the lungs);
  2. chest pain, coughing up sputum and possibly blood;
  3. weakness or fatigue;
  4. weight loss and appetite;
  5. chills, fever and night sweats;
  6. transmission of the disease to others is possible (with localization of tuberculosis in the lungs);
  7. there may be changes on chest x-rays, positive smears or cultures.

It is possible to be infected with TB bacteria, but not be sick or contagious. This is called "latent tuberculosis infection".

A person with latent TB infection:

  • has no symptoms;
  • does not feel sick;
  • cannot spread the disease to other people;
  • has normal chest x-ray and sputum smear results.

When there is a transition from a latent infection to the active phase of the disease, a person becomes ill and, if the lungs are affected, becomes contagious.

How does the test "work"?

The Mantoux reaction is the body's reaction to the intradermal administration of tuberculin. At the injection site, a specific inflammation occurs on the skin, caused by the accumulation of T-lymphocytes - specific blood cells responsible for cellular immunity. The essence of the reaction lies in the fact that particles of mycobacteria seem to attract lymphocytes from nearby blood vessels of the skin. React to the introduction of tuberculin those lymphocytes that are already "familiar" with Mycobacterium tuberculosis. If the "meeting" with the causative agent of the disease took place, then there will be more such lymphocytes, inflammation will be more intense, and the reaction to the test will be positive.

To put it simply, the body's reaction to tuberculin is one of the varieties of allergies. Let's make a reservation right away: a positive Mantoux test is not one hundred percent proof of infection with tuberculosis. To exclude or confirm this diagnosis, a number of other studies are required: exclusion of association with vaccination; chest x-ray; microbiological culture of sputum; ELISA (enzymatic immunoassay), which detects antibodies to tuberculosis; PCR (polymerase chain reaction), which detects the causative agent of tuberculosis, etc. Often, in combination with a positive Mantoux test, these additional diagnostic methods help to make a final decision on the diagnosis.

Contraindications

There are a number of diseases that are unambiguous contraindications for the Mantoux test. These include:

  • skin diseases;
  • acute and chronic infectious and somatic diseases in the acute stage (Mantoux test is performed 1 month after the disappearance of all symptoms of the disease or immediately after quarantine is lifted);
  • allergic conditions in the acute stage;
  • epilepsy.

Immunity after prophylactic vaccinations can also affect sensitivity to tuberculin, so the Mantoux test should be planned before any vaccinations. And if your child has already been given a Mantoux test, then you can vaccinate him - in the absence of contraindications - immediately after evaluating the results of the test. If the Mantoux test is performed not before vaccination, but after them, then tuberculin diagnostics should be carried out no earlier than 4 weeks after the vaccination.

Carrying out the procedure

In our country, the Mantoux test is carried out once a year, regardless of the results of the previous test, starting from the age of 12 months. Children under 1 year of age are not given a Mantoux test, as the result will be unreliable or inaccurate due to age-related developmental features immune system: reaction may be false negative.

The Mantoux test is placed in a sitting position with a special tuberculin syringe intradermally (in the middle third of the inner surface of the forearm). After the introduction of tuberculin, a specific bulging of the upper layer of the skin, better known as a "button", is formed.

"Button" can not be smeared with brilliant green, peroxide or cream. It is strictly forbidden to allow it to come into contact with water and other liquids: this may affect appearance skin at the injection site of tuberculin and distort the results of the test. It is also impossible to seal the wound with adhesive tape: under it, the skin may sweat. Parents should keep the baby from combing the "button" in order to avoid additional allergization. Improper care of the tuberculin injection site may affect the test result.

From the history
In 1882, the microbiologist Robert Koch discovered a staining method that allowed him to see, identify and describe the causative agent of tuberculosis, Mycobacterium tuberculosis, or Koch's bacillus. For this, in 1905, Koch received the Nobel Prize. In 1890, Koch invented a water-glycerine extract from mycobacteria called "tuberculin", originally proposed for the treatment of tuberculosis, but proved to be ineffective. However, this is an important discovery. The Austrian Clemens Pirke discovered in 1907 that repeated contact of a patient with tubercular antigen (tuberculin) causes an allergic reaction. Pirquet suggested applying tuberculin to skin damaged by a scalpel to diagnose tuberculosis (Pirquet's reaction), and a little later, the French doctor Charles Mantoux began to inject tuberculin intradermally. Thus was invented the still widely used tuberculin skin test, or the Mantoux reaction. The Mantoux test has been used in Russia since 1965.

Evaluation of results

On the 2-3rd day after the introduction of tuberculin, a specific thickening of the skin is formed - the so-called papule. It looks like a raised, slightly reddened, rounded area of ​​​​skin. The papule differs from the surrounding skin in its consistency: it is denser due to cellular infiltration around the tuberculin injection site.

After 72 hours, with a transparent ruler (to see the maximum diameter of the infiltrate), measure and record the transverse (with respect to the axis of the hand) size of the infiltrate in millimeters. In this case, only the size of the seal is measured - redness around the seal is not a sign of tuberculosis or infection.

The reaction may be:

  • negative - the absence of infiltrate (compaction), hyperemia (redness) or the presence of a prick reaction (0-1 mm);
  • doubtful - infiltration (papule) 2-4 mm in size or hyperemia of any size without compaction;
  • positive - pronounced infiltrate, papule with a diameter of 5 mm or more. Such a reaction may be weakly positive (infiltrate 5-9 mm); medium intensity - 10-14 mm; pronounced -15-16 mm or hyperergic (too pronounced). Hyperergic in children and adolescents is considered a reaction with an infiltrate diameter of 17 mm or more, in adults - 21 mm or more, as well as a vesiculonecrotic reaction with the formation of pustules and necrosis.

false positive reaction. Separately, it is necessary to say about the false positive Mantoux reaction - those cases where the patient is not infected with the Koch bacillus, but the Mantoux test shows a positive result. One of the most common causes of this reaction is infection with nontuberculous mycobacteria. Other causes may be the patient's allergic disorders and any recent infectious disease. Currently, there are no methods for reliably differentiating the response to tuberculosis and non-tuberculous mycobacteria (the natural habitat of non-tuberculous mycobacteria is soil and water; these bacteria cause diseases of the skin, lungs, joints, the manifestations of which are similar to tuberculosis). However, the following factors may indicate tuberculosis infection:

  • hyperergic (infiltrate 17 mm or more) or severe reaction;
  • a long period that has passed since the BCG vaccination (more than 7 years);
  • recent stay in a region with increased circulation of tuberculosis (socially disadvantaged countries or areas of the country with a high population density with a low standard of living);
  • having had contact with a carrier of a tubercle bacillus;
  • the presence in the patient's family of relatives who were ill or infected with tuberculosis.

Location. If the child attends Kindergarten or a nursery, then the Mantoux test is carried out in the treatment room of the children's institution. As a rule, this is a planned mass tuberculin diagnostics, the timing of which parents are notified in advance. If the child does not attend an organized team, then the test is carried out in the treatment room of the district children's clinic, followed by the supervision of the district pediatrician.

