When should you not give manta to a child?

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Doctor Komarovsky about the Mantoux test

Sometimes the Mantoux test, popularly called the “button” test, is mistakenly considered a graft. And when someone clearly explains to mothers that what was injected into their offspring’s arm at school, kindergarten or in the treatment room is not a vaccine, but a test, a test, then a lot of questions arise.

Table of contents:

The famous children's doctor Evgeny Komarovsky tells what Mantoux is and why such an injection is given.

What it is

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

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

Today, the Mantoux test is considered an effective diagnostic method throughout the world. Alternative ways to find out whether a child has tuberculosis also exist, but they are few. One of the modern tests, Diaskintest, is just being introduced. In Russia, the drug is registered and certified completely officially. Its diagnostic effect is based on the isolation of certain specific antigen proteins that are sensitive only to the aggressive pathogen of tuberculosis. If a regular Mantoux test can give a reaction to the components of the BCG vaccine, then Diaskintest gives a positive reaction exclusively to microbes that are pathogenic. From this point of view, the new test is more advanced. If it is negative, there is no disease; if it is positive, there is a disease.

Why do this

The vaccination, aimed at ensuring that the child develops anti-tuberculosis immunity, is done in the maternity hospital. It's called BCG. However, despite vaccination, a child can become infected with tuberculosis, although the vaccine significantly reduces this likelihood. This is due to a gradual decrease in antibodies to the tuberculosis 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.

In our environment there is always someone who is a carrier of the tuberculosis bacillus; we encounter such people in transport, in a store, on the street, because the policy of the Russian state does not provide for the strict isolation of people with such a diagnosis from society.

The Mantoux test should be performed once a year, starting from the moment the child turns 1 year old. If the test gives a negative result, this is interpreted as the fact that immunity to the tuberculosis bacillus has not been formed after the maternity hospital vaccine, and for such babies the doctor has the right to recommend a tuberculin test not once, but 2 times a year, so as not to “miss” the disease.

According to the existing rules, samples must be taken in different hands. If this year the child was treated on the left, then in a year it should be done on the right. The place for tuberculin injection is always the same - the inner surface of the forearm, its middle third. If you see that the test was made in the other third of the forearm, you can’t count on the correct result.

Rules for conducting the test

As before vaccination, before the Mantoux test, about a month in advance, you should make sure that the baby is feeling well. He must be healthy, he must not have any acute diseases or allergies. If the child has a fever, it is better to postpone the test date to a later date.

You cannot do the test if the child has skin diseases, especially during the period of exacerbation, if he has a history of diagnoses of “Bronchial asthma” or “Rheumatism”, and also if the children’s group that the child attends is currently quarantined. All of these are strict contraindications.

After any regular calendar vaccination, the Mantoux test should be performed no earlier than a month later. Also, more than 30 days must pass after the illness. If you properly prepare for a diagnostic test, the results are less likely to be false or erroneous.

Is it possible to swim

You can often hear the opinion that after a Mantoux test a child should not be bathed for 3-4 days. Evgeny Komarovsky claims that this is not so, and washing is not at all contraindicated; it is possible to wet the tuberculin injection site. But there are still a number of restrictions and prohibitions regarding that very “button”:

  • The site of tuberculin injection should not be intensively scratched or rubbed (including with a washcloth).
  • It is strictly forbidden to lubricate the injection site with antiseptics, iodine, or ointments.
  • You cannot stick a patch on the Mantoux test, tie a bandage, or make compresses or lotions.
  • The child should not wear clothes with long sleeves that are not suitable for the weather, as sweat and friction of the fabric against the sample site can cause a clearly positive erroneous reaction.

Sample results

A qualified medical professional should evaluate the body's response to tuberculin. However, mothers usually cannot wait to figure out the intricacies of diagnosis on their own. Their desire is quite understandable and understandable, says Evgeny 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 day is chosen so that the doctor has the opportunity to evaluate the result exactly 72 hours later (on Monday). The site of tuberculin injection changes during this time. Sometimes redness (hyperemia) is observed. There is often some swelling, an increase in size, and thickening at the injection site. It is called a papule. The health care worker does not measure the redness, but the enlarged papule; for this purpose, they must use a transparent ruler.

  • Negative. If there is any redness or enlargement in the injection area, there is no swelling.
  • Doubtful, controversial. If there is redness (hyperemia) or a papule measuring no more than 2-4 mm. In this situation, the doctor, having assessed the general condition of the child and looked at his medical record, can either equate the result to negative or prescribe additional diagnostic tests.
  • Positive. A mild result is determined if the size of the papule is from 5 to 9 mm. The average result is a papule measuring from 10 to 14 mm. The pronounced result is a papule with a diameter of more than 10 mm.
  • Excessive. The size of the papule with this result is always more than 17 mm. In addition, a general reaction of the body is observed - enlargement of the lymph nodes, the appearance of ulcers on the skin, signs of an inflammatory process in the papule itself. This result is highly likely to indicate developing tuberculosis.

Alarming results

Sometimes parents are faced with a situation where a test that was previously always negative turns positive (and there was no BCG vaccination). In medicine, this phenomenon is called the “tuberculin test turn.” If it occurs, this may mean that the child has become infected with a tuberculosis bacillus. The child will be scheduled for a consultation with a TB doctor, an x-ray of the lungs will be required and additional tests will be performed, after which the child will be prescribed treatment.

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

If over the course of 4-5 years the Mantoux test remains pronounced (more than 12 mm in transverse measurement), this may also indicate the development of pulmonary tuberculosis.

