The Mantoux test is one way to detect a disease such as tuberculosis. This test is often done in childhood. According to the results of this test, the doctor may suggest the presence of some deviations in the child's body. In some children, a hyperegic Mantoux reaction is detected. This does not confirm the presence of the disease. However, a similar fact indicates some features of the body. What this result means will be discussed later.
Mantoux General Information
The Mantoux reaction (photo below) is a mandatory control procedure in childhood. In the first few days after birth, a BCG vaccine is given to the baby. It is necessary so that the body receives protection from such an ailment as tuberculosis. A year later, the effectiveness of her work is checked using a Mantoux test. Further, this procedure is carried out annually up to the age of fifteen. For adults, this procedure is almost never prescribed. Only in exceptional cases, a similar test may be required when the doctor has reason to suspect that a person develops tuberculosis in the body.
What does hyperergic Mantoux reaction mean? This may be the result of the examination. Do not panic if the child has such a reaction. You need to understand what a similar result means. During the analysis, tuberculin is used . This is a special diagnostic drug that is used during testing. It was opened at the end of the 19th century. Tuberculin was the result of the work of the German scientist R. Koch. The researcher hoped to defeat the disease through his development.
The causative agent of tuberculosis is Koch's bacillus. To defeat this ailment, it took much more than an open vaccine. This ailment requires an integrated approach. For people who are already sick with tuberculosis, the vaccine was inactive. However, tuberculin was of great benefit to healthy people.
After the discovery of Koch, 20 years later, Charles Mantoux drew attention to the fact that with the help of the body's reaction to the drug, a healthy person can be distinguished from a patient. After that, tuberculin in small quantities began to be used for diagnostic purposes.
Diagnostic goals
Mantoux reaction (photo hyperergic reaction can be considered further) allows you to achieve certain goals in the fight against tuberculosis. First of all, with its help, children who have no reaction to this test at all are identified. This becomes the reason for the subsequent inoculation of BCG.
Diagnostics also allows you to monitor the dynamics of changes in the Mantoux reaction. This allows doctors to more thoroughly approach the process of determining the likelihood of developing tuberculosis.
The third goal that the examination pursues is to identify a hyperergic response. This is necessary for a more thorough examination.
It is worth saying that the Mantoux test identifies both primary infected children and those who are asymptomatic carriers of Koch's bacillus. When vaccination is done, it is not the virus itself that is administered, but only tuberculin. This is an extract from the bacteria that causes tuberculosis. Tuberculin cannot cause the disease.
What does hyperergic reaction to manti mean ? To understand this, you need to know the mechanism of action of the vaccine. But in fact, doctors still do not know for certain the mechanism of interaction of tuberculin with human immunity. It should be understood that tuberculin is not an antigen. It does not create immunity that can resist Koch's wand. However, fragments of an artificial vaccine can attract T cells that are close to the skin. And not all, but only those who had contact with the tuberculosis bacterium. Because of this, a red inflammatory spot forms at the injection site.
Features of the vaccine
The Mantoux test (a photo of a hyperergic reaction is presented below) is similar in its action to an allergic reaction. However, a false positive result when vaccination is received quite often. The result is affected not only by the presence of the Koch stick.
The presence of chronic diseases can cause a hyperergic reaction, as well as a tendency to allergies in general. Also, the cause may be a recent inflammatory disease, structural features of the skin, nutrition of the child. At a certain age, the Mantoux reaction is no longer made due to a false result. The phase of the menstrual cycle also affects this.
If the child lives in an ecologically unfavorable area where radiation or emissions of harmful chemical elements are present, the reaction can also be hyperergic.
Abnormalities in the Mantoux reaction may indicate improper transportation of the vaccine or inappropriate storage conditions. Perhaps during the procedure low-quality tools were used. Also, the reason for the incorrect answer may be errors during the administration of the vaccine itself or an incorrect interpretation of the result.
It should be noted that the Mantoux test can not be done if a person has chronic ailments or diseases in an acute form, with allergies, skin diseases. It is also forbidden to vaccinate a child if he has epilepsy. Such procedures are not carried out during the quarantine period, as well as for children under 6 months of age.
How is vaccination done?