Terminology issues. It is necessary to clarify two terms that parents may encounter. First of all, this is the so-called "turn" of the Mantoux test - a change (increase) in the test result (papule diameter) compared to last year's result. The turn criteria are:

  • the first appearance of a positive reaction (papule 5 mm or more) after a negative or doubtful one; strengthening of the previous reaction by 6 mm or more;
  • hyperergic reaction (more than 17 mm), regardless of the duration of vaccination;
  • reaction more than 12 mm 3-4 years after BCG vaccination.

After 72 hours, measure the size of the seal with a transparent ruler.

It is the turn that makes the doctor think about the infection that has occurred over the past year. For example, if the result of the sample for each of the last 3 years was 12 mm, and in the fourth year the result was 17 mm, then with a high degree of probability we can talk about the infection that has occurred. Naturally, in this case, all influencing factors must be excluded: allergy to tuberculin components, allergy to other substances, a recent infection, the fact of recent vaccination with BCG or another vaccine, etc. In this case, the further joint action of the doctor and parents is a comprehensive examination of the child to exclude the diagnosis of tuberculosis.

booster effect Mantoux test - amplification effect (from the English word boost - "gain"), i.e. an increase in the diameter of the papule with frequent (more than once a year) sampling (this is possible if mass infection is suspected, contact with a tuberculosis patient, etc.). The effect is associated with an increase in the sensitivity of lymphocytes to tuberculin. The booster effect also has a downside: people infected with tubercle bacillus lose their ability to respond to tuberculin over the years, and eventually the test result becomes false negative. In children, this effect is less pronounced than in adults, but Mantoux test more than once a year is undesirable.

Disease or result of vaccination? It is imperative to be able to differentiate a positive result tuberculin test due to post-vaccination immunity and manifestations of tuberculosis infection. In order to distinguish one from the other, you need to know:

  • the size of the post-vaccination skin scar after BCG immunization;
  • time elapsed since vaccination or revaccination;
  • previous test results and current papule size.

The scar left after BCG vaccination is located on the left shoulder, on the border of the upper and middle thirds. As a rule, it has a rounded shape, its dimensions range from 2 to 10 mm, the average size is 4-6 mm. There is a relationship between the size of the scar and the duration of post-vaccination immunity. So, with a scar size of 5-8 mm, the duration of immunity in most children is 5-7 years, and with a scar diameter of 2-4 mm - 3-4 years. The absence of a scar, if in the first 2 years of life the result of the Mantoux test is 10 mm, speaks in favor of infection.

In addition, an important sign that makes it possible to distinguish post-vaccination immunity from infection is the presence of pigmentation (brownish staining of the place where the papule was) 1-2 weeks after the Mantoux test. The papule that appears after vaccination usually has no clear contours, it is pale pink and does not leave pigmentation. The post-infection papule is more intensely colored, has clear contours and leaves pigmentation that lasts about 2 weeks. The following signs indicate the primary infection with mycobacterium tuberculosis:

  • first identified, after doubtful and negative reactions, the size of the papule is 5 mm or more;
  • an increase in the result compared to the previous year by 6 mm, if it was positive and caused vaccination BCG;
  • persistent (for 3-5 years) (stored reaction with an infiltrate of 10 mm or more;
  • hyperergic reaction, regardless of the timing of vaccination;
  • infiltrate larger than 12 m or more 3-4 years after vaccination;
  • predisposing factors: the presence in the family of patients (or those suffering from) tuberculosis, out-of-family contact with tuberculosis patients, being in an endemic region, low socioeconomic status, low level parents' education.

If infection is suspected, the child or teenager immediately referred for a consultation with a phthisiatrician.

If your doctor is unable to determine whether a positive test result is due to vaccination or infection, a preliminary conclusion is made about the unclear etiology of a positive test result, and the test is repeated after 6 months. If, with a second test, the result is again positive or increases, then without additional studies, a conclusion is made about infection. With a decrease in the size of the papule, a conclusion is made about the post-vaccination nature of the positive result of the previous test.

If the result is positive...

If the Mantoux test showed a positive result and all influencing factors were excluded: vaccination with BCG and other vaccines, a recent infection, an allergy to tuberculin components, then additional examinations are carried out to clarify the diagnosis. This is chest x-ray, microbiological sputum culture, examination of family members.

Children and adolescents with newly diagnosed TB infection are at increased risk of developing symptomatic TB: it is estimated that 7-10% of these children may develop primary TB with all its symptoms. Therefore, such children are subject to observation in the TB dispensary during the year. Within 3 months, he undergoes chemoprophylaxis with isoniazid. At the end of this period, the child is transferred to the supervision of the local pediatrician as "infected for more than one year." If a year later the child does not show signs of increased sensitivity to tuberculin and hyperergic reaction, then he is observed by a pediatrician on a general basis. In such children, the result of the annual Mantoux test is carefully monitored. An increase in the reaction by 6 mm or more indicates the activation of the infection.

Children infected for more than one year with a hyperergic reaction to tuberculin and an increase in the reaction by 6 mm or more are observed in the TB dispensary. They also undergo chemoprophylaxis for 3 months. If the test result is positive, but the previous test was not one, but two or more years ago, the child is considered "infected with an unspecified statute of limitations." In this case, a repeat test after 6 months is recommended. Based on the results of the second test, the issue of the need for observation in the TB dispensary and chemoprophylaxis is decided.

Important differences
Mantoux test is often associated with BCG vaccination, and sometimes parents even confuse these concepts. Attention: BCG vaccine(unlike many other vaccines), although it can prevent up to 80% of severe forms of infection in children, it is not a means of controlling tuberculosis infection, since it does not prevent infection. Tuberculosis prevention is based primarily on the early detection of people infected with tubercle bacillus and their adequate treatment. The BCG vaccine itself (Bacillus Calmette-Guerin; Bacillus Calmette-Guerin) is a tuberculosis vaccine prepared from a strain of a weakened live bovine tuberculosis bacillus, Mycobacterium bovis, which has lost its virulence for humans, being specially grown in an artificial environment. The bacilli retain sufficient antigenicity (the ability to elicit an immune response) to make the vaccine effective in preventing tuberculosis. The standard calendar for the introduction of BCG is as follows: the first injection of the vaccine is carried out in the maternity hospital, in the first 3-7 days of life (in the absence of contraindications); further - at 7 years (with preliminary control of the Mantoux test and provided that it is negative) and at 14 years (also with the control of the Mantoux test before vaccination) - for those who were not vaccinated at 7 years of age. In settlements where the epidemiological situation for tuberculosis is unfavorable, revaccination is carried out at 6-7, 11-12 and 16-17 years. Revaccination (re-introduction at the appropriate time) of BCG is subject to healthy individuals only with a negative reaction to tuberculin.

Rabiyat Zainiddinova,
neonatologist, Ph.D. honey. Sciences,
Scientific Center for Children's Health, Russian Academy of Medical Sciences, Moscow

Author's article



Discussion

we have such vaccinations at our school and 6 out of ten people have a positive reaction. And every year poor children are sent to a tube. indicator of tuberculosis?

The nonsense of this procedure lies in the following. First, children are made BCG vaccinations(from the same tuberculosis!), which (according to doctors!) gives a 100% guarantee against this disease. Question: what are doctors afraid of if they still want to detect tuberculosis with the help of Mantoux?