If parents refuse the test

Recently, a lot of unprofessional and unreliable information has appeared about the dangers of the Mantoux test. So, on the Internet, on social networks, there are scary stories about the toxicity of this diagnostic test due to the phenol it contains. Therefore, the number of parents who refuse to have their children tested has increased significantly. Evgeny Komarovsky claims that the administration of tuberculin in no way poses any danger to the child.

Phenol as a preservative is indeed contained in the drug, which is administered 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 breakdown product of certain compounds, is excreted in the urine. In order for a child to be exposed to the toxic effects of tuberculin, he needs to administer about a thousand doses per day!

Adviсe

Very often, parents have a question about whether they should give their child antihistamines before the test. Evgeny Komarovsky argues that this cannot be done. Since the main purpose of the Mantoux test is to see if there is an allergic reaction to tuberculin, antihistamines may interfere with this.

There is no concept of a single “norm” when conducting a tuberculin test in children.

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Source: http://www.o-krohe.ru/komarovskij/proba-mantu/

Mantoux vaccination

Content:

In the modern world, the problem of tuberculosis is very acute. The rate of spread increases every year and, unfortunately, is accompanied by a fairly high mortality rate. In our country, BCG vaccination in newborns is carried out en masse, unless there are contraindications. Today, this is the most effective way to prevent tuberculosis infection.

However, BCG vaccination is not a 100% guarantee. Therefore, in order not to miss the problem, they use a so-called test that allows you to determine the presence of the above-mentioned infection. This test is called: Mantoux test, or Mantoux vaccination.

importantThe essence of the procedure is the subcutaneous injection of a drug - tuberculin, artificially created with the content of tuberculosis microbacteria. Excessive redness or swelling at the injection site is a reaction that indicates the presence of dangerous bacteria in the body.

Mantoux vaccinations for children help control the spread of infection among the “younger” population.

When is the Mantoux test done?

The first time this vaccination is given is 12 months after birth. It is simply pointless to do it before a year, because the results of the reaction are different and cannot be completely trusted. Upon reaching the age of 2, the child is vaccinated with Mantoux every year, regardless of previous results.

You need to know that the test should not be carried out on the same day as other vaccinations that are given to develop immunity, because It is known that this test will give a false positive reaction. However, after receiving the test results, vaccinations can be carried out in the required quantity even on the same day.

Vaccination, carried out against various diseases before the test is taken, requires an interval of at least 4-6 weeks (this depends on the vaccine: inactivated or live).

  • Mantoux vaccination is done with a special tuberculin syringe once a year intradermally, in the area of ​​the middle third of the inner surface of the forearm.
  • The dose volume administered is 0.1 ml, or two tuberculosis units (TU).
  • The procedure is performed by specialists who insert the needle with the bevel upward to the required depth so that the hole is completely immersed in the skin, but at the same time does not go under the skin. To do this, stretching the skin, the needle is slightly raised.
  • A specific swelling, called “buttoning,” of the upper layer of the skin is a normal reaction to the injection of tuberculin.

There are other methods for performing the Mantoux test: cutaneously (Pirquet reaction), and with plastic applicators, thanks to which not only tuberculin, but also other tests can be applied to the pointed ends. The number of TEs can also be different: for example, in the USA they introduce 5, but then the conclusions are drawn differently.

results

information Within two to three days after Mantoux vaccination, a compaction called a “papule” may form at the injection site. Externally, it represents a rounded area rising above the skin.

The resulting papule is the result of saturation of the skin with cells: sensitized lymphocytes. If you press it lightly with your finger and release it, or press it with a transparent ruler, you will notice a whitish tint.

The dimensions of the Mantoux graft are determined under high-quality lighting an hour after the test. The ruler is installed transversely to the longitudinal axis of the forearm to measure only the size of the seal. Redness surrounding the infiltrate cannot be considered an infection or a sign of immunity to tuberculosis, although when there is no “papule”, it is definitely recorded. Depending on the result, we can talk about different types of reactions:

  • negative: 0-1 mm;
  • doubtful: 2-4 mm;
  • positive: 5 mm or more:
    • weakly positive: 5-9 mm;
    • medium intensity:mm;
    • expressed:mm.
    • hyperergic: 17 mm or more;
  • vesicular-necrotic (formation of pustules and the appearance of areas of necrosis): regardless of the diameter of the infiltrate, a reaction accompanied by regional lymphadenitis (enlarged lymph nodes), lymphangitis, daughter screenings;
  • false negative: some patients infected with the tuberculosis bacillus have a negative reaction (this may be due to anergy, when the immune system is not able to respond to tuberculin);
  • false positive: a reaction in uninfected patients (one of the most common reasons is the presence of mycobacteria of non-tuberculosis etiology, but there may be allergic disorders, a recent infection, or a vaccination that was given a month ago).

The reaction to Mantoux vaccination may have a “turn”: an increase in the diameter of the infiltrate compared to last year by 5 mm or more (for example: 12, 12, 12, 17 mm).

informationFor specialists, this is a very valuable diagnostic sign, which allows the doctor to draw a conclusion about an infection that has occurred during the last year.

In this case, it is necessary to exclude all influencing factors: allergies, recent infection, recent BCG vaccination or another vaccine less than one month old, and the like.

When you can't vaccinate

It should be said that this test is not dangerous either for a healthy child’s body or for children who have any somatic diseases. However, there are a number of reasons why Manta needs to be postponed:

  • age up to 12 months;
  • skin problems;
  • period of acute diseases of both infectious and non-infectious origin;
  • quarantine area for some disease;
  • allergic manifestations;
  • epileptic seizures;
  • less than 4 weeks after the previous vaccination.

Parents should be aware of these features, and then the Mantoux vaccination will not cause concern if there are no specified contraindications for this. The test can be performed a month after the reasons that prevented this have disappeared.

