Peculiarities of conducting a pirke test. Tuberculin test or Mantoux test: norm for children and useful information for parents

Is it necessary to get the Mantoux vaccine?

• What is the Mantoux test?
• Should I make Mantoux?
• Prevention of tuberculosis

Is Mantoux vaccination mandatory? Many mothers ask pediatricians this question. It is immediately necessary to clarify that the Mantoux test is called grafting incorrectly. This is not a vaccination, but a test. Its goal is not to develop immunity against a specific pathogen, but to determine whether there are mycobacteria in the body, causing tuberculosis. Every year the number of people suffering from tuberculosis throughout the world is increasing, both adults and children suffer from it. The mortality rate from this disease is increasing every year. Therefore, the test is very important for early diagnosis tuberculosis in a child.

Is it necessary to make Mantoux in mandatory? Is there any alternative?

What is the Mantoux test?

The Mantoux test (tuberculin test) is a subcutaneous injection of tuberculin and a further assessment of the immune response to it. If the reaction to the administered drug is pronounced, this means that the immune system is already familiar with the causative agent of tuberculosis and reacts to it. Tuberculin is an extract of mycobacteria, which are the causative agents of tuberculosis.

The test result is usually assessed on the third day. It is not redness that is being studied, but a compaction, a papule (the so-called button). Depending on its size, the sample result can be positive, negative, false positive or doubtful. The pediatrician evaluates the results and records them in the outpatient and vaccination records. In some cases, it is possible to refer the child to an appointment with a TB specialist to confirm or refute tuberculosis.

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Should I make Mantoux?

It is usually given to children after the first year of life until they are 18 years old every 12 months. It is not advisable to do it for young children, since the results will be unreliable. Mantoux is usually done in a garden, school or clinic at the place of residence.

IN Soviet times The Mantoux test was performed on all children without exception. Nowadays there are many parents who are against not only this test, but also vaccination of the baby in general. There are a lot of disputes about this. However, if the child has not had a tuberculin test, there may be problems in the kindergarten or school. Is this legal?

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Prevention of tuberculosis

In accordance with the Sanitary and Epidemiological Rules SP 3.1.1295-03 (prevention of tuberculosis), parents whose children tested positive for tuberculosis or dubious result, within a month from the date of the test, they must provide a certificate from a TB doctor stating that the child is healthy. Without this certificate, it is recommended that the child not be allowed into the kindergarten or school. Recommended, but not required. But what should parents do if they are fundamentally against the Mantoux test? Not a word is said about this in this document.

In practice, an alternative to the Mantoux test can be an x-ray of the lungs, which is recommended for children to do once every two years. Another way to avoid testing is Diaskintest.

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Which is better: Mantoux reaction or x-ray?

It is worth thinking carefully about what is more harmful to the child’s body (the Mantoux reaction or x-rays). It is unlikely that X-rays can be a good alternative to the test, since X-rays are small doses of radioactive radiation, which can hardly be called useful for a growing organism. This procedure weakens children's body, since it is more sensitive to radiation than, for example, the body of an adult. The use of radiographic examination may be justified if there are compelling reasons for this, for example, a suspicion of a fracture of the limb. But when it becomes necessary to conduct this examination even once every 2 years, the total x-ray load on the body will be excessive. This is a poor alternative to the Mantoux test.

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What is Diaskintest and Pirquet's test?

Diaskintest involves the injection under the skin of a solution of proteins characteristic of tuberculosis pathogens. This is a more effective test: it does not give a reaction to the BCG vaccination. Developed in Russia and is currently widely used. False-positive reactions during diaskintest are practically impossible, with the exception of cases when a person suffers cancer or infected with HIV. In these cases, the immune system is weakened, which may negatively affect the test result.

There are certain contraindications to performing diaskintest:

1. Allergy or epilepsy.
2. Diseases of internal organs in the acute stage.
3. Infectious diseases with fever.
4. Recent scheduled vaccination of the child (more than a month must have passed since the date of vaccination).

If at least one point is present, a tuberculin test cannot be done. If your child has been sick recently, you should definitely wait a little while taking the test, since after the illness the body is still weakened for some time.

Over several years of use, Diaskintest has proven itself to be completely safe. In addition, its reliability is 90%.