And it’s still not clear what type of tuberculosis the Mantoux test is designed for? Maybe tuberculosis of the bones and joints? :-)

The main clinical forms of tuberculosis are:
1.1.1. Tuberculosis intoxication in children and adolescents
1.1.2. Tuberculosis of the respiratory organs
Primary tuberculosis complex
Tuberculosis of intrathoracic lymph nodes
Disseminated pulmonary tuberculosis
Miliary tuberculosis
Focal pulmonary tuberculosis
Infiltrative pulmonary tuberculosis
Caseous pneumonia
Tuberculoma of the lungs
Cavernous pulmonary tuberculosis
Fibrous-cavernous pulmonary tuberculosis
Cirrhotic pulmonary tuberculosis
Tuberculous pleurisy (including empyema)
Tuberculosis of the bronchi, trachea, upper respiratory tract
Respiratory tuberculosis combined with occupational dust lung diseases (coniotuberculosis)
1.1.3. Tuberculosis of other organs and systems
Tuberculosis meninges and central nervous system
Tuberculosis of the intestine, peritoneum and mesenteric lymph nodes
Tuberculosis of bones and joints
Tuberculosis of the urinary, genital organs
Tuberculosis of the skin and subcutaneous tissue
Tuberculosis of peripheral lymph nodes
Tuberculosis of the eye
Tuberculosis of other organs

There are MORE accurate methods for determining the presence / absence of tuberculin bacillus in the body, namely:

1) PCR analysis (for Mycobacterium tuberculosis)
2) ELISA analysis (for mycobacterium tuberculosis)
3)TV Spot
4) Suslov's test (so far only done in Kyiv!)

After such a button, the hand of children at school actually hurts ... if you want, do it yourself!

Why is the COMPOSITION of such a sample not written in the article? Ingredients of Mantoux:
1) PHENOL - a highly toxic substance obtained from coal tar! .. F. - protoplasmic POISON, i.e. toxic to all cells of the body! .. No one has conducted studies on the safety of introducing phenol into a child's body ... here!

2) TWIN-80. Tween-80, aka polyoxyethylene sorbitol monooleate, aka
polysorbate-80. One study reports that Tween-80 (polysorbate-80) increases the activity of estrogen, the female sex hormone. The long-term effects of the influence of this chemical compound have not been studied.

“Previous studies by Gaidova et al. show that Polysorbate-80 (also known as "Tween-80"), administered by intraperitoneal injection to newborn female rats 4-7 days after birth, caused estrogenic effects, including early opening of the vagina, prolongation of estrus, and permanent estrus. Some of these effects were observed many weeks after the use of polysorbate-80 was discontinued" (Gaidova et al. "Delayed effects of the use of "Tween-80" in the neonatal period on the reproductive organs of female rats", Food Chem Toxicol 31(3) :183-90 (1993) Institute of Preventive and Clinical Medicine, Limbova, Bratislava).

Well, then PCR of urine can only show tubes. urinary tract and all. You better specify what exactly they will accept, blood, urine, saliva, sputum.

we are left alone for another year. I found out whether it is possible to make Dioskin instead of mantou right away. But they are basically made only at the Institute of Tuberculosis. 09/02/2014 16:35:19, KoshMarochka.

Discussion

if you have done manti so far, then in any case you will have to do this test. in order to compare the indicator with the previous, last year. if the reaction compared to last year is larger (bigger in diameter), then you will be sent to do a dioskin test. we have a similar situation. every year the diameter of the mantle increases, for two years in a row we drive in the tuba. dispensary. they make dioskin there, there is no reaction and they leave us alone for another year. I found out whether it is possible to make Dioskin instead of mantou. The phthisiatrician at the dispensary said no. Mantu is a more accurate test, you need to do this. maybe they have some kind of protocol to follow. Maybe it's different everywhere, depending on which doctor you get. a friend advised that the mantoux reaction should be less, you can give antihistamines 5 days before and 5 days after, something like that.

depends on why you don't want to do the mantoo. The most difficult thing is if you are generally against the introduction of substances that are unhealthy and questionable for diagnosis into the body of your child. And also against X-ray exposure of a healthy child.
Officially, a phthisiatrician has the right to give an opinion only on the results of a mantoux or x-ray. It is difficult to say what compromise will be made in your case by a phthisiatrician, a clinic, a kindergarten. Theoretically, there is also a diaskin test (it is done similarly to a mantoux, but there are practically no false positive results), blood for antibodies (useless analysis), the most modern quantiferon test does not respond to BCG and nothing needs to be injected. But all these miracles of progress often do not interest anyone in polyclinics.

The uninformativeness of mantoux against this background is primarily due to the fact that in vaccinated children it does not show the first encounter with tuberculosis, because. it is clear that the contact was during vaccination ...

Discussion

my son had a hyperergic reaction to Mantoux, we have been doing it all our lives, despite the doctor being "tubefied" (and this is 80% of children after the maternity BCG), after each Mantoux there are a lot of health problems. Decide already on your status (tuberculosis, turn, treat, do not treat) and refuse already, until you, like us, have got a lot of everything from Mantoux (lymphadenitis on the side of Mantoux, for example).

My daughter had an allergic reaction to manta. When we finally proved it, they got rid of us. And if there is a tendency to allergies, it is necessary to drink tavegil 3 days before maniu. The doctor will prescribe the dose.

I myself had the same thing in my childhood. They observed me until the age of 12, that is, every year at school they did Mantoux (like all children) and made sure that it did not increase sharply. adults are checked only for the active form (using fluorography). And adults are not tested for infection, because 90% of adults are already infected, so why check. It is believed that by about the age of 30, all people are infected with true Mycobacterium tuberculosis, i.e. get acquainted with it, but this does not necessarily end with a disease. Making BCG is also to some extent "acquainting" the body with Mycobacterium tuberculosis, but this is not infection. It is believed that a vaccinated child has become infected if he has a test turn - an increase in Mantoux by 6 mm or more compared to last year's test. If your x-ray is in order, then in general you need to worry no more than all other people.

The Mantoux test is an important tool for the early diagnosis of tuberculosis, but it does not give a 100% guarantee: both false positive and false negative results are possible.

After BCG, the child should develop immunity to tuberculosis, and the Mantoux reaction shows the amount of antibodies, that is, indirectly, of course.

Discussion

We are also infected. It's okay, it's not a diagnosis. After BCG, the child should develop immunity to tuberculosis, and the Mantoux reaction shows the amount of antibodies, that is, indirectly, of course. And by the age of 6, the circle from Mantoux should become smaller and smaller, i.e. antibodies disappear unnecessarily. And BCG revaccination is done to reactivate them. And if a vaccinated child met with tuberculosis, which is very likely in our conditions, then his antibodies will be activated even without re-vaccination, and the circle from Mantoux will be larger than it should be. Usually, with a tube infection, tests are given for every fireman, X-ray or fluorography is done, and if the phthisiatrician decides to play it safe, he will also prescribe pills. We were not assigned. It's just that BCG revaccination is contraindicated for us. I didn’t really want to :), we have so many of these antibodies. By the way, a tube-infected child once will always be tube-infected. Re-tuberculosis can occur an infinite number of times.