After vaccination, it is not recommended to treat the area with anything until the results have been assessed. If the reaction is negative and the injection site looks neat on the outside, it does not need to be treated. If this area of ​​skin has some unpleasant external manifestations (ulcers or pustules), then after the results obtained you can take care of them, as with ordinary wounds.

important When caring for the injection site, it is very important that the child does not scratch it or wet it prematurely with water. It is not recommended to cover this area with adhesive tape, as the skin underneath may sweat and this can lead to irritation.

A child should be instilled with a culture of attitude towards vaccinations from an early age - it should be explained that incorrect behavior can give false results.

What to do if the Mantoux test is positive

The Mantoux test is not one hundred percent proof of the presence of tuberculosis infection, although it is indeed a very important criterion. There are other diagnostic methods:

  • examination of all family members;
  • sputum culture;
  • fluorography.

Children's cases of primary detection of infection are accompanied in 7-10% of patients with symptoms characteristic of tuberculosis. Such children require medical observation and accompaniment in an anti-tuberculosis dispensary for a year. Moreover, for the first 3 months, patients undergo chemoprophylaxis with isoniazid, and then are transferred under the control of a local pediatrician.

If after a year signs of increased sensitivity to tuberculin do not appear and there is no hyperergic reaction, then the child is accompanied by a doctor, like other children. But the results of subsequent annual tests must be treated even more carefully. If the infection has been observed for more than a year, then mandatory observation at a tuberculosis dispensary is necessary, where, taking into account the individual characteristics of the hyperergic reaction to tuberculin, a treatment regimen is prescribed.

important A serious attitude towards the injection site is required not when there is redness, but when the size of the “papule” reaches more than 6 mm, because this indicates activation of the infection, and in the case of 15 mm, immediate administration of effective treatment is necessary.

To vaccinate or not to vaccinate

Unfortunately, not all parents understand the degree of responsibility that they place, first of all, on themselves by refusing to vaccinate their child with Mantoux. At the same time, they cannot give themselves an answer to the question “why?” In fact, this test does not harm the body, but on the contrary helps to find an infection if it is present there.

Mantoux vaccination is very necessary before BCG revaccination. After all, it is this test that can relatively accurately determine the need for re-administration of the Calmette-Guerin vaccine (BCG), since children with a positive Mantoux test or a history of a tuberculin test are not recommended to be re-vaccinated with BCG at the age of 7 years.

Source: http://deti.baby-calendar.ru/kalendar-privivok/mantu/

When a child should not have a Mantoux test: contraindications, side effects and complications

For decades, almost all schoolchildren have been exposed to the Mantoux test. Analyzing the “button”, the doctor concludes that there is a risk of contracting a very serious and dangerous disease - tuberculosis. The procedure is repeated annually. However, many parents do not fully understand how necessary this event is and whether it is harmful.

The benefit of Mantoux is that it is a kind of indicator of the presence of the causative agent of tuberculosis in the body. Given that the number of people infected with tuberculosis is increasing every year, all newborns should be vaccinated against tuberculosis (BCG). Mantoux allows you to monitor the effect of vaccination in order to promptly identify the disease and begin therapy.

Despite the fact that Mantoux is the main method of preventive examination of children for tuberculosis, the test has a number of contraindications

Mantoux test - benefit or harm?

Recently, the number of tuberculosis patients has been rapidly increasing. One of the most accessible and simplest means of identifying this infectious disease is to conduct a tuberculin test. Mantoux is not a vaccination, but a test for the presence of tubercle bacilli in the body. The main condition is a preliminary examination by a general practitioner, who must rule out fever, any skin diseases, impaired immune function, and also assess the likelihood of allergies.

From 1 year old to 15 years old, Mantoux is considered a mandatory procedure once a year. A small amount of neutralized enzymes of tuberculosis bacteria, which are thermally treated, is injected subcutaneously into the forearm area. By analyzing the child’s body’s reaction to the “button,” the doctor can assess the process of developing immunity against tuberculosis and the child’s chances of resisting this dangerous disease.

Despite the fact that Manta has been used for diagnostic purposes for quite a long time, doctors have divided opinions regarding its safety. Some experts believe that the test is not a vaccination, so it does not have any effect on the immune system. And others believe that unexpected negative consequences are possible, since the mechanism of interaction between tuberculin and immunity is still not exactly known, and the composition of tuberculin that is administered to a child contains many harmful substances.

Tuberculin is a heterogeneous mixture of organic substances of varying complexity, which are obtained from mycobacteria. It does not contain the Koch bacillus itself, but only its metabolic products. In addition, the drug contains sodium chloride, Tween-80 stabilizer, salts of phosphate buffer solution and phenol, which acts as a preservative. Traces of ballast impurities may also be present.

After the introduction of tuberculin, the body does not produce specific antibodies, so it cannot be called an antigen. It is also not a toxin. Most experts classify it as a group of incomplete antigens.

Normal reaction to Mantoux

The reaction can be analyzed when three days have passed, but not more than a week after the test. It is during this period that you can see a specific papule, which is denser and distinguished by redness against the background of the rest of the skin. To measure its diameter, doctors use a transparent millimeter ruler, which is placed across the forearm. In cases where the papule is not visible, the hyperemic area of ​​skin is of no diagnostic value.

The result is considered negative if there are no changes at the site of the Mantoux test, and if a papule is present and there is redness of the skin, then positive. The diameter of the papule directly depends on the number of pathogens present - the more of them there are in the child’s body, the larger the diameter of the “button” will be. The diagnostic results are recorded in the medical record.

Temporary contraindications

The following conditions are contraindications to the Mantoux test:

  • skin rash of any nature;
  • allergy;
  • chronic and acute infectious diseases;
  • any colds.