The Pirquet test is similar to Mantoux both in its technique and in the interpretation of the results. The difference is that with the Pirquet test, scratches are applied to the skin without bruising. After 48 hours, the result is read.

IN Lately V medical laboratories ELISA and PCR methods are also used. Many parents are convinced that by testing their child’s blood, sputum or saliva using these methods, they can get a definite answer: is the child infected with mycobacteria or not. This is not entirely true. These methods are not effective when the infection of the body has occurred quite recently; they are not able to reflect the activity of tuberculosis pathogens.

If parents decide that their child does not need to do Mantoux every year, they should clearly understand the purpose of this test and what its benefits are. They must be aware that they are taking responsibility for the health of other children with whom their child communicates. Tuberculosis is very insidious disease. The trend toward not testing for tuberculosis could lead to the spread of the disease among children.

If parents, for some reason, do not want their child to have a Mantoux test done annually, they need to consult with a pediatrician and choose an alternative method of testing the body for tuberculosis.

This disease is much more common than many people think.

mymylife.ru

Pirke test: indications, evaluation of results

Tuberculosis is a fairly common infectious disease that can be found in literally every country in the world. The disease can occur due to the entry of various bacteria or Koch's bacillus into the body. The disease is most often transmitted by airborne droplets and has severe symptoms, namely:

• dizziness;
• wet cough;
• hemoptysis;
• weakness;
• feverish condition;
• causeless weight loss;
• night sweats.

Tuberculin tests are contraindicated in the presence of various skin diseases, allergic reactions, bronchial asthma, epilepsy, and infectious diseases. You should not do tests within one month after the injection of immunoglobulin or a biological sample.

Diagnosis of tuberculosis

The main organ that is damaged by tuberculosis is the lungs. Other internal organs It is quite rare to suffer from this disease. It is possible to diagnose tuberculosis using fluorography, CT ( computed tomography), radiography, tuberculin skin test (Pirke test) and other types laboratory research. In order to diagnose the disease, vaccination is carried out once a year.

What is a skin test reaction?

One of the methods of preventive testing of children for tuberculosis is the Pirquet test. This immunological test can show whether a growing organism, even in the early stages, has a tuberculosis infection. The body's reaction to the appearance of tuberculin is called the Pirquet reaction, and it determines the body's sensitivity to Mycobacterium tuberculosis. The pirke test is also performed on adult patients. age group as a control analysis when assessing the effectiveness of treatment.

Sample composition

The sample contains tuberculin, a special extract from destroyed Koch bacilli, invented back in 1890 by the German doctor Robert Koch. It was this doctor who became the discoverer of such a disease as tuberculosis. The hood began to be used in 1907. Initially, they lubricated the skin with it and monitored the reaction, and only after that they began to try injecting tuberculin subcutaneously.

Today, the Pirquet test, the composition of which includes a mixture of killed filtrates of human and bovine microbacterial cultures, is observed in many people of different age groups. In addition to the active main substance - Pirquet tuberculin, the test includes the following additional substances:

• phosphate buffer solution salts;
• sodium chloride.

How does this happen?

The principle of operation of the test, the composition of which is based on tuberculin, is to apply the drug to the skin. The skin of the forearm or shoulder is well disinfected only with carbolic acid, because alcohol-containing substances leave protein on the skin, which is undesirable for the purity of the analysis. Incisions on the skin are made using a scarifier with a depth of no more than 5 mm. The patient must wait up to 5 minutes until the solution is absorbed, and the residue is carefully wiped off with a paper towel. After the procedure, the patient is monitored for 48 hours and the reaction to the substance is analyzed.

As a result of the introduction of tuberculin at the site of scratches, specific inflammation(papule), which is caused by an accumulation of T-lymphocytes. It is these blood cells that are responsible for anti-tuberculosis immunity. The skin may change color and density in the area of ​​the papule. This diagnostic method is used quite rarely due to its low information content and low diagnostic effectiveness. After the sample has been taken and before the results are obtained, it is not recommended to:

• wet the place where the sample was taken;
• wipe the papule with various medicines or ointments;
• cover the papule with a band-aid;
• comb or tear.

results

On average, when the Pirquet test is performed, the results are assessed after 2-3 days, that is, 48-72 hours. A focus of irritation appears at the site where the scratch was made. Its area is measured by doctors. The results are classified as follows when the Pirquet test is performed:

• the norm is observed when minimum indicator measuring papules (on average up to 5 mm);
• an indicator of 3 mm indicates the need for re-vaccination and re-analysis of the irritation result;
• if a papule measuring from 4 to 10 mm is detected, this means possible infection tuberculosis or being a person at risk (that is, constantly being in contact with an infected person);
• if the focus of irritation measures from 10 to 15 mm or ulcers are found at the site of vaccination, then this indicator indicates a high probability of infection with tuberculosis.