06/27/2003 11:02:55 PM, byaka

Firstly, the meaning of the Mantoux and Pirquet tests is exactly the same - the intensity of immunity against Mycobacterium tuberculosis is determined. The only difference is in the method of administration of the drug (tuberculin). According to Pirke, the skin is scarified with a special lancet. According to Mantoux, he suggested - intradermal administration of tuberculin.
Everything is described in great detail on the page http://www.privivka.ru/immunize/mantoux.htm
If the "Mantoux test showed a positive result, all influencing factors are excluded - BCG vaccination and other vaccines, recent infection, allergy to tuberculin components. Since the Mantoux test is an important, but not 100% reliable means of diagnosing tuberculosis, additional examinations are carried out - chest x-ray, microbiological culture of sputum, examination of family members.
Children and adolescents with newly diagnosed TB infection are at an increased risk of developing symptomatic TB - it is estimated that 7-10% of these children may develop primary TB with all its symptoms. Therefore, such children are subject to observation in the TB dispensary during the year. Within three months, chemoprophylaxis with isoniazid is carried out. At the end of this period, the child is transferred under the supervision of the local pediatrician as "infected for more than one year."

I will say this about my daughter - there is nothing "military" in this. They made a "stick" - nothing. We drank the drug for 6 months and continue to live in peace.
The medical withdrawal from BCG and Mantoux does NOT mean that the vaccine is HARMFUL, but only that it is USELESS in an infected child.
This infection is also not terrible. We have been infected for a long time.

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 ...

Discussion

In the case when samples were taken irregularly (with an interval of more than two years) and it is impossible to establish the timing of infection, the conclusion is made "infected with MBT with undetermined timing of infection." The child is sent to the TB dispensary. Persons with a newly diagnosed hyperergic reaction are observed in the VI "B" group, and with a normergic reaction are registered in the "O" group dispensary observation. The Mantoux test is repeated after 6 months. In the absence of an increase in sensitivity to tuberculin, children (adolescents) are transferred under the supervision of a local pediatrician as "infected for more than one year without hyperergy and an increase in sensitivity to tuberculin."

The pediatrician makes the conclusion "allergy of unclear etiology" in the case when, using the differential diagnostic signs of infectious and post-vaccination allergies, it is impossible to resolve the issue of the nature of the allergy (infectious or post-vaccination). To clarify the etiology of allergies, children (teenagers) are sent to the PTD, where, after the examination, they are registered in the "O" group of dispensary observation. After 6 months, the Mantoux test is repeated. If the size of the reaction remains the same or increases, the allergy is considered infectious. A decrease in sensitivity to tuberculin indicates a post-vaccination allergy.

The second important task for a pediatrician related to issues of tuberculin diagnosis is the selection of individuals for revaccination with BCG vaccine.

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. Revaccination with the BCG vaccine is subject to healthy individuals only with a negative reaction to tuberculin.

Mass tuberculin diagnostics is one of the most important sections in the work of a pediatrician for the early detection of tuberculosis in children and adolescents, for the selection of contingents for revaccination.

Tuberculin diagnostics requires regular testing and analysis. When interpreting tuberculin samples in those vaccinated with BCG vaccine, it is necessary to take into account the size of the scars, the intensity of the positive reaction to tuberculin, the time elapsed after vaccination, the dynamics of sensitivity to tuberculin and the external manifestations of the infiltrate.

In case of suspicion of an infectious nature of an allergy to tuberculin, a child or adolescent should be immediately referred for a consultation with a phthisiatrician.

Associate Professor Alexander GAVRILOV.
Department of Phthisiopulmonology, RSMU.

03/16/2002 20:05:41, tires

Tuberculosis risk groups are identified among children and adolescents with positive reactions, which are caused by infection of the body with virulent Mycobacterium tuberculosis (MBT). Under conditions of mandatory vaccination and BCG revaccination, positive reactions to the Mantoux test can be the result of both infectious and post-vaccination allergies. Therefore, before proceeding to resolve the issue of the nature of the allergy, it is necessary to establish the presence and size of the skin scar at the site of the BCG vaccine; the time elapsed since vaccination (revaccination) and compare them with the size of the infiltrate and the previous results of tuberculin tests.

The post-vaccination scar is located on the left shoulder at the border of the upper and middle thirds, round in shape, the size can vary from 2 to 10 mm, but more often the average size is 4-6 mm. It is necessary to determine the diameter of the scar, the size of which correlates with the duration of post-vaccination immunity and the severity of post-vaccination allergy. So, with scars 5-8 mm in size, the duration of immunity in most children is 5-7 years, with scars 2-4 mm - 3-4 years. In the absence of a scar and an infiltrate size of more than 10 mm in the first 2 years of life, one should think about an infectious allergy. If a skin scar is detected, it is necessary to carry out differential diagnostics of post-vaccination and infectious allergies.

post-vaccination allergy. Depending on the individual reactivity of the organism, the reaction to the Mantoux test 1-1.5 years after BCG vaccination may be negative, doubtful, and in 60 percent. positive. Positive reactions as manifestations of post-vaccination allergy develop 6-8 weeks after vaccination and reach the highest intensity by 1-2 years. This is due to the fact that by this period, post-vaccination immunity reaches its maximum severity. Therefore, in the first two years of life after BCG vaccination, positive reactions to the Mantoux test can be from 5 to 16 mm in diameter (see figure). Most children with a graft scar 2-5 mm in diameter are characterized by tuberculin reactions with an infiltrate size of 5 to 11 mm.

An infiltrate size of 12-16 mm is noted in children with a post-vaccination mark of 6-10 mm or in revaccinated individuals with a post-vaccination mark of 6-10 mm.

In the future, as the time after BCG vaccination increases, there is a decrease in sensitivity to tuberculin up to its extinction. It should be emphasized that 3-5 years after vaccination, a reaction with an infiltrate of 12 mm or more is a manifestation of an infectious allergy. After 6-7 years, most children vaccinated with the BCG vaccine have negative or questionable reactions. With a post-vaccination reaction, the infiltrate is flat with indistinct contours, pale pink in color, undergoes a reverse development after 1-2 weeks, leaving no pigmentation.

Children and adolescents with post-vaccination allergies should regularly perform a Mantoux test to detect primary infection.

infectious allergy. The BCG vaccine does not give 100 percent. protection against the development of tuberculosis and does not prevent infection. Infection with virulent MBT strains causes a more pronounced sensitization in the child's body to tuberculin than the BCG vaccine. Therefore, MBT infection is accompanied by either stabilization of sensitivity to tuberculin, or its increase.

The following signs indicate the primary infection of MBT according to the Mantoux test with 2 TU PPD-L: the first appearance of a positive reaction (infiltration of 5 mm or more) after a previously negative or doubtful one; strengthening of the previous, post-vaccination allergy, by 6 mm or more; the appearance of a hyperergic reaction at any time after BCG vaccination (criteria for the "turn" of tuberculin sensitivity); the formation of an infiltrate of 12 mm or more 3-4 years after BCG vaccination.

On examination, the infiltrate, reflecting an infectious allergy, is clearly defined, bright red in color, rises above the surface of the skin. Pigmentation at the site of the infiltrate persists for more than two weeks.