Another contraindication is to vaccinate and Mantoux in the same period, because the latter greatly weakens the immune system, which can cause an incorrect reaction to the test. The break between procedures ranges from several weeks to two months, depending on the type of vaccine. A TB doctor may insist on temporarily refusing to carry out the test if the child has recently suffered a complex infection or suffers from prolonged allergies. This period can last up to six months. If quarantine is declared in the group that the child attends, the test can be done only after the quarantine is lifted.

Absolute contraindications

To avoid the development of complications associated with the test, it is necessary to understand under what conditions the procedure is unacceptable. A certain category of children cannot be tested due to existing diseases. This includes children suffering from:

  • dermatitis;
  • chronic forms of infectious diseases;
  • rheumatism;
  • bronchial asthma;
  • epilepsy;
  • schizophrenia;
  • various neurological diseases.

Before performing the Mantoux test, the doctor must clarify whether the child has any temporary or absolute contraindications

Testing this category of children may lead to a severe allergic reaction and give a distorted result. That is why the TB doctor is provided with the entire medical history of the child to prevent an undesirable reaction. Only a doctor can decide whether the test can be performed on the baby or whether there are contraindications.

Side effects and complications in a child

Many parents are concerned about the question: can Mantoux cause complications? Official medicine claims that the risk of complications is minimal, but in pediatric practice a slightly different picture is observed. It has been established that Mantoux vaccination can cause the following side effects:

  • violations by housing and communal services;
  • weakness and apathy;
  • temperature increase;
  • vomit;
  • skin rash;
  • redness and peeling of the skin;
  • a week after the test, the child may begin to cough.

In children with weak immunity and allergies, the Mantoux test can cause side effects similar to symptoms of intoxication

The symptoms after the test are quite similar to the manifestation of the body’s reaction when interacting with toxic substances. This suggests that Mantoux still contains toxins (phenol), albeit a small part, so it can cause side effects in particularly sensitive children prone to allergies. Symptoms usually go away on their own after 1-3 days. If you experience significant side symptoms that last more than 3 days, you should definitely consult a doctor.

If the doctor did not check for a runny nose in the child before performing Mantoux, then the body’s reaction may be unpredictable. Your child may tolerate the test without any unusual symptoms, or the runny nose may worsen and become chronic. Thus, carrying out the test is advisable only if the child is absolutely healthy and the doctor has not seen any hidden pathologies.

Are there alternative methods of testing for tuberculosis?

In most cases, the Mantoux test is used to diagnose tuberculosis, which is carried out once a year. However, for a certain category of children this method is unacceptable, so doctors use alternative options for testing the body’s reaction to Koch’s bacillus. The most popular of them:

Immunogram

To perform an immunogram, blood is taken from a child's vein, which is then examined for the number of cells produced to fight mycobacteria. The indicator allows you to analyze the ability of the child’s immunity to resist the disease.

Suslov method

Suslov's method is based on studying a drop of venous blood with the addition of a certain amount of tuberculin. Through a microscope, a specialist examines the characteristic pattern of blood cells. The reliability of this method is only 50%. Such diagnostics are always carried out in conjunction with additional measures, the list of which depends on the age of the baby (x-ray of the lungs, fluorography, tomography, etc.).

Diaskintest

Diaskintest is a highly sensitive intradermal test that can be used to completely safely test a child for carriage and infection with tuberculosis. The principle of interaction is the same as with Mantoux: a specific protein that is part of the administered drug causes a reaction, based on the intensity of the interaction the probability of the disease is calculated.

Most of the contraindications for Mantoux remain with Diaskintest (fever, acute forms of illness, vaccination and allergic reactions). The combination of Mantoux and Diaskintest makes it possible to give the baby an accurate diagnosis.

Interferon test

A modern development in the field of tuberculosis research is the interferon test (quantiferon). It is based on the analysis of specific interferon, which is produced by T-lymphocytes that have contact with a vaccinated or infected mycobacterium. The advantage of this test is that it has no contraindications or side effects and is well tolerated even when the baby is ill.

The accuracy of this diagnosis is the highest, it is not influenced by external factors, and distortion of the results is minimized. The only drawback is that the result of infection and disease is not distinguishable.

If we consider the cost of these methods, the Mantoux test remains the most affordable method today, but conducting a quantiferon test will cost the most. Early diagnosis of the disease is very important, therefore, even if the Mantoux test is contraindicated for a child, it is worth using any alternative options.

I believe that the Mantoux test should be done, especially if the child attends school or kindergarten, because a child who is not checked on time poses a danger to all the children around him. Before you refuse for no reason, you should think carefully.

A positive Mantoux reaction does not mean at all that a person has tuberculosis or is a carrier of the Koch bacillus. To make a diagnosis, you will need to undergo many more procedures. I don’t understand at all what the point of Mantoux is if it is so unreliable and has many side effects.

My child almost died from a mantu sample. The child is 1.8. When I told the TB doctor about this, she calmly replied, “This can’t be, it’s not from the mantoux test.” The temperature remained at 40 degrees for a week. Thoughts were that this was the end, EVERYTHING. And again they don’t lag behind, again they demand manta. I'm afraid what will happen, I don't know.

Attention! All information on the site is provided for informational purposes only and is for informational purposes only. For all questions regarding the diagnosis and treatment of diseases, you must consult a doctor for an in-person consultation.

Source: http://vseprorebenka.ru/zdorove/privivki/protivopokazaniya-mantu.html

Contraindications to the Mantoux test

The Mantoux test is an important preventive measure that detects the presence of tubercle bacilli in the body. A tuberculin test is mandatory for a child regularly, starting from the first year. This is a kind of allergy test that is administered subcutaneously. Do not confuse it with anti-tuberculosis vaccinations, such as BCG and BCG M. The substance - tuberculin, which contains Mantoux, is an allergen, not an antigen.

