Dr. Komarovsky about Mantoux test

Sometimes the Mantoux test, popularly referred to as the “button,” is mistakenly considered a graft. And when someone intelligibly explains to the mothers, the fact that the scion in the pen was injected in the school, kindergarten or in the treatment room is not a vaccine, but a test, a test, then a lot of questions arise. The famous pediatrician Yevgeny Komarovsky tells what Mantu is and why such an injection is made.

The tuberculin test is a diagnostic method, a test for the presence of a microbe that causes tuberculosis in the body - the tubercle bacillus. For these purposes, the child is injected subcutaneously with a special drug, which is based on the microenvironment of the causative agent of the disease - tuberculin. Then, experts evaluate the body's response to the injected substance. The fact is that people suffering from tuberculosis, infected, and those who are healthy, diametrically oppositely react to tuberculin. This reaction is similar to the manifestations of allergy: if a person has a microbe, the causative agent of tuberculosis, tuberculin causes a certain inadequate allergic (immune) response, if the child does not have a chopstick, nothing happens.

Dr. Komarovsky will tell the children in more detail and thoroughly all questions on the subject of manta in the next video.

Today, the Mantoux test worldwide is considered an effective diagnostic method. Alternative ways to find out if a child is sick with tuberculosis also exist, but they are few. One of the modern samples - "Diaskintest"Is still being introduced. In Russia, the drug is registered and certified completely official. Its diagnostic action is based on the secretion of certain specific protein-antigens that are sensitive only to the aggressive causative agent of tuberculosis. If a regular Mantoux test can give a reaction to the components of the vaccine BCGthen Diaskintest gives a positive reaction solely on microbes that are pathogenic. From this point of view, the new test is more perfect. If it is negative, there is no disease; if positive, there is a disease.

Vaccination, aimed at ensuring that a child has developed an anti-tuberculosis immunity, is made even in the maternity hospital. It is called BCG. However, despite vaccination, the child may become infected with tuberculosis, although the vaccine significantly reduces this probability. This is due to a gradual decrease in antibodies to the tubercle bacillus. If the baby has not developed immunity at all after the first vaccination, he is given a second one - before school, at the age of 7 years.

Mantou must be tested once a year, starting from the moment when the child is 1 year old.. If the test gives a negative result, it is interpreted as the fact that immunity to the tubercle bacillus after the maternity vaccine has not been formed, and the doctor has the right to recommend such babies not to conduct the tuberculin test 2 times, but not to “miss” the disease.

It is necessary to do tests according to the existing rules in different hands. If this year the child was done in the left, then after a year you need to do in the right.Place for the introduction of tuberculin is always the same - the inner surface of the forearm, the average third. If you see that the sample is made in another third of the forearm, you can not count on the correct result.

As well as before vaccination, before trying Mantoux, for about a month, you should make sure that the baby feels good. He should be healthy, he should not be observed any acute diseases and manifestations of allergies. If the child has a fever, it is better to postpone the test to a later date.

You can not do the test, if the child has skin diseases, especially in the period of exacerbation, if he has a history of diagnoses "Bronchial asthma"Or" Rheumatism ", as well as if a quarantine is currently announced in the children's collective that is visited by the child. All this - strict contraindications.

You can often hear the opinion that a child after a Mantoux test cannot be bathed for 3-4 days. Yevgeny Komarovsky argues that this is not the case, and it is absolutely not contraindicated to wash, it is possible to wet the injection site. But a number of restrictions and prohibitions in relation to the very "buttons" still exist:

• The tuberculin injection site should not be scratched and rubbed intensively (including a washcloth).
• The injection site is strictly prohibited to lubricate with antiseptics, iodine, and ointments.
• On the Mantoux test, you should not stick a plaster, tie a bandage, make compresses and lotions.
• It is not allowed to wear long-sleeved clothes for a child because of the weather, since sweating and friction of the fabric against the test place can cause a pronounced positive error reaction.

An assessment of the body's response to tuberculin should be carried out by a qualified medical professional. However, mothers usually can not wait to independently understand the intricacies of diagnosis. Their desire is understandable and understandable, says Yevgeny Komarovsky. Especially for moms and dads, he explains what the Mantoux reaction can tell.

Accounting is carried out 72 hours after the test. Therefore, the most convenient day for diagnostics is Friday, in most Russian clinics this particular day is chosen so that the doctor has the opportunity to evaluate the result in exactly 72 hours (on Monday). Place of introduction of tuberculin during this time varies. Sometimes there is redness (hyperemia). Often there is some swelling, an increase in size, compaction at the injection site, It is called - papule. The health worker does not measure redness, but an enlarged papule, for this it is necessary to use a transparent ruler.

The reaction may be:

• Negative. If there are any reddenings, there is no increase in the injection area.
• Doubtful, controversial. If there is a reddening (hyperemia) or papule not larger than 2-4 mm. In this situation, the doctor, assessing the general condition of the child and looking at his medical record, can either equate the result to a negative one, or prescribe additional diagnostic tests.
• Positive. Weakly expressed result is determined if the papule size is from 5 to 9 mm. The average result - papule has dimensions from 10 to 14 mm. The pronounced result is a papule in a diameter of more than 15 -16 mm.
• Excessive. The size of the papules with this result is always more than 17 mm. In addition, there is a general reaction of the body - an increase in lymph nodes, the appearance of ulcers on the skin, signs of an inflammatory process in the papule itself. Such a result in high probability can speak about developing tuberculosis.

Sometimes parents are faced with a situation where the test, previously always negative, is converted to a positive one (but there was no BCG vaccination). In medicine, this phenomenon is called the "turn of the tuberculin test." If it occurs, it may mean that the child has become infected with a tubercle bacillus. A consultation of a phthisiatrician will be ordered to Chad, an x-ray of the lungs will be needed and additional tests will be done, after which the child will be given treatment.

Infection with a dangerous disease can be suspected even if the Mantoux test after a positive result (after BCG vaccination) gradually decreased every year and then suddenly increased sharply (it was 5 mm, it became 9 mm). Such changes in the size of the papules are also the basis for additional examination and prescription of treatment if necessary.

Recently, there is a lot of unprofessional and unreliable information about the dangers of the Mantoux test. For example, scary stories about the toxicity of this diagnostic test because of the phenol contained in it “walk” on social networks on the Internet. Therefore, the number of parents who refuse to do their children samples, has increased significantly. Yevgeny Komarovsky claims that the introduction of tuberculin in no way poses any danger to the child.

Phenol as a preservative is indeed contained in the preparation, which is injected intradermally, but its amount is very small (about the same amount is contained in 5-6 ml. Of urine). By the way, phenol is a natural substance for the human body, it, as a decay product of certain compounds, is excreted in the urine. In order for a child to be exposed to the toxic effect of tuberculin, he needs to administer about a thousand doses per day!

Very often the parents have a question, whether it is necessary to give antihistamines to the child before the test. Yevgeny Komarovsky argues that this can not be done. Since the main task of the Mantoux test is to see if there is an allergic reaction to tuberculin, antihistamines can interfere with this.

The concept of a single "norm" when conducting a tuberculin test in children does not exist.