The period of time within a year after the establishment of primary infection is called the early period of primary TB infection (IPPT). Children and adolescents in TIPP are a group at increased risk of developing tuberculosis, since in this period 7-10 percent. of these, the development of primary tuberculosis is possible. Such a child should be referred to a TB dispensary. If the child is recognized by the phthisiatrician as healthy, then he is observed in the PTD for one year according to the VI "A" group of dispensary registration. Chemoprophylaxis is carried out for three months.

After the end of observation in the VI "A" group, children (teenagers) are transferred under the supervision of a district pediatrician with the conclusion "infected with MBT for more than 1 year."

Among those infected with MBT for more than one year, those infected for more than a year are distinguished without hyperergy and an increase in sensitivity to tuberculin; infected for more than a year with a hyperergic reaction; infected for more than a year with an increase in infiltration by 6 mm or more without hyperergy.

1. Those infected for more than one year without hyperergy and increased sensitivity to tuberculin are observed by the local pediatrician. They are subject to an annual Mantoux test in order to timely detect an increase in their reaction to hyperergic or by 6 mm or more.
2. Those infected for more than one year with a hyperergic reaction are subject to observation in the PDD according to VI "B" group of dispensary registration. Chemoprophylaxis is carried out for three months.
3. Those infected for more than a year with an increase in infiltrate by 6 mm or more are sent to a phthisiatrician and are observed in the PDD according to the VI "B" group of dispensary registration. Chemoprophylaxis is carried out for three months.

Tuberculosis is one of the most dangerous and widespread diseases, which especially often affects the body of young children.

That is why the vaccine against tuberculosis is given to children a few days after birth, still in the maternity hospital.

Does a child need mantu and BCG preparations

Immunization is designed to prevent and prevent the severe and deadly course of tuberculosis. All newborn children who have no contraindications to it are subject to vaccination. Children who were born prematurely or with low birth weight are vaccinated with a drug with a smaller amount of antigen. For the vaccination of healthy children, a vaccine is used, premature and underweight - BCG-M.

Children cannot be vaccinated against tuberculosis on the same day as immunization against other diseases. If for some reason the child did not receive a dose of vaccine against this disease upon discharge from the maternity hospital, such manipulation should be carried out in a children's clinic.

The BCG vaccine preparation consists of different subtypes of Mycobacteria bovis. To obtain bacteria for the production of a drug that protects the child's body from tuberculosis, the method of sowing bacilli on a nutrient medium is used. This cell culture in a nutrient medium grows within a week. Then the bacillus is isolated, filtered, concentrated, homogenized, diluted with water, and the vaccine is ready for use in the prevention of tuberculosis.

Currently, many different BCG vaccine preparations are produced in the world, but 90% of all medicines contain one of the following strains of mycobacteria:

  • French "Pasteurovsky" 1173 Р2;
  • Danish 1331;
  • strain "Glaxo" 1077;
  • Tokyo 172.

Vaccination against tuberculosis in children is equally effective regardless of the strains of mycobacteria used. Prevention of the disease is carried out only with drugs registered in the Russian Federation - BCG and BCG-M.

The initial dose of BCG vaccine contains 0.05 mg of the drug diluted in a solvent. The vaccination is carried out in the maternity hospital on the 3rd-7th day of a newborn's life in the morning in a room specially designated for such manipulations. The vaccine preparation can be introduced into the child's body only after the child has been examined by a specialist.

In a children's clinic, if vaccination was not carried out in the maternity hospital, the district pediatrician examines the child using thermometry. If necessary, blood and urine tests can also be taken, as well as a consultation with specialist doctors. In the history of a child who is being immunized against tuberculosis, the date of vaccination, the series and control number of the vaccine, the manufacturer and the expiration date of the drug are put.

The vaccine against tuberculosis is strictly administered intradermally in the left shoulder. First, you need to inject a small amount of the vaccine preparation under the skin, and, after making sure that the needle has entered to the desired depth, release the entire dose of the drug. Immediately after vaccination, subject to the rules of the technique for administering the vaccine, a papule should form at the injection site. white color 7-9 mm in size, which usually disappears after 15-20 minutes. The introduction of the vaccine under the skin is not allowed, as this can lead to the formation of a cold abscess. The injection site should not be bandaged, treated with iodine or other antiseptic agents. Revaccination is carried out for all children 7–14 years of age who have a negative reaction to the Mantoux test.

Whether a child needs Mantoux, many parents want to know, especially those who decide on some vaccinations. This procedure is not immunization, it does not protect the body from the development of the disease, its purpose is completely different. Mantoux is placed in order to determine whether antibodies to tuberculosis have been developed, that is, according to its results, one can judge the effectiveness of BCG vaccination.

Mantoux reactions for tuberculosis: positive and negative

In the 20th century, the Frenchman Charles Mantoux used the substance tuberculin in a special way, which occurs in the human body when infected with a tuberculosis infection. From that time to this day, tuberculin has been used throughout the world to determine the Mantoux reaction in tuberculosis in children and adults.

At its core, this is not a vaccination, but a test that allows you to determine the presence of a tuberculosis infection in a child's body. Many parents talk about the existence of a vaccine against Mantoux tuberculosis, although in fact such manipulation is just an allergy test, completely safe for children.

If a negative mantoux with tuberculosis, this means that the child's body did not react in any way to the introduction of a vaccine preparation into it, therefore, it did not develop antibodies to the infection. Children who have had a negative reaction to manta are recommended to carry out such manipulation twice a year to minimize the risks of complications from tuberculosis.

How does the mantoux test work on the body? Tuberculin, which is administered subcutaneously to a child, contains weakened Mycobacterium tuberculosis. If the body has previously been in contact with a tubercle bacillus, it responds to this test.

When and how often do mantoux to children, the first vaccination of a one-year-old child

When is manta made for children for the first time? For the first time, an allergy test is carried out at 1 year, at which time the effect of the BCG vaccine is checked. Then it is placed annually, then in the right, then in the left hand. The sample is placed on the inner surface of the forearm subcutaneously, resulting in the formation of a small bubble. After 72 hours have passed since the introduction of tuberculin into the child's body, the condition of the injection site is checked. The size of the circle at the injection site will show whether there is an infection of the body with a tubercle bacillus or not.

When asked by parents how often manta is done to children, experts answer that the procedure is carried out twice a year in order to timely detect infection of the body with an infection. In case of an increased risk of developing tuberculosis in a child, the sample is placed starting from the age of 6 months.

The first mantoux is put on the child at 12 months of age. Mantou one year old baby set to determine the effectiveness of vaccination against tuberculosis, carried out shortly after birth.

A positive mantle for tuberculosis 72 hours after the administration of the drug increases in size, turns red and thickens. To correctly determine the size of the injection site, it is important to measure not the amount of redness, but the papule itself. For measurement, a transparent ruler is usually used, it should be measured not along, but across the arm. Sometimes, for a more accurate measurement, the papule is first circled with a ballpoint pen, and only then measured.

What should be a mantoux in a child: a photo of the reaction is normal and large sample sizes in children

Below in the photo, what a mantoux looks like with tuberculosis, parents can get acquainted with the possible options for an allergy test.