The Mantoux test in children (the photo of the procedure is presented below) is carried out at intervals approximately once a year. For this, an extract from thermally and chemically treated tuberculosis bacteria is used.
An aqueous solution of tuberculin is injected subcutaneously into the upper layers of the epithelium on the forearm. For this, the skin is specially raised during vaccination. For one injection, 0.1 mg of solution is required. This procedure does not harm the body. The well-being of a person does not change, he does not feel weak or sick.
If a tubercle bacillus has never entered the body before , the reaction will be negative. If the body was familiar with Koch's bacillus, a seal and a small tumor form around the injection site. Active T-lymphocytes are collected here from the nearest lymphatic channels. This seal is called papule. In this case, they say that the reaction to the vaccine is positive.
Studying the norms and deviations in the Mantoux reaction, it should be said that the appearance of a papule is not always evidence of pathology. The fact is that when BCG is vaccinated, the child's body gets acquainted with the bacteria of tuberculosis, developing immunity against them. If this vaccine was given 5-7 years ago, a negative reaction is considered normal.
The result can be obtained after 3 days. In this case, the child should not wet the papule, comb it. Otherwise, it will not be possible to get an accurate result.
Interpretation
The doctor estimates after 3 days after the test for the Mantoux reaction the size of the papule. You cannot interpret the result yourself. Only a doctor can draw conclusions about vaccination results. There are 5 possible diagnostic results.
The first one is negative. In this case, there is no seal or redness on the arm. This indicates a lack of reaction of the child's body to the vaccine administered. So, BCG vaccination was ineffective, it will need to be repeated.
The second option is a dubious reaction. In this case, the redness does not exceed 4 mm in diameter. Redness of the same diameter may also be present. This is an uncertain result. A TB doctor can explain in detail what a similar result means.
A reaction is considered positive when the diameter of the papule is 5-16 mm. This does not mean at all that the child is sick. This is not even a sign of pathology. However, it is impossible to say unequivocally that this is good. If the child has previously been vaccinated with BCG, a similar body reaction is the norm. If after such vaccination more than 7 years have passed, this indicates the likelihood of infection.
The Mantoux reaction should be no more than 16 mm in diameter (with BCG)
Mantoux reaction is considered hyperergic, the size of which after 3 days is from 17 mm. In this case, suppuration and soreness may appear, pain and itching appear in the area of the papule. The child wants to constantly scratch the vaccination site. Nearby lymph nodes may be enlarged. In this case, the doctor may suggest that tuberculosis develops in the body. A more in-depth diagnosis is being conducted.
The reaction can also be false positive. In appearance, it is very similar to a hyperergic or even positive result. However, this phenomenon is not caused by Koch's wand, but by other processes in the body. This, for example, may be an allergic reaction to the components that make up the vaccine.
Cause for concern
The results of the Mantoux reaction can only be controlled by a doctor. The interpretation has several features that ordinary inhabitants do not know about. So, a cause for concern is the appearance of a hyperergic reaction if one of the relatives or neighbors is sick with tuberculosis. It is also worth worrying if the child has contacted a person who has tuberculosis.
It is necessary to distinguish the response to infection from the effects of vaccine immunity. In the first case, you can observe the papule, which changes color over time. After the test, a brown stain remains on the skin. It has an intense color and a clear contour. If the hyperergic Mantoux reaction in children is caused by post-vaccination immunity, the papule does not have clear contours and its color is pink.
If, after vaccination, an infiltrate of 12 mm or more remains on the skin, this should cause concern for parents. Also, the Mantoux bend is an occasion for further in-depth examination. In this case, the size of the papule grows by no less than 0.5 cm from the moment of the first test, especially if it was negative or doubtful.
A signal about infection with Koch's bacillus is the fact that after BCG, the Mantoux reaction was positive, and after a year the papule grew by 0.5 cm. It is also a deviation from the norm, if for 3 years the red spot has a size of more than 1 cm and all the time inflammation is observed .
This test is not given at the same time as other vaccinations. If a child was given a vaccine from killed viruses (flu, diphtheria, etc.), the Mantoux reaction can be done no earlier than a month later. When vaccinated with “live” viruses (rubella, mumps), such a diagnosis is carried out at least 6 months later.