The test has its own indications and contraindications. There are quite a few prohibitions for all ages and they must be taken into account, since neglect can lead to serious consequences.

Contraindications in young children are quite difficult to identify. That is why parents must clearly know when the test will be carried out and promptly warn medical personnel about the presence of prohibitions or complaints from the child.

Sample components

The administered tuberculin consists of complex components that can be quite difficult to tolerate by the human body. Therefore, even if no restrictions were identified before the primary Mantoux, the patient’s condition must be carefully monitored in order to provide immediate medical assistance if necessary.

The drug consists of the following components:

Intolerance by the patient's body to any of the listed components can lead to serious complications.

Prohibitions

There are the following number of prohibitions on conducting the annual Mantoux test:

Coughing attacks and runny nose

If you have a cough or runny nose of any nature (allergic reaction, respiratory injury or acute respiratory infections), this test is contraindicated. We must wait until the patient recovers completely. Otherwise, the Mantoux reaction may not show accurate results.

Fever

Such a preventive measure is contraindicated even with a minimal rise in body temperature. This is due to the fact that a slight increase in it indicates the presence of an inflammatory or infectious process in the body. The immune system begins to fight emerging diseases, and an additional load in the form of Mantoux can only worsen the situation.

The test can be performed no earlier than fifteen days after complete recovery. This is also necessary to eliminate the risk of relapse.

Diarrhea

Diarrhea is evidence of intoxication. Before administration, it is necessary to wait for complete recovery for at least a week after the cessation of loose stools.

Neurological pathologies

For neurological disorders, such as epileptic seizures, a number of mandatory studies must be carried out. Only after the results of the examination and confirmation that the sample will not harm the patient’s condition can a reaction be carried out. The procedure is performed under the strict supervision of a specialist.

Skin diseases

For any skin pathologies, the reaction will not give accurate results; moreover, carried out during the height of the disease, it can further aggravate the patient’s condition.

Allergic reaction

An allergy that made itself known several days before the test is a complete contraindication to its implementation. The Mantoux reaction in this case will not only not show the necessary results, but will also cause significant harm to the patient’s health.

Temporary contraindications

Mantoux cannot be carried out on the same day as vaccination and revaccination. Vaccinations activate the immune system to fight the tuberculosis bacillus. If a vaccine and a test are given at the same time, it is impossible to predict the body’s reaction, and the Mantoux result may be false.

Manta must be done before vaccination or revaccination, and it will not affect the vaccinations themselves. Injections can be given immediately after receiving information about the test. If vaccinations are scheduled according to the medical calendar before the test, then you must wait at least thirty days between vaccination and revaccination. If the vaccine contains live tuberculosis microbacteria, this diagnostic method can be carried out no earlier than a month and a half later.

Read more about vaccinations against tuberculosis in the articles BCG and BCG M.

Temporary contraindications also include quarantine in a school or preschool institution. This is due to the fact that the body may be weakened due to the constant fight against an infectious disease, as a result of which quarantine was declared. Mantu can be placed only a month after its completion. Otherwise, incorrect results may appear.

Temporary contraindications can be violated only with the permission of the attending physician, as well as if infection with a stick is suspected.

Side effects

If the tuberculin test was done without taking into account contraindications, or the body does not accept any components of tuberculin, the following side effects may occur:

  1. Increased body temperature.
  2. Severe chills.
  3. Disturbances in the functioning of the gastrointestinal tract.
  4. Dizziness.
  5. Acute allergic reaction.

If you adhere to all contraindications and recommendations, the tuberculin test is painless and without any serious consequences. If the reaction causes negative complications, then it is necessary to notify a medical professional about this before the next test.

Mantoux test without contraindications

After the reaction, a small compaction will appear on the skin. The spot should be slightly swollen. On the third day, the specialist measures the sample, but does not take into account the size of the redness that has appeared around the lump. A negative result is detected in cases where the size of the swelling is less than one millimeter. This indicates that the patient’s body did not react to the injected substance tuberculin, which means that the presence of microbes that cause tuberculosis is absent.

Children with weakened immune systems also have a negative reaction. This indicates that the child suffered an infection with the tuberculosis bacillus, and less than three months have passed since that moment. In order for all sample indicators to be reliable, it must be performed in compliance with all rules and recommendations.

If the size of the injection in children is less than four millimeters, this indicator is considered doubtful. A positive result occurs in cases where the compaction measures from five to sixteen millimeters. This reaction suggests that the immune system can fight pathogenic bacteria. If the result is very strong, it is called hyperergic. In this case, the Mantoux test can have a size of about seventeen millimeters. This sign indicates that the patient is infected with the tuberculosis bacillus. If a small purulent formation appears at the injection site, this may indicate a viral infection.

Immunity to Koch's bacillus is developed in the case of a positive result of the tuberculin test. The swelling will be pinkish in color without distinct lines. The Mantoux test passes quickly, and no spots form at the injection site.

There is such a thing as a Mantoux turn. It means that the swelling from the injection has increased compared to the previous result. This is a sign of pathogenic microbes in the body.

If you test frequently (more than once a year), sensitivity to Mantoux increases. In this case, the injection site increases, and this is considered a false result. This phenomenon is called the “booster effect.” If a medical professional has doubts about the accuracy of the indicators, he refers the patient to a phthisiatrician who will conduct a full diagnosis.