Reactions can be different, namely:

Positive. The norm of mantoux for tuberculosis in children can be from 5 to 16 mm in diameter. The seal can have different sizes, based on the severity of the reaction. It can be mild when the dimensions of the seal reach 5-9 mm, medium - 10-14 mm, intense - 15-16 mm.

Sharply positive - hyperergic. This is a large mantle in a child, in which case the papule in diameter reaches 17 mm or more. Experts also talk about this type of reaction when there are foci of inflammation on the skin, the appearance of edema and an increase in lymph nodes.

negative. It is also possible that 72 hours after the introduction of tuberculin into the body, there will be no reactions on the child's body. The Mantoux reaction in children is not normal when there are no marks at the injection site - no redness, no thickening, no swelling.

Doubtful. In this case, there is redness, but there is either no seal at all, or it does not exceed 4 mm in diameter. Doubtful reaction on the Mantoux test, as a rule, equate to negative.

Above in the photo, the norm of mantoux in children will help parents familiarize themselves with possible acceptable reactions to this manipulation. If a child has a sharply positive reaction to the Mantoux test, he should be examined by a phthisiatrician in the near future. The specialist will carry out some medical measures aimed at determining active tuberculosis bacteria in the child's body.

All parents can familiarize themselves with the permissible sizes of mantoux in children in the photo below:

Knowing what the child should have a mantle, parents can independently determine whether the injection site is normal. After the introduction of tuberculin, a seal filled with liquid is formed on the skin, better known as a “button”.

Improper care of the injection site can affect the result, so parents should familiarize themselves with the basic rules of behavior after the Mantoux test:

  • until the reaction is assessed, it is impossible to treat the “button” with either brilliant green or other antiseptic agents;
  • the seal must not be allowed to come into contact with water or other liquids;
  • it is forbidden to seal the injection site with adhesive tape, as the skin sweats under it;
  • parents should not allow the child to scratch the tuberculin injection site.

After the reaction of the Mantoux test has already been checked, if a wound or abscess forms, the tuberculin injection site can be treated with antiseptic agents.

How many times do mantoux to children and contraindications to vaccination

You should understand how many times they make manta to children and follow all the above rules. There are situations when a Mantoux test cannot be given to a child. Contraindications include any skin diseases, exacerbations of chronic diseases, acute somatic disorders. The test can be put only a month after all the symptoms have completely disappeared.

Allergic conditions of the child's body and bronchial asthma are also contraindications to an allergy test. Epilepsy is an absolute contraindication to the Mantoux test.

On the day with the tuberculin test, other vaccinations should not be carried out - and others. If you do not follow this rule, there is a risk of false positive reactions. In the case when immunization against other infections was carried out before tuberculin diagnosis, an interval of one month should be maintained, and only then a Mantoux test should be done.

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Tuberculosis is a particularly dangerous disease for a baby that can spread in children's groups. The insidiousness of the disease lies in the defeat of not only the lungs, but also other organs, including bones. Tuberculosis can develop asymptomatically, therefore, in the first days of a newborn's life, BCG injection, and at the age of one, they make the first tuberculin test - the Mantoux reaction, its norm is estimated depending on how much time has passed after the BCG vaccination, designed to form anti-tuberculosis immunity.

Advice: in the wake of mass protests against vaccinations, a number of parents refuse to take mantoux as well. However, it should be noted that with such a small injection, which is not considered a vaccination, doctors are trying to assess the immune response to the antigen of the tuberculosis pathogen.

What is a mantoux test

To date, the mantoux test is considered the main method for checking the reaction of a child's body to the presence of a tuberculosis infection. To conduct an immunological test, tuberculin is injected under the skin of the child's hand, a kind of mixture of certain substances called Koch's alttuberculin, named after the scientist who discovered the causative agent of tuberculosis.

Subcutaneous administration of the drug, which is a purified allergen of tuberculosis, in children causes the appearance of a specific reaction of a delayed type, which is expressed by the development of hyperemia and the appearance of an infiltrate, called a papule, at the injection site. The size of the local inflammation caused by lymphocytes indicates the presence of microbacteria responsible for tuberculosis in the child's body.

The large size of intense inflammation indicates that the mantoux test is characterized by a positive result, and this is considered to be a fact of infection with a tubercle bacillus. To assess the immune response to the presence of Koch's bacillus, the size of the inflamed plaque, which looks like a button, is measured with a ruler.

Important: the result for the presence of tuberculin appears only in a child infected with a dangerous disease or who received BCG vaccination. In the preparation itself, Koch's bacillus is absent, only traces of the vital activity of the microorganism are present.

When it is necessary to do mantu:

  • the first mantoux test is done to a child at the age of one year, if the newborn has been vaccinated with BCG;
  • subsequent testing is repeated every year with the obligatory sequence of the injection site under the skin (the left hand is changed to the right);
  • the duration of the period when the mantoux test is placed is 14 years.


Despite the fact that the tuberculin test is not a vaccination at all, it is not carried out with atopic dermatitis and other skin diseases, epilepsy, with allergic reactions in a child, exacerbations of chronic ailments.

What mantoux test can be considered normal

The result of the introduction of a tuberculin preparation under the skin is the formation of a specific swelling of the skin like a button, the size of which is estimated three days (72 hours) after the injection. What does the plaque (infiltrate) look like:

  • the button is firm to the touch;
  • swelling protrudes above the skin;
  • the color of the plaque is yellowish-reddish.

If in the growing body of a child there are a lot of immunity cells that are "familiar" with a tubercle bacillus, then the size of the seal will be significant. In order not to confuse the infiltrate after the injection with hyperemia, it is compared to the touch with the skin in the area free from the injection. In the case of an infiltrate, thickening is characteristic of the skin area; with hyperemia, the skin at the injection site and healthy skin have the same thickness.


In children, testing for the fact of tuberculosis is carried out for a number of years (until the age of majority), for adults the procedure is not relevant, they are checked during a fluorographic examination. For children, the normal result is the presence backlash on the introduced tuberculin, the required assessment of the size of the papule is carried out by palpation.

Sample results: ascertaining standards

  1. A negative result of the mantoux test is evidenced by the complete absence of compaction in response to an injection of a maximum of one millimeter.
  2. A plaque size of 2-4 mm with registration of redness (hyperemia) of any diameter indicates a dubious variant of the Mantoux reaction in children.
  3. The positive form of the Mantoux reaction is said to be with significant sizes of the infiltrate exceeding the 5 mm boundary.
  4. If the size of the plaque diameter exceeds 16 mm, we are talking about a hyperergic clearly expressed positive variant of the reaction to the injection procedure.

The size of the infiltrate can be measured only with a transparent ruler, the size of the reddened halo around no useful information does not carry, it is registered only in the absence of a papule. To assess the reasons for a positive test reaction in children, attention is paid to the pigmentation of the place where the plaque was located after a two-week period when the test was made. The button, as a result of vaccination, does not differ in clarity of contours, its color is pale pink, the papule disappears without a trace with time. The result of the post-infection reaction is a button of intense color with a clear edging and pigmentation that lasts for two weeks.