Vaccination in adults
The hyperergic Mantoux reaction in children and adults can vary significantly. After 15 years, such a test is done extremely rarely. The Mantoux test in an adult, uninfected person should be negative. However, even slight reddening of the skin at the injection site can be regarded as a dubious result. Also, the appearance of a small papule (up to 4 mm) also does not preclude the possibility of infection with a Koch bacillus.
Upon receipt of a similar result in an adult, a thorough examination is required. This allows you to identify infection at an early stage.
If the papule in an adult reaches 5 mm or more, this is called a positive reaction. In this case, a comprehensive diagnosis is also required. In an adult, a hyperergic reaction is called a papule with a diameter of more than 20 mm. In this case, a comprehensive examination is required. However, it is impossible to diagnose tuberculosis only on the basis of the Mantoux test. This is always worth remembering.
Even with the appearance of a hyperergic reaction, this does not mean at all that the person is infected.
In what cases does a hyperergic reaction cause great concern?
A hyperergic Mantoux reaction can cause concern when certain associated factors appear. These include the following circumstances:
- the close environment of the child includes people infected with tuberculosis;
- it is known that the child had contact with a sick person;
- the family’s area of residence is considered to be at risk for infection with Koch's bacillus (many people with tuberculosis live here).
The factors listed are purely social. However, parents should know what should be alerted after conducting Mantoux tests. The faster they respond to some characteristic signs of tuberculosis, the faster and easier the treatment.
If the child has signs of irritation at the injection site for more than 2 weeks, and the papule has a size of 12 mm or more, you should immediately consult a TB doctor. This is a common sign of infection with a Koch wand. The Mantoux reaction is necessarily controlled in dynamics. If it has grown by 5 mm or more, compared with last year, this is a dangerous sign.
Also, the color of the papules is controlled. It should not be red or brown. Its normal shade is pink light color. The edges should be blurry.
What should parents do?
After a Mantoux test, a hyperergic reaction should be the reason for contacting a doctor. This can be done 3 days after vaccination. Parents should not panic, because they will scare the child, and they themselves will be on the verge of a nervous breakdown. By this they will not help your baby in any way. In this case, you need to act correctly. Having pulled himself together, you should contact a TB doctor.
The doctor will prescribe examinations, which should not be avoided. All requirements must be followed exactly. A TB doctor examines. After receiving the results of the examinations, the doctor will be able to say for sure whether the child has tuberculosis or not. It is worth noting that all the relatives of the baby who live with him in the same apartment are examined. If you do not take timely action, it can be dangerous for the child, as well as those around him.
Features of the survey
The hyperergic Mantoux reaction is the reason for conducting more in-depth examinations. After examination, the phthisiatrician will appoint an X-ray of the lungs. Moreover, not only fluorography is done, but a large picture, in which all the details and details will be visible. To do this, it is better to contact the clinic, where modern equipment is installed.
Sputum is also collected and analyzed. After this, the child necessarily gives blood. She is examined for signs of tuberculosis. The same tests are carried out by relatives of the child. If no member of the family, including the baby himself, shows signs of tuberculosis, the Mantoux result is considered false positive. In this case, no action will be taken.
During the examination, it can be established that the cause of the hyperergic reaction may be an allergy. An ointment will need to be applied to the injection site to eliminate the effects of inflammation.
If the child has signs of tuberculosis, he is placed at risk. Statistics say that after treatment, 10% of children can get sick again. Therefore, doctors especially carefully monitor their health. Do not treat this as something terrible, irreparable. A child who is under the close supervision of doctors is more likely to not get this disease again. Moreover, today the methods of treating tuberculosis are much more advanced than 20 or even 10 years ago. After treatment, the baby is observed for a year. Next, they again make a Mantoux test. If it is within normal limits, the child leaves the risk group. In the future, with the right attitude towards the disease, he manages to defeat quickly. After the child will be observed by a regular pediatrician, like other children.
Having considered the features and causes of the Mantoux hyperergic reaction, parents will know how to relate to this phenomenon. This will identify the pathology quickly, starting treatment in a timely manner.