Source: http://tbdoc.ru/analysis/protivopokazaniya-k-mantu.html

All about Mantoux vaccination

Many people call the Mantoux test a vaccination, but it is not a vaccination. Vaccination is given in order to create immunity to the pathogens of a particular disease. What then is the Mantoux test and why is it made? The Mantoux test is not done to develop immunity to the causative agent of tuberculosis, Koch's bacillus, but to assess the presence of this immunity in a child. This test has been known to everyone since childhood as a “button” and is completely harmless for a child, but very important in terms of diagnosis. For parents, the Mantoux test raises many questions to which we will try to find answers.

Why is Mantoux test done?

As we have already said, the Mantoux test allows you to assess the presence or absence of immunity in a child to tuberculosis pathogens. The Mantoux test is mainly used to identify among children:

  • Primary infected (those who first “caught” the tuberculosis bacillus);
  • Infected for more than a year;
  • Carriers of the tuberculosis bacillus (those who have tuberculosis pathogens in their bodies, but have no symptoms of the disease);
  • Those who need revaccination against tuberculosis.

All this information is needed in order to confirm the diagnosis where it exists and carry out prevention if the child is healthy.

Is it necessary to install Manta?

Refusal of vaccinations is now not at all uncommon, so parents are often interested in whether or not it is necessary to get Mantu. Mantoux tests are not done compulsorily, so no one can force you to put a “button”. If parents object to conducting a tuberculin test for their child, they write a refusal. However, WHO strongly recommends performing Mantoux tests, especially in countries where tuberculosis is very common. Russia belongs to this category of countries, so it is better for Russian parents not to neglect this test.

Indications and contraindications

The first Mantoux test is planned to be done at 1 year of age. There is no point in doing this test before one year of age, since the immune system of a child under one year of age is still developing, and the results will not be reliable. Starting from 12 months, the Mantoux test is done every year, and it is advisable to do it every year at approximately the same time.

If there are no indications for more frequent testing, Mantoux is given once a year for prevention. If the test gives positive results or someone close to the child is sick with tuberculosis, the “button” can be done 2-3 times a year.

In some cases, the Mantoux test needs to be postponed. Contraindications for it:

  • Chronic and acute skin diseases;
  • Any infectious diseases;
  • Allergies of any nature;
  • Epilepsy;
  • Some somatic diseases (bronchial asthma, rheumatism).

Mechanism of the Mantoux reaction

The Mantoux test is in other words called the tuberculin test. Tuberculin is a substance that is introduced into the body in order to assess the degree of its “familiarity” with Koch’s bacillus. It is an “extract” of tuberculosis bacteria. That is, there are no living microorganisms in it.

Using a special syringe, tuberculin is injected intradermally from the inside of the forearm. What happens in the body after this? Particles of bacteria that get under the skin begin to “attract” cells of the immune system, T-lymphocytes. However, not all T-lymphocytes react to tuberculin, but only those that have already dealt with the tuberculosis bacillus. This process is called the "Mantoux reaction". Due to the accumulation of lymphocytes under the skin in the place where tuberculin was injected, a compaction is formed - a papule, or that very “button”.

Button sizes

The most important thing when performing a Mantoux test is to measure the result correctly. The injection site often becomes red and inflamed, swelling and induration appear. The result of the test in this case will be only the diameter of the seal; the size of the redness does not affect the result in any way and is an individual reaction.

The diameter of the papule is measured only using a rigid transparent ruler, and then these dimensions are compared with the norms:

  • 0-1 mm – “negative reaction”;
  • 2-4 mm – “doubtful reaction” (the child is at risk);
  • from 5 mm – “positive reaction” (high probability of disease, but one Mantoux test does not make a diagnosis, additional research is needed);
  • from 17 mm – “hyperergic reaction” (a serious sign of the disease).

Sometimes the Mantoux test ends with a false negative or false positive reaction. In the first case, the infected child has a negative Mantoux reaction, in the second, on the contrary, the healthy child has a positive one. This happens with immunodeficiencies, cancer, after hemodialysis, and also if the test procedure itself was carried out with violations. Sometimes the reason lies in the tuberculin itself, which was transported or stored incorrectly.

By its nature, the Mantoux reaction can be classified as one of the types of allergic reactions, therefore the characteristics of the body also affect the result. That is why the mantu sample is evaluated dynamically, that is, in comparison with samples from previous years. An alarming sign is a change in the size of the papule by more than 6 mm.

Complications after the Mantoux test

Usually the Mantoux test is very easily tolerated by children. In rare cases, side effects occur after it: lymph nodes may enlarge and the temperature may rise. Sometimes children complain of weakness and headache. All this happens quite rarely, but if after the Mantoux vaccination the temperature rises, there is no need to worry, you just need to give the child an antipyretic and monitor the condition.

Button care

The “buttons” are measured on the third day after tuberculin administration. This means that all 3 days you need to follow some rules. The “button” does not require any special care, but there are things that should not be done so as not to affect the result:

  • there is no need to disinfect the injection site, smear it with brilliant green or peroxide;
  • Do not cover the vaccination site with a band-aid;
  • Do not touch the reddened area of ​​skin with your hands, rub or scratch it;
  • contact of the vaccine with water should be avoided.

What happens if you get it wet?

Everyone knows the rule that Manta cannot be soaked for 3 days. At the same time, parents have a reasonable question: for how many days can the vaccine not be wetted? You can’t deprive a child of water procedures for all 3 days - it’s not hygienic. — It is advisable that the injection site does not fall under water for the first 48 hours, but if you get the Mantoux vaccine wet, you just need to dry it with a towel and inform the doctor about this when measuring. You can give your child something anti-allergic (Claritin, Zertec).

“You can swim or shower with a Mantoux test. You should not swim in open water to avoid infecting the wound. You cannot rub this area with a washcloth, or use any liquids or solutions - brilliant green, iodine, peroxide. Do not cover the wound with a band-aid. It is necessary to ensure that the child does not scratch the wound. All this can affect the test result. Don’t worry about your mistake.”