How to distinguish signs of post-vaccination immunity from infection:

When was the BCG vaccine given? Scar length (BCG vaccination) Mantoux sample size estimation, result
Post-vaccination immunity Cause Uncertainty The fact of infection
A year ago 6 to 10 mm 5 to 15 mm 16 mm Over 17 mm
Up to 5 mm Up to 11 mm 12 to 15 mm Over 16 mm
Missing Doubtful reaction 5 to 11 mm Exceeds 12mm
Two years ago Does not affect The result of the sample has decreased or the dimensions remain the same Enlargement of the papule after a positive previous reaction The sample became positive or increased by 6 mm
3-5 years after BCG injection Does not affect The result of the test became smaller, the maximum size is 5-8 mm There is no tendency to decrease or the size has increased by 2-5 mm The sample may become positive or the size index increases to 12 mm
6-7 years later Does not affect The reaction tends to fade Enlargement up to 5 mm Dimensional indicator exceeds 6 mm

The fact that the tuberculin test is viable indicates a threat of possible infection of children over the next year, if allergy-provoking factors, recent infectious diseases and vaccination, including BCG, are excluded.

By itself, a positive variant of the tuberculin test in children is not always considered an absolute fact of the presence of tuberculosis, the presence of indirect signs for several years should cause concern:

  • increase from year to year of sensitivity to the drug;
  • every year a sharp increase in the size of the infiltrate;
  • visits to regions with a threatening tuberculosis risk;
  • contact of children, even minimal, with a patient with tuberculosis in its open form;
  • obtaining information about sick relatives in the family circle.

One of the concerns of parents and the evaluation of diagnostic results can be called the wrong way of administering the tuberculin drug. With its deep introduction, blood appears at the injection site, in order to avoid this, the syringe needle is immersed in the skin with the cut up and the skin is slightly lifted, then intradermal injection will be provided.


Important: you should do a tuberculosis test every year on time, and also know how to correctly evaluate the result, since there are many patients with a dangerous disease in society who are not even aware of their problem. Moreover, tuberculosis microbacteria are present in the microflora of the lungs of adults.

How to care for the injection site

Although the mantoux injection is not a vaccination, you should know what you can do after the injection and what you can’t do:

  • for a test carried out over several years, the child’s hand is changed each time;
  • every year recommend testing at the same time in a sitting position;
  • it is not allowed to smear the button with anything, as well as scratch it;
  • it is impossible to wet the injection site with various liquids, as well as to seal it with a plaster;
  • wound treatment in children with traditional means is allowed after fixing the result.


Important: in the normal course of anti-tuberculosis vaccination in children, the size of the papule should decrease every year within a few millimeters, and by the age of seven, the injection mark becomes almost invisible. If the previous sample is significantly different from the next, then we can talk about tubing, when specialist help is required.

How Mantoux is made - the principles of setting the sample Mantoux vaccination side effects their cause and prevention

In Russia, a tuberculin test is carried out in those children who are 1 year old. This test is also called the Pirquet test. This is a study of immunity, aimed at the timely detection of tuberculosis pathogens in the body. We offer to figure out what the Mantoux reaction is, the norm in children, and why diagnostics are needed with the help of tuberculin.

Mantoux test

The reaction indicates how children's immunity reacts to the introduction of tuberculin. At the site of the subcutaneous injection of the Koch stick, a characteristic inflammation occurs on the skin, caused by the accumulation of lymphocytes responsible for immunity at the cellular level. Tuberculosis bacteria, when administered, cause a response of those lymphocytes that have already met with the infectious agent. The greater their number, the stronger the inflammatory process, the greater the likelihood that the reaction will be positive.

When is the test done?

The sample is placed on an individual basis according to indications, does not depend on the date of the previous test. Children under one year of age are not tested, as the final result will be inaccurate due to the peculiarities of the immune system at this age.

From the age of one year, the study is carried out once a year. But a tuberculin test may be needed 2 times a year in the following cases:

  • diabetes;
  • peptic ulcer;
  • blood disease;
  • pneumonia, bronchitis, tonsillitis;
  • subfebrile condition for an unknown reason.

Also, multiple diagnostics is indicated if the baby has not been vaccinated with the tuberculosis vaccine (BCG).

Caring for the "button"

The so-called "button" is nothing more than a papule, that is, a specific inflammation upper layers skin after injection of Mycobacterium tuberculin.

If your baby has had a Pirquet test, follow these guidelines:

  • it is forbidden to lubricate the papule with a solution of brilliant green, hydrogen peroxide or any cream;
  • it is forbidden to wet the mantle;
  • do not put a band-aid on the “button”;
  • try to keep the baby from scratching the papule.

Incorrect care of the "button" will affect the test results. After evaluating the results, in the event of an abscess, ulcer, treatment can be carried out medicines by doctor's prescription.

Dimensions and norms

The reaction is evaluated according to the dynamics of past studies. Every year, the size of the papule, according to the norms, is reduced by several millimeters. By the age of 7, the “button” should not be visible. Then revaccination is carried out.


The result of the Pirquet test can be of several types:

  • Negative result. It suggests the absence of compaction at the injection site or a reaction in the amount of 0 to 1 mm. This means that infectious agents never entered the small organism. Or the BCG vaccine, which usually lasts 5-7 years, no longer protects. Then BCG revaccination is required.
  • Doubtful result. Papule from 2 to 4 mm in the presence of hyperemia of any size without infiltration. It is difficult to talk about the degree of protection of the baby from infection. Probably, a certain amount of mycobacteria still got into his body.
  • Positive result. With button sizes of 5 mm or more. The reaction suggests that harmful mycobacteria have already entered the body, but the baby is healthy. The doctor's task is to weigh the degree of susceptibility of a small organism to tuberculosis bacteria. Positive reaction is divided into the following types:

Weak-positive reaction with seal size from 5 to 9 mm.

Reaction of average intensity at the sizes from 10 to 14 mm.

Pronounced reaction with a size of 15 to 16 mm.

  • Excessively pronounced result with a papule diameter of 17 mm or more. It is necessary to consult with a phthisiatrician. Perhaps the baby is either sick, or he is very susceptible to the pathogen.

We evaluate the result

The assessment is carried out 72 hours after the administration of the drug, that is, on day 3.

Visual inspection begins with an assessment of the external condition of the papule. The doctor may note one of three conditions:

  • complete lack of reaction;
  • hyperemia (redness);
  • the formation of an infiltrate (seal).

Infiltrate can be distinguished from hyperemia by palpation. The doctor compares the thickness of the skin in the fold over the normal skin area and over the injection site. If the skin fold at the site of the test is thicker, this indicates the presence of an infiltrate. If the thickness is the same, then it's just hyperemia.

Then, using a transparent colorless ruler, measure and record the transverse size of the seal, if any. Normal redness around the injection site is not considered a sign of TB infection. It is due to the individual reactions of the baby's body.

Side effects and complications

The Pirquet test can cause an unexpectedly sharp allergy, and not only at the injection site. In this case, it becomes impossible to determine the degree of protection of the child's body from Mycobacterium tuberculosis. Tuberculin itself is non-toxic, but it contains phosphate,
chloride solutions and preservatives that can give such a side effect.