Graduated sample

This type of study has been improved and consists of skin application of the drug using several scratches. Unlike the traditional version of the study, a graduated test allows you to determine the differential diagnostic value in the process of clarifying the nature of the allergy to tuberculin. A skin test is carried out by applying tuberculin to the skin with 100%, 25%, 5% and 1% concentration. Skin preparation is carried out in the same way as with the traditional Pirquet test. The notches are applied strictly in order, and various marked pipettes are used. For each patient use only sterile materials. After the “white roller” appears, the remaining tuberculin can be removed. This type of diagnosis is most often carried out to determine the effectiveness of tuberculosis treatment.

Calibrated sample results

Graduated skin test Grinchar and Karpilovsky are assessed 48-72 hours after the procedure. There are such reactions of the body to different concentrations tuberculin:

• anergic reaction (no reaction to tests);
• nonspecific reaction (only slight redness can be noticed on a sample with a 100% solution concentration);
• normergic reaction (there is a moderate reaction of the body to tuberculin, and there are no reactions at all to samples with 5% and 1% solutions);
• hyperergic reaction ( this result characterized by a response to all types of samples; the higher the concentration of tuberculin in the solution, the greater the reaction);
• equalizing type of reaction (all samples taken have the same papules, skin colors and sizes of inflammation);
• paradoxical reaction (with a higher concentration of tuberculin in the sample, a more pronounced reaction is observed).

So, we looked at a diagnostic method such as the Pirquet test. Its result does not indicate the localization of the disease in the body or the ability of a person to infect healthy people. It only indicates the body’s reaction to the causative agent of tuberculosis. The Pirquet test (Mantoux reaction is its alternative) is considered mandatory for children.

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Pirquet's test

Tuberculosis is highly contagious and deadly dangerous disease, tormenting humanity since time immemorial. It is very easy to become infected with it, since the causative agent, mycobacteria, is extremely tenacious and can easily survive in the environment and can also be transmitted through the air.

This disease is before last stages proceeds completely unnoticed by the patient and his relatives, and hardware diagnostics makes sense only if there are damages in internal tissues. A method for effectively diagnosing tuberculosis in the early stages was discovered only in 2008, and before that time scientists offered less effective methods definitions of infection that could at least somehow help.

A little history: Clemens Pirquet

Clemens Pirquet was an Austrian pediatrician (1874-1929), who was the first to take a step towards developing a method for the early diagnosis of tuberculosis using tuberculin, obtained by Koch himself. Tuberculin was isolated in 1890 by the discoverer of the pathogen bacilli itself and represents proteins and substances characteristic of mycobacteria. In 1907, Clemens Pirquet, continuing Koch’s research in this area, came to the discovery of the concept of “allergy” (yes, it was he who studied allergy then), and also developed a method of scarification tests (allergy tests) based on it, the essence of which is allergic the body’s reaction to an injected substance if it becomes familiar with it, which may mean the presence of a pathogen that is characterized by the injected substances. It was Pirquet’s tuberculin test that was the ancestor of Mantoux, which is used to this day as a test for tuberculosis after refinement by Charles Mantoux.

What is Pirquet's test?

Initially, Clemens Pirquet, through long-term research, discovered an allergic reaction to tuberculin in case of illness, so he proposed influencing people with it for diagnosis. Initially, the test was carried out cutaneously (dry tuberculin, and then a fairly concentrated solution of tuberculin obtained from killed bacilli was applied to the surface of the forearm).