Restrictions on food and everyday life

Even if the child does not have a food allergy, it is better not to eat anything potentially allergenic during the Mantoux test. What not to eat after Mantoux vaccination:

You need to eliminate allergens not only in your diet, but also in your everyday life. In particular, reduce “communication” with pets and ensure that the vaccination does not touch synthetic fabrics.

Should we be afraid of Mantoux’s positive reaction?

If the Mantoux test is positive, this does not mean that the child has tuberculosis. There may be several reasons for a positive reaction, and not all of them are related to infection. So, the reasons for the increase in Mantoux may be as follows:

  • the rules of behavior after the injection are not followed (an allergy or severe irritation may appear instead of a real reaction);
  • low-quality tuberculin was administered (in this case, it is better to repeat the sample in an independent laboratory);
  • the nurse measured the papule incorrectly;
  • the characteristics of the body are such that the test shows a positive result (sometimes a hereditary factor plays a role, sometimes - dietary features, in particular, an excess of protein foods);
  • there was a recent (within two years) BCG vaccination (the so-called post-vaccination immunity, the papule has vague contours, and a pigment spot remains in its place).

If all these factors are excluded, and the reaction is positive, you need to go for further examinations. A diagnosis cannot be made based on the Mantoux test, so the child will need to undergo fluorography and submit sputum for microbiological culture. Be sure to examine other family members.

Vaccinations before and after Mantoux

The Mantoux test is not included in the vaccination calendar, and since it is not tied to any deadlines, it must be administered in such a way that other vaccinations do not affect the result.

  1. If vaccinations are planned BEFORE Mantoux, then vaccination with live vaccines should be carried out 6 weeks before the test, inactivated - 4 weeks before the Mantoux test.
  2. No vaccinations can be given on the same day as the Mantoux test.
  3. 3 days after the test, when the result is measured, you can give any vaccinations.

Thus, the main restrictions relate to vaccinations before the test, and which vaccination is given after Mantoux does not really matter.

The Mantoux test is really important for the prevention of tuberculosis, and it is completely harmless for the child’s body. Knowing the meaning of this test and how to do it correctly, parents can really help identify tuberculosis at an early stage and protect their child from the disease.

Mantoux test – School of Dr. Komarovsky

My 11-year-old child has never had a reaction to mantu. We haven’t heard enough from doctors: from advanced tuberculosis to primary infection. It’s good that you got to a good doctor and he explained that some people have genetic resistance to tuberculosis bacteria and such people never get sick with this disease.

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Source: http://razvitie-krohi.ru/zdorove-rebenka/privivki/vse-o-privivki-mantu.html

Mantoux test in a child: all the questions that concern parents

Unfortunately, today the incidence of tuberculosis in children is growing, while the level of medical literacy of parents is falling. The media launches information about the dangers of vaccination, and people are happy to believe it. Although it would be worth asking in more detail.

The same, alas, applies to awareness of the Mantoux test. Most parents are not even aware of what this test is and why it is needed. And doctors often neglect the need to inform mothers in the maternity hospital.

This is why parents often wonder whether to vaccinate their children with Mantoux. We will consider in detail all the important aspects of this procedure, which will allow us to assess the need for children to undergo it.

About Mantu in simple words

There is a lot of information on the Internet and literature about the Mantoux test for children, but often it is intended not for an ordinary parent, but for a physician. It is quite logical that much remains unclear.

So, first of all, you need to understand that Mantoux is not a vaccine. Vaccination is the inoculation of a disease for preventive purposes. Mantoux is a determination of the reaction to the introduction of a tuberculosis antigen.

A tuberculin test is an intradermal or cutaneous injection of tuberculin to determine a specific immune response. Now more details.

  1. What is tuberculin? Tuberculin is a certain concentration of antigens of three types of Mycobacterium tuberculosis. These antibodies are contained in the drug in a quantity that is safe and necessary for testing immunity and does not harm the child.
  2. What is an immune response? This is the body's response to antigens. Human blood contains antibodies, tuberculin contains antigen. When an antigen meets an antibody, an immune reaction occurs. In this case, it manifests itself in the form of redness and swelling at the site of tuberculin injection - papules.
  3. Where do antibodies to tuberculosis come from in a child’s blood? And it’s true, he wasn’t sick. In the maternity hospital, the baby is vaccinated with BCG, which is a vaccination in its correct sense. With it, the baby is vaccinated with the same antibodies. They allow you to develop natural immunity and significantly reduce the risk of disease. BCG is the vaccine against tuberculosis. And Mantoux simply allows you to determine the presence of these antibodies.

Now the main question is whether to give Mantoux to a child and why? The main goal is early diagnosis of tuberculosis. Depending on the concentration of these same antibodies in the blood, the reaction manifests itself to a greater or lesser extent. This measure measures two opposing outcomes—the immune response to the vaccine and to the disease. The first is the norm, the second is a pathology. We regularly come into contact with mycobacterium tuberculosis on the streets and in transport and cannot be sure that there are not a dozen sick people per hundred people in the carriage. There will definitely be one. The Mantoux test is needed in order to notice the disease in its mild form, in the latent asymptomatic phase, and in this case, cure it without consequences for health.

Of course, if making the usual Manta is still a little scary, then there are alternatives, which we will talk about later.

How does the Mantoux test work?

The test is based on the reaction of the antigen-antibody complex (immune reaction). A child with a Mantoux vaccination will have a positive reaction, but within the normal range.