Symptoms of an abnormal reaction to a tuberculin test are:

  • increased body temperature;
  • skin rashes;
  • increased sensitivity of the skin;
  • loss of appetite;
  • weakness and lethargy.

The causes of the resulting symptoms are various violations:

  • Contraindications were not taken into account during the study.
  • Exceeding the norm of the administered drug.
  • Incorrect introduction.
  • Poor vaccine quality.
  • Violation of safety rules during the test.
  • Violation of the requirements for the storage and transportation of the drug.
  • Individual intolerance.

Contraindications

There are special cases in which research cannot be done. These include:

  • dermatological diseases;
  • infectious diseases in the acute period;
  • a history of allergies of any origin;
  • ARVI or ARI;
  • epilepsy.

Neglect of these points can harm the health of the baby.

Enlarged Mantoux in a child

An enlarged papule during a tuberculin test can indicate not only tuberculosis, but also have other causes.

First, it is an allergy. If your child has any allergies, the allergen must be ruled out at the time tuberculin is administered (3 days). If you do not know what exactly causes an allergic reaction in a baby, then limit contact with pets, eating highly allergenic foods, and taking medications as much as possible.

Be sure to tell your doctor about this fact.

Secondly, this is an incorrect assessment of the result of the study. If in doubt, it is recommended to contact another medical institution for a second test and a new check of the measurement results.


Thirdly, this is an individual feature of the child's body. The hereditary factor, the excessive presence of protein products in the diet, and many other reasons can significantly affect the outcome of the diagnosis.

And, finally, fourthly, a papule enlarged beyond the norm may indicate the presence of a pathogen in the baby's body. Most likely, the child will be included in a special risk group. It is important to protect the baby from lung diseases and even consult a phthisiatrician or pulmonologist in a timely manner.

Sample Refusal

According to Russian laws parents have the right to refuse to conduct a Mantoux test. In other words, this vaccination is anti-tuberculosis care, that is, it is carried out voluntarily, only with the consent of the child's representatives.

In the children's clinic, you can make an application according to the provided sample.

When refusing a mantoux test, you must be firmly convinced that your children could never and nowhere come into contact with a person with tuberculosis.

Such a refusal by law does not entail undesirable legal consequences. But from the point of view of the danger to children's health, you should know that the risk of contracting tuberculosis in this case is increased.

The decision to conduct a tuberculin test should be made independently, based on the individual characteristics of the child's body and your risk assessment.


It is better to take all the necessary precautions and be sure of the safety of your children's health than to regret later that the necessary studies were not carried out in a timely manner.

The Mantoux test is prescribed to detect the presence / absence of a tubercle bacillus in the human body. To do this, a drug called Tuberculin is introduced into the body.

As a rule, the Mantoux test is performed on children once a year, unless repeated checks are required.

Three days after the administration of the drug, it is necessary to measure the size of the residual trace from the injection on the skin. An increase in the area of ​​the skin reaction allows you to determine the presence of mycobacteria in the body.

Enlarged papule when assessing the Mantoux reaction

After performing the test, a slightly visible scratch or inflamed red spot may be observed at the injection site. At the same time, a papule can form at the site of redness - a button, which is measured with a ruler. Why do they do it? The reaction of the body to the injected tuberculin is measured precisely by the size of the resulting seal. What should be the norm?

There are several variations of the tuberculin test reaction. Depending on how much Mantoux is increased in a child in comparison with the norm, the Mantoux reaction is:

Tuberculin test is not included in the list of mandatory vaccinations, but it is done massively for children different ages, which often occurs without regard to contraindications. However, this neglect often leads to negative consequences, the most harmless of which is an increase in the papule, which is not associated with infection with tuberculosis, and therefore does not represent the correct result.

These contraindications include:

  • infectious diseases;
  • chronic diseases;
  • asthma and epilepsy;
  • propensity to various allergies;
  • skin diseases.

Does a large papule always indicate infection with tuberculosis?

In addition to the presence of contraindications, the size of the Mantoux reaction is affected by the age of the children and the time of the previous BCG vaccination.


The first BCG vaccination takes place in the maternity hospital. This affects the result of the first Mantoux reaction, which is performed when the child is one year old. It is permissible to consider the size of 10 mm as the Mantoux norm for a child per year. Over time, the child's body will resist the infection, and the button from the sample will decrease in size.

Do not be afraid if, in the second year of a child's life, the doctor wrote a diagnosis in the card - Mantoux hyperemia. This only means that the baby has an allergic reaction to tuberculin, which is manifested by reddening of the skin at the injection site and a significant increase in the size of the papule (more than 17 mm).

Attention! If the Mantoux reaction in a child is too small, and the trace remains only a dot in a child under 7 years old, a second BCG revaccination is required.

In such cases, a retest is carried out after a year, and the reaction should normally be within 10 mm.

An increased reaction of the tuberculin test is not always a confirmation of the fact of infection with a tubercle bacillus. We can talk about the process of infection in cases where the size of the papule increases every year or sharply exceeds the permissible 5 mm.

In a baby, an increased size of the papule may indicate a post-vaccination allergy to the BCG tuberculosis vaccine. This is due to the fact that the duration of anti-tuberculosis immunity obtained by the body after BCG vaccination is two to three years.

The diagnosis is not only influenced by the result of the Mantoux test, since this test does not guarantee a 100% correct and accurate result, that is, it is not taken into account as evidence of tuberculosis infection, but only as a reason for further examination.

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The increase in the size of the papule after the test can be influenced by many factors, without taking into account which the procedure was done:

  • the contraindications described above;
  • recent vaccinations;
  • allergy to the administered drug;
  • the presence of worms;
  • poor quality of the vaccine.

If there is a large Mantoux in a child, what should I do? The doctor may suggest consulting a TB specialist or giving a referral to a TB dispensary in the following cases if:

  • the reaction to the test in a child is defined as a "turn";
  • there is a steady increase in the size of the reaction every year;
  • a very large Mantoux in a child has been observed regularly for several years.

The phthisiatrician, in turn, should familiarize himself with the patient's history, with the patient's possible diseases of a chronic nature. It is necessary to establish the reasons why an enlarged Mantoux occurs in a child.

Before making an accurate diagnosis, a full examination is necessary:

  • a blood test for the presence of viruses;
  • tests to identify possible allergic reactions;
  • sputum examination;
  • X-rays of light.

After the Mantoux test, the child may experience side effects as a result of the development of an allergy or individual intolerance to the vaccine. The first signal of violations in the state of health of the child may be an increase in the trace from Mantoux. Usually in this case, the following symptoms also develop:

  • increase in body temperature;
  • lethargic state;
  • skin rash;
  • disruption of the stomach;
  • cough.


If a child has a bad Mantoux, this means that a visit to the doctor is necessary to confirm the absence of the disease. If this is repeated, then the child should be observed in a tuberculosis dispensary for a year.

In the event of a significant increase in the papule after the reaction of the Mantoux test in a child, it is necessary to check all family members.

The clinical manifestations of the disease may not yet be expressed, and a large Mantoux in a child will help determine the presence of a virus in the body. In addition, this procedure in some cases is the reason for the repeated administration of the BCG vaccine.