What should be the reaction to Mantoux: norm and pathology

The Mantoux test is carried out in each clinic, kindergarten or school. Once a year, children meet with a medical professional to provide their hand for the introduction of a substance under the skin. Do you know what this procedure is and for what purpose it is carried out? Some mistakenly believe that this is a vaccine, but it is not. Mantoux is a test to detect tubercle bacillus in the human body . What should be the reaction to Mantoux in children, what precautions should be followed, and how to prepare for the test, you will learn further from this article.

Contribution to the story of Robert Koch

The famous microbiologist Robert Koch in 1882 discovered the existence of a stick, which led to the emergence of a terrible disease - tuberculosis. After some time in medicine, a concept such as “Koch's wand” or “Mycobacterium tuberculosis” appeared. All scientists of the world began to invent a cure for this ailment. Robert Koch was among the first to advance in this direction.

He tried various methods of killing bacteria: boiling them, treating them with chemical reagents, combining them with other bacteria, etc. After some time, Koch synthesized a substance he called tuberculin. With his help, the scientist intended to save the world from a terrible disease - tuberculosis. They began to test tuberculin in humans, but it turned out that there was no particular benefit from it.

Contribution to the history of Charles Mantoux

In 1908, an unknown French scientist Charles Mantoux first proposed the use of tuberculin as a diagnostic test that would determine the presence of Koch's bacillus in the human body. Charles's medical education allowed him to notice distinctive reactions to a tuberculin test. That is, healthy people and those suffering from tuberculosis reacted differently to the injected substance.

Over time, the name of Charles Mantoux already appeared in the name of the test itself - the Mantoux test. Since most doctors do not go into details and do not talk about the purpose of this test, many people believe that this is such an annual vaccination. Some parents even write a refusal of a certain “Mantoux vaccination”, however this is just an allergy test, absolutely safe and extremely useful.

For several decades, the Mantoux test is carried out all over the world, as a rule, once a year. Particular attention is paid to the degree of reaction in children. What should be the reaction to Mantoux in children? At certain periods of age, there are subtleties and nuances, it is also worth considering the genetic predisposition and much more to reliably determine the reaction of the body. We will consider these issues in more detail below.

What is the relationship between BCG vaccine and Mantoux test?

The relationship between these procedures is pretty close. So, even in the hospital, the baby is vaccinated against tuberculosis - BCG vaccination. The goal of this vaccine is to develop antibodies against tuberculosis infection in the baby’s immune system. A year after vaccination, a Mantoux test is carried out in order to ensure the successful formation of antibodies after vaccination. What should be the reaction to the “vaccination” of Mantoux? The human body can react differently, but we'll talk about this later.

A positive reaction to the Mantoux test is the best response of the body. Sometimes the child’s immune system does not respond to BCG vaccine and does not form protective antibodies against the disease, in such cases the reaction will be negative. Before entering school, at about 6 years old, the child is sent for a second BCG vaccination. Such children who did not respond to the initial vaccination should be carefully monitored and carried out a Mantoux test twice a year so as not to miss the possible infection with dangerous tubercle bacilli.

The mechanism of action of the Mantoux test

The composition of tuberculin contains scanty residues of living tuberculosis bacteria. If the human body met (fought) with a tubercle bacillus - there will be a reaction to the sample. If in the “memory” of the immune system there are no “memories” of meeting with these mycobacteria, then it will not react in any way to the introduction of tuberculin. In other words, the Mantoux test is an allergy test. If the child has a tubercle bacillus in the body, then he will give an allergic reaction to the introduction of the substance tuberculin.

By the type of reaction to the sample, the presence of active bacteria that infect the child’s body is judged. What Mantoux reaction is considered normal? Through vaccination (BCG), the child’s immune system is infected with weakened tuberculosis bacteria, so the test should be positive? In short - yes, but more on that later.

How and where are Mantoux samples introduced?