Specific blood cells – T-lymphocytes – are responsible for immunity to tuberculosis. When a person comes into contact with tuberculosis, a certain number of these cells become the very antigens to the disease that form immunity. When an antigen of the tuberculosis bacterium is administered intradermally, a reaction of the antigen to the antibody occurs, “recovered” T-lymphocytes accumulate at the site of injection of the antigen, and the most common inflammation occurs in the skin, which is manifested by redness, itching, swelling and minor pain.

How to care for your sample

Actually no special care is required. There are general recommendations for avoiding distortion of results:

  • do not smear with any preparations such as brilliant green or peroxide, as they lubricate the reaction, and its results cease to matter at all. The fact is that these drugs have an anti-inflammatory effect;
  • if a child has allergies, do not allow them to come into contact with allergens, as this can provoke more severe manifestations of the reaction;
  • it is possible to wet the sample, but it is not recommended to allow strong contact with soap, creams, detergents, oils and talcs, as they change the chemical composition of the exudate (“impregnation” of the skin during inflammation) and the picture may be distorted;
  • There is no need to seal the Mantoux area for children - perspiration may form under the patch, which will intensify the inflammatory process.

Tryout calendar

There is a schedule for vaccinations and Mantoux for children. The test is carried out annually, starting from twelve months. The last test is carried out at 15 years of age. A prerequisite is permission to conduct a test. There is a certain system - in even years, Manta is done on the right forearm, in odd years, on the left.

According to the vaccination calendar, the test is carried out for all children aged from one year to 15. If there are no contraindications, children receive the BCG vaccine in the maternity hospital, so the first test follows 12 months after vaccination - Mantoux is given to one-year-old children. For children who have not been vaccinated against tuberculosis, the test is done twice a year in the absence of contraindications documented by a medical certificate. With the same frequency, tuberculin diagnostics are performed for children with chronic nonspecific diseases and diabetes mellitus, which may affect the risk of the disease.

What might be the reaction to the Mantoux test?

The result of tuberculin diagnostics is assessed 48–72 hours after tuberculin administration. Two types of reactions are possible: papule and hyperemia. A papule is an elevation above the skin level with or without a change in color. Another name is infiltration. People call the papule a “button”.

Hyperemia is redness. It may be swollen or flush with the skin. The result is assessed by measuring the diameter of the papule or redness using a transparent ruler.

There are the following reaction options for the Mantoux test:

  1. A negative result is that the papule or hyperemia has a diameter of 0–1 mm, which indicates the absence of contact with Mycobacterium tuberculosis.
  2. A questionable result is an infiltrate with a diameter of 2–4 mm or redness of any size without infiltration. This result is common in vaccinated children.
  3. A positive result is any manifestation more than 5 mm in diameter - screenings (rashes away from the test site), pathologies of the lymph nodes, vesicular rash at the injection site. This option has three degrees of severity:
    • weakly positive – skin reaction with a diameter of 5–9 mm;
    • medium positive – 10–14 mm;
    • pronounced sample - 15–16 mm;
    • hyperergic test – 16 or more millimeters, vesicular-necrotic changes (ulcers, tissue destruction).

Positive results are typical for a very sensitive immune system or contact with a pathogen of varying severity. A cause for concern is a pronounced and hyperergic test result.

Are there any contraindications?

In certain conditions of the body, the Mantoux test in a child can give hypersensitive reactions. Therefore, it is not advisable to do it at this time. These conditions include:

  • various skin diseases;
  • acute diseases;
  • chronic diseases in the acute stage;
  • epilepsy;
  • acute allergic reactions.

After recovery, both vaccination and Mantoux can be given to children on the 5th–6th day of a healthy state.

Should you make Manta for your child?

The forums are full of horror stories about terrible allergies and the lack of need for Mantoux and BCG. The main argument for this is the independent development of immunity without vaccination. The whole point is that without vaccination, immunity can only be gained after an illness. To produce it, the body needs contact with the pathogen and recognition by blood cells.

The latter, after contact, become reactive antibodies against tuberculosis antigens. Vaccination provides a safe dose of antigen to develop immunity. As for the Mantoux reaction, it is indicative of 50%. Weakly positive and then on a positive scale helps to establish the risk of a disease or its fact. Pronounced reactions are indicators of the disease and are 70% reliable. Therefore, the answer to the question “should Mantoux be given to a child” is obvious.

If you are concerned about the possibility of your child contracting tuberculosis - a common and very serious disease today - it is still worth getting vaccinated, and Mantoux is still worth it.

Alternative

The only alternative to this method of tuberculin diagnostics are two modern methods - the Diaskintest and the Quantifiron test.

Diaskintest is a highly sensitive intradermal test that allows you to accurately and safely diagnose tuberculosis. The principle of interaction is the same - a highly specific protein in the diagnostic drug causes a skin reaction, the intensity of which determines the presence of a possible infection.

Quantiferon test, otherwise interferon test, is one of the latest developments in the diagnosis of tuberculosis. It is based on the determination of interferon specific for those in contact with mycobacterium tuberculosis, which is produced by the same T-lymphocytes.

In terms of safety, they are approximately equal to Mantoux. When a reaction to tuberculosis is given to children, the effectiveness is the same both in Mantoux and in alternative diagnostic methods.

Thus, the Mantoux test is a truly accurate way to monitor the risk of tuberculosis in a child. With a responsible approach to the procedure and sterility, the Mantoux test does not pose any danger and will help control the disease. We must not forget that one hundred percent protection against tuberculosis does not exist, because Koch bacilli are very tenacious and extremely difficult to kill. Carriers of the disease do not always go to hospitals, much less try to protect others. Protecting your child from this disease is vaccination and regular monitoring using the Mantoux test.

Author: Sukhorukova Anastasia Andreevna, pediatrician

Source: http://mama66.ru/child/1227