At the same time, it was forbidden to use ethyl alcohol for sterilization purposes, since it disrupted the entire process, and a solution of carbolic acid was recommended instead. After application to clean skin, mechanical damage its integrity by scratching with a lancet to ensure that the substance enters the body. At the site of penetration, in case of infection, an allergic reaction appeared in the form of redness and papules, as in modern tuberculin tests. The result was measured between 48-72 hours from the moment of placement, and the result was assessed as follows:

1. There is no reaction - the person is healthy.
2. A papule of three millimeters – it is not clear whether there is an infection or not. The test is repeated.
3. A papule from four millimeters to one centimeter is a reaction to tuberculosis during infection.
4. Papule more than ten millimeters with profuse redness - sharp positive result.

Pirquet's first test was inconvenient to use and also had a rather inaccurate result, which is why it was modified.

Mantoux as a continuation of the Pirquet test

After Pirquet, the vaccine was refined and appeared in the form of a simpler subcutaneous injection, which we use to this day. Mantoux is the same tuberculin, but injected directly under the skin. In addition to the method of implementation, the interpretation of the results also changed, as more thorough studies were carried out, and mass BCG vaccination was introduced, which affects the result of the test. The result of mantoux is also assessed by local allergies in the form of a papule - a lump under the skin, an ulcer or an abscess.

Sample readings are taken seventy-two hours after placement:

1. Lack of reaction - this result is possible only in the absence of BCG vaccinations or its ineffectiveness.
2. From five to nine millimeters is a weakly positive result, which is the norm with a BCG vaccination.
3. From ten to fourteen millimeters is a reaction of medium intensity.
4. Up to sixteen – a pronounced reaction, and more – hyperrergic.

Moderate, severe and hyperrergic reactions indicate the presence of tuberculosis bacilli or other mycobacteria in the human blood. Moreover, the presence of bacteria does not always mean disease, since bacilli can be in a dormant anabiotic form, in which they are in the blood of many people, without causing them harm for the time being.

A positive mantoux result indicates the possibility of getting sick rather than the disease itself.

You can talk about infection with tuberculosis if the size of the mantoux reaction has increased from the usual by six millimeters or more and continues to grow.

Diaskintest as the last word in the diagnosis of tuberculosis

In addition to the mantu, the Pirquet test served as the ancestor of another tuberculin test, created in 2008 by Russian scientists and called Diaskintest. This test is also based on tuberculin, but not from bacterial proteins, but from proteins of the immune system antibodies to them.

Our body, with the help of lymphocytes, produces antibodies to all foreign microorganisms and substances so that they attach to them and make them visible to “blind” killer cells of phagocytes, capable of finding hostile cells only in this way.

Each microorganism has its own antigen protein, and the active form of tuberculosis bacilli is no exception. Since tuberculosis is the presence of a pathogen in an active form in the blood, any positive reaction of this test means the disease, and the size of the papule only indicates the level of infection.

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All about the Mantoux test

The Mantoux test (Pirquet test, tuberculin test, tuberculin diagnostics, tuberculin skin-test, PPD test) is a method for studying the strength of immunity to the causative agent of tuberculosis by assessing the reaction to a special mycobacterial drug, tuberculin.

History of tuberculin diagnostics

Tuberculin in it classic look was invented in 1890 by the famous German doctor Robert Koch, after whom the causative agent of tuberculosis, Koch’s bacillus, is also named.

Tuberculin was applied to the skin damaged by a special borik. Later, this method was modified and skin damage (scarification) began to be performed with a special lancet.

It is approximately in this form that Pirquet’s test has survived to this day. Somewhat later, the French doctor Mantoux proposed another modification of the test - intradermal injection of tuberculin. The Mantoux modification test has been used in Russia since 1965.

What is tuberculin?

The meaning of tuberculin is to “indicate” the presence of the tuberculosis bacillus in the body so that the body’s response (qualitatively and quantitatively) to this “presence” can be assessed. In this sense, tuberculin copes with its task perfectly - it is for this reason that the drug was never subjected to radical processing and for more than 100 years, to this day, it has been one of the main means of diagnosing tuberculosis.

And again a little history. Tuberculin (the exact name is “alttuberculin”, AT) Koch is an “extract”, a lysate from mycobacterium tuberculosis, inactivated by heat. The classic preparation, in addition to tuberculin itself, contained many impurities - remnants of the nutrient medium on which bacteria were grown, salts and other substances that affected the purity of the reaction and made it difficult to assess the result of the samples.