Each student, without hesitation, will be able to show the place where the papule usually appears after the mantle, although during the procedure most of the children turn away and do not watch how the injection is made. But after this, the medical worker points to the so-called “button” that formed on the patient’s hand.

Traditionally, the test is placed on the inner side of the forearm, approximately in its central part. The needle slightly punctures the skin and tuberculin is injected with a syringe, which is collected in a small ball. After three days, you need to check the result (doctors say: "Keep a record").

How to understand which Mantoux reaction is considered normal? Using a ruler, the circumference of the resulting button is measured, and the degree of reaction can be judged by the results of the data obtained. A positive, sharply positive and negative reaction is distinguished.

Options for Possible Mantoux Vaccination Reactions

The types of reactions to the Mantoux test are as follows:

1. Positive. A seal formed at the injection site, which is additionally examined and its physical characteristics examined (weak — diameter of the “button” 5–10 mm, medium — diameter of the papule 10–15 mm, strong — diameter of the seal 15–17 mm). That is, the norm of the papule on the Mantoux in children is not more than 16-17 mm in diameter.
2. Very positive. The diameter of the papule with such a reaction is more than 17 mm, inflammation on the skin, swelling or enlarged lymph nodes may also be present.
3. Negative. Three days later, there are no signs at the site of the Mantoux test - neither condensation nor redness.
4. Doubtful. Inflammation of the skin is present, but the diameter of such a papule is less than 4 mm. Often such a reaction is not taken into account and equated with a negative one.

Severe inflammation of the papule, more than 17 mm, is an occasion to consult a TB doctor to check the body for the presence of active tuberculosis mycobacteria. The best option for the reaction is considered positive (medium and mild). This response of the immune system suggests that it has developed antibodies, and the presence of active tuberculosis bacteria in the body has not been identified.

Doubtful and negative reactions indicate that active bacteria are not present in the body, but also there are no antibodies to the disease, immunity has not been developed. This reaction is an occasion for close attention for a potential patient, and the Mantoux test should be doubled, that is, not 1, but 2 times a year.

Mantoux bend

Such a medical concept should be known to all parents. The turn of a tuberculin test shows the opposite result compared to last year's tests, although there should be no reason for this. If the previous test showed a negative reaction, and after a while the reaction changed sharply to a positive one, then most likely the body is infected with a tuberculosis infection (the child is sick and does not have immunity to this disease). Such statements are relevant only if the child has not been re-vaccinated at 6 years old.

Indicators of tuberculosis infection

The healthcare professional is required to analyze not only the true response to the Mantoux test. Using this test, the presence or absence of tuberculosis bacillus in the body is determined, and it is possible to evaluate the reaction after several years. So, what should be the reaction to Mantoux, if we assume infection with tuberculosis:

• turn tuberculin test;
• the presence of a sharply positive (hyperergic) reaction;
• if for 4 years the diameter of the papule exceeds 12 mm.

Such situations are a sure signal in which doctors should more closely monitor the child and send him for an additional examination for tuberculosis.

Mantoux test preparation

Sensible parents know that on the eve of any vaccination, special attention is paid to the baby's health. It is important to monitor the condition of the child so that he does not have a cold and does not show signs of allergy (rash and irritation on the skin). In order to avoid side effects, pediatricians advise taking all kinds of preventive measures, for example, taking antihistamines several days before the test and antipyretic drugs at the first sign of fever.

Such a strategy is correct and prudent, but only before vaccination, and the Mantoux test is not such, so the actions of parents should be slightly different. In any case, the child should be healthy, without allergic and infectious manifestations. Antipyretic and antihistamines should not be given, because the Mantoux test is the allergy test. If an antihistamine is given, then the results will be distorted. That is why it is so important for parents to know what the reaction to Mantu should be, because it is on this factor that the condition of the child is determined. In no case can nothing be changed, otherwise doctors will not be able to detect the presence of antibodies in the body of the child.

When you can not conduct a Mantoux test?

If you have understood what the reaction to the Mantoux “vaccination” should be, then you are well aware that you cannot test immediately after the illness. At least a month before the breakdown, the child should not encounter the following diseases and situations:

• acute viral or infectious disease;
• skin irritation and rash;
• exacerbation of any chronic disease;
• allergic reaction;
• bronchial asthma;
• epidemic or quarantine in an educational institution (school, kindergarten, nursery).

A month after the test, the child should not observe the above situations, and only then can we confidently judge the results of the reaction.

To wet or not to wet?

Immediately after the Mantoux test, the nurse warns the child and his parents about precautions, so that the injection site is not wetted and scratched. But explaining the reason for such requirements to medical staff is difficult, because these rules have been preserved since the Soviet era, and now it is not relevant at all. Parents and children often ask what should be the reaction to the Mantoux “vaccination” if the injection site is wetted? Not every health worker can answer this question.

It turns out that the earliest tests for determining tuberculosis were carried out by introducing tuberculin not under the skin, but on its surface (a small scratch was made on the skin and tuberculin was placed in it). Naturally, such conditions could not guarantee the reliability of the results after the Mantoux test, because the ingress of water greatly distorted the indicators.

The last Mantoux tests using scratching the skin were carried out some 15 years ago, and most health workers use the “old” rules. However, for a long time, tests are done exclusively subcutaneously, which means that you need to follow the rules of modern medicine.

You can wet the injection site, wash it as much as you like, and even swim in the pool - you can’t get anything from the outside.

How is tuberculosis infection?

As a rule, a person is infected with mycobacteria directly from a patient with an active form of tuberculosis. When an infected person talks, coughs or sneezes, he spreads Koch's wand over a large distance around himself. If you eat the dairy products of a sick animal, you can also become infected with tuberculosis. The disease develops with the following factors:

1. Inadequate nutrition.
2. Adverse environmental and social living conditions.
3. Smoking, alcoholism and other addictions that lead to a decrease in immunity.
4. Emotional stress and stress.
5. The presence of lung diseases, gastric ulcers, diabetes, 12 duodenal ulcer.

If you have at least one of the above factors, you need to consult with a specialist about what should be the reaction to Mantoux in this case, and adhere to further doctor's recommendations. Some factors can worsen the state of health and the immune system, so you should not smoke and take alcohol, thereby mutilating yourself.

Adverse reactions from the Mantoux test

A positive reaction to a Mantoux test for tuberculosis or a norm for the physical characteristics of the papule is not all that awaits the child and his parents. There are also adverse reactions, most of which are not recognized by world medicine and pediatricians from government institutions. However, doctors from private institutions that do not report to the state confirm the likelihood of adverse reactions.

If the first reaction to the Mantoux test for tuberculosis in children is normal, then this does not mean that there will be no complications in subsequent years. Here are the most common reactions:

• lethargy and apathy;
• temperature rise;
• skin rash;
• bowel disorder;
• cough (a week after the test).

The above reactions of the body indicate that toxic substances are in the composition of the Mantoux test. And although their number is scanty, some children are affected by the toxin, and they may experience an adverse reaction to Mantoux. In children at 5 years of age, the transfer of a sample without any reactions is the norm.

Normal Mantoux reaction in children of different ages

The response of the body after the test should be studied with knowledge of the age of the child. After all, the rate of reaction to Mantoux in children at 2 years and 10 years old is slightly different. In adults, the Mantoux test should be negative. There are the following norms for the diameter of the papule:

1. The rate of reaction to Mantoux in children at 4 years of age looks like a papule 10-14 mm in size.
2. In children at the age of 5, the “button” is less than 10 mm.
3. For children at 7 years of age, the presence of a dubious or negative reaction is characteristic.
4. The normal size of the papule in children 8-10 years old is 16 mm.

At 3 years old, the rate of reaction to Mantoux in children is approximately equal to the test readings at an older age, parents should not worry if their child’s papule diameter does not match the indicators. The main thing is that the measurement of the “button” should be carried out qualitatively.