Since the late 60s of the 20th century, purer tuberculin preparations, the so-called PPD (Purified Protein Derivate), have been developed, which are still used today. In Russia, the drug PPD-L is used, i.e. purified tuberculin obtained by the Russian scientist Linnikova in 1965.

A modern tuberculin preparation, in addition to tuberculin itself, contains salts of a phosphate buffer solution, sodium chloride, Tween-80 stabilizer, and phenol as a preservative. Basically, the drug is free of ballast impurities, but it may contain them in trace amounts, which can affect the result of the reaction.

However, the exact mechanism of interaction of tuberculin with the immune system is still not completely known. On the one hand, a lysate of proteins (peptides, amino acids) cannot be a full-fledged antigen. Indeed, tuberculin does not induce the formation of immunity.

But this point of view does not explain the intensification, as with vaccination, of the reaction with frequent testing - the so-called. “booster effect” of the Mantoux test. So what is tuberculin? Most likely, tuberculin can be characterized as a heterogeneous mixture of organic substances varying degrees complexity derived from mycobacteria.

What is the Mantoux reaction?

The Mantoux reaction is the result of the body's reaction to the introduction of tuberculin. At the site of injection of the drug into the skin, specific inflammation occurs caused by infiltration of T-lymphocytes - specific blood cells responsible for cellular immunity(as opposed to the antibody immune response, in which antibody proteins play a major role).

Fragments of mycobacteria seem to attract lymphocytes from nearby blood vessels skin. But not all T-lymphocytes come into play, but only those that are already fully or partially “familiar” with the Koch bacillus.

If the body has already had a chance to “get acquainted” with the real Mycobacterium tuberculosis, then there will be more such lymphocytes, the inflammation will be more intense, and the reaction will be “positive” (there is an infection with Koch’s bacillus).

Naturally, a positive reaction means that the inflammation exceeds that caused by the injection itself and a certain diagnostic threshold. By measuring the diameter of a papule (inflammatory “plaque” or “button”) with a ruler, you can assess the strength of immunity to the tuberculosis bacillus.

Strictly speaking, the body’s reaction to tuberculin is one of the types of allergies (for tuberculin itself is not a full-fledged antigen, but rather an allergen). That is why existing allergic diseases can affect the result of the Mantoux test.

Above is a somewhat simplified biological mechanism of the Mantoux reaction. It should be remembered that the result of the reaction can be influenced, in addition to existing allergic diseases, by recent infections, chronic pathology, immunity to non-tuberculous mycobacteria, age.

Other accompanying factors also play an important role - phase menstrual cycle in girls; individual characteristics of skin sensitivity; balanced nutrition of the child, etc. The results of mass tuberculin diagnostics have an unfavorable impact environmental factors: increased background radiation, the presence of harmful emissions from chemical production, etc.

The results of tuberculin diagnostics can also be influenced by various disorders in the methodology of its implementation: transportation and storage of tuberculin, when using non-standard and low-quality instruments, in case of errors in the technique of performing and reading Mantoux reactions.

Taking into account the above factors, in isolation, a positive Mantoux test in itself is not 100% proof of tuberculosis infection. To confirm the diagnosis, a number of other studies are required - to exclude a connection with BCG vaccination, fluorography chest, microbiological culture of sputum and a number of others. In its turn negative result does not provide a 100% guarantee of the absence of Koch's bacillus in the body.

Why is the Mantoux test needed?

Or rather, is the Mantoux test necessary at all? On this score, WHO answers in the affirmative - yes, for countries with a high relevance of tuberculosis (which are Russia and most CIS countries at the moment), this test is one of the effective measures for controlling infection.

Even in those countries where the relevance of tuberculosis is low, for example in the USA and France, the Mantoux test is used quite actively to identify those infected with tuberculosis in high-risk groups.

Reaction (test) Mantoux is needed for:

• identifying primary infected people, that is, those who have been infected with tubercle bacilli for the first time;
• identifying those infected for more than one year with hyperergic reactions to tuberculin;
• infected for more than one year with an increase in infiltrate by 6 mm or more
• diagnosis of tuberculosis in persons who are infected with Koch's bacillus, but do not manifest, in this moment, symptoms of the disease;
• confirmation of the diagnosis of tuberculosis;
• selection of children subject to revaccination against tuberculosis.

The selection of children and adolescents for revaccination is carried out based on the results of the Mantoux test at 6-7 and at 14-15 years. In areas where the epidemiological situation for tuberculosis is unfavorable, revaccination is carried out at 6-7, 11-12 and 16-17 years of age. Healthy individuals only with a negative reaction to tuberculin are subject to BCG revaccination.

Contraindications to the Mantoux test

It should be especially emphasized that the Mantoux test is harmless both for healthy children both adolescents and children with various somatic diseases. Tuberculin does not contain living microorganisms, and in the used dosage of 2 TU (0.1 ml) it does not affect either the body’s immune system or the entire body as a whole.

Testing does not make sense in children under 12 months, because the test result will be unreliable or inaccurate due to age characteristics development of the immune system - the reaction may be false negative. Children under 6 months of age are unable to respond adequately to the Mantoux test.

Contraindications to performing a tuberculin test are:

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

The test is not allowed in those groups where there is a quarantine for childhood infections. The Mantoux test is performed 1 month after all clinical symptoms disappear or immediately after quarantine is lifted.

Immunity after preventive vaccinations may affect sensitivity to tuberculin. Therefore, the Mantoux test must be planned before any vaccinations. In this case, vaccinations are carried out immediately after assessing the test results.

If the Mantoux test is performed not before, but after vaccinations, tuberculin diagnostics should be carried out no earlier than 4 weeks after the vaccination, as well as the administration of immunoglobulins (serums).

Thus, absolute contraindications there is practically no need to perform a tuberculin test.

How is the Mantoux test performed?

In accordance with Order of the Ministry of Health of the Russian Federation dated November 22, 1995 324, in Russia the Mantoux test is performed once a year, starting at the age of 12 months, regardless of the results of the previous test.

Using a special tuberculin syringe, tuberculin is injected intradermally (the middle third of the inner surface of the forearm) in the equivalent of 2 tuberculosis units (TU). The volume of the administered dose is 0.1 ml. The needle is inserted with the bevel upward, to a depth sufficient for the outlet to be completely immersed in the skin.

In order to make sure that the needle has not penetrated the skin and to ensure intradermal administration itself, the needle is slightly raised, stretching the skin. After the introduction of tuberculin, a specific bulge of the upper layer of skin, better known as a “button,” is formed.

How to care for the “button”?

The simplest answer is no. At least until the results are assessed. There is no need to smear the sample site with brilliant green or peroxide. It is very important not to allow the sample site to come into contact with water or other liquids.

There is no need to cover the wound with an adhesive plaster - the skin under it may sweat. Do not allow your child to scratch the button. Remember that improper care of the tuberculin injection site can affect the test result, and neither the patient nor the doctor needs this.

After assessing the results, if an abscess or ulcer has formed, it can be treated like any other wound, using all traditional means.

How are results assessed?

“It doesn’t matter how they voted, it’s important how they counted” - the authorship of this common saying about elections is attributed to Stalin. It is impossible not to agree with the great leader. The most important thing in the Mantoux test is not the performance, but the evaluation of its results, and even more important, the conclusions from the result of the sample evaluation.

After the administration of tuberculin, on the 2-3rd day a specific skin thickening is formed - the so-called. "papule". In appearance, it is a slightly reddened rounded area of ​​skin raised above the skin. Unlike ordinary redness, this papule differs to the touch from the surrounding skin in its consistency - it is denser.

From an anatomical point of view, this papule is the result of infiltration of the skin with lymphocytes sensitized (that is, sensitive) to Koch's bacillus. Naturally, the more lymphocytes that “know” about mycobacteria in the body, the larger the infiltrate (papule) will be.

The size of the papule is measured in sufficient light with a transparent ruler (so that the maximum diameter of the infiltrate is visible) on the 3rd day (48-72 hours) after tuberculin administration. The ruler should be positioned transverse to the longitudinal axis of the forearm.

It is not allowed to use a thermometer and other “improvised materials” for measurements, such as graph paper and homemade rulers made from X-ray film. Only the seal size is measured. Redness around the lump is not a sign of immunity to tuberculosis or infection.

There are several “versions” of setting up and evaluating the results of the Mantoux test. Strictly speaking, tuberculin can be administered in several ways - cutaneously (Pirquet reaction), intradermally (ordinary Mantoux) and using plastic applicators on the pointed ends of which tuberculin is applied (in addition, other substances can be applied to simultaneously perform other tests).

We will focus on two approaches to assessing results - Russian and American. It should immediately be emphasized that in addition to the assessment methods, the production methods also differ. Thus, in domestic practice, the Mantoux test is performed with 2 TE, while in the USA the test is performed with 5 TE. The American assessment method differs by taking into account the degree of risk of infection with tuberculosis of a given patient; depending on this, the size of the infiltrate is interpreted.

Classification of Mantoux test results

The reaction is considered:

• negative or in the complete absence of infiltration (compaction) or in the presence of a prick reaction (0-1 mm);
• doubtful - with an infiltrate (papule) measuring 2-4 mm with only hyperemia (redness) of any size without infiltrate (compaction);
• positive – in the presence of a pronounced infiltrate (papule) with a diameter of 5 mm or more. Reactions with an infiltrate size of 5-9 mm in diameter are considered weakly positive; medium intensity – 10-14 mm; pronounced – 15-16 mm;
• hyperergic (i.e. too pronounced) in children and adolescents is considered a reaction with an infiltrate diameter of 17 mm or more, in adults - 21 mm or more, as well as a vesiculo-necrotic (i.e. with the formation of pustules and necrosis) reaction, regardless of the size of the infiltrate, lymphangitis, daughter dropouts, regional lymphadenitis (enlarged lymph nodes).

An increase in infiltrate of 6 mm or more is considered an increasing reaction to tuberculin.

False negative reactions - in some patients, the Mantoux test may be negative even in the presence of infection with tubercle bacilli. Such reactions may be caused by:

• Anergy – that is, the inability of the immune system to respond to “irritation” by tuberculin. This reaction can occur in individuals with various immunodeficiencies, including AIDS. In this situation, a special test for anergy is performed (Mantoux test with more high content tuberculin – 100 TU), it is necessary to examine the child’s immune system for defects;
• Recent infection - within the last 10 weeks. In this situation, in the USA it is recommended to repeat the test 10 weeks later, after eliminating infection factors;
• Too young - children under 6 months are unable to “respond” to the introduction of tuberculin.

False-positive reactions - such reactions mean that the patient is not infected with Koch's bacillus, but the Mantoux test shows a positive result. One of the most common reasons Such a reaction is infection with non-tuberculous mycobacterium. Other reasons may be the patient's existing allergic disorders and recent infection.

Currently, there are no ways to reliably differentiate the reaction to tuberculous and non-tuberculous mycobacteria, however, the following facts may speak in favor of tuberculosis infection:

• hyperergic or severe reaction;
• a long period that has passed since BCG vaccination;
• recent stay in a region with increased circulation of tuberculosis;
• previous contact with a carrier of the tuberculosis bacillus;
• the presence of relatives in the patient’s family who were ill or infected with tuberculosis.

It should be noted that in the USA, due to the lack of universal BCG vaccination, a positive reaction due to existing immunity caused by BCG vaccination is interpreted as a false positive, but patients with such a reaction are tentatively considered infected regardless of the fact of vaccination.

The “turn” of the Mantoux test is a change (increase) in the test result (papule diameter) compared to last year’s result. It is a very valuable diagnostic sign.

The turning criteria are:

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

It is the turn that makes the doctor think about what happened during last year infection. For example, if the test result for the last three years looked like 12, 12, 12, and in the fourth year the result was 17 mm, then with a high degree of probability we can talk about an infection that has occurred.

Naturally, it is necessary to exclude all influencing factors - allergies to tuberculin components, allergies to other substances, recently previous infection, the fact of recent vaccination with BCG or another vaccine, etc.

The “booster” effect of the Mantoux test is an amplification effect (boost (English) – strengthening), i.e. an increase in the diameter of the papule with frequent (more than once a year) testing. Despite the fact that tuberculin is not a full-fledged antigen and cannot induce the formation of immunity, the effect is apparently associated with an increase in the sensitivity of lymphocytes to tuberculin.

Has a booster effect reverse side– persons infected with the tuberculosis bacillus lose the ability to respond to tuberculin over the years and eventually the test result becomes false negative. The booster effect (in both its manifestations) occurs in adolescents and adults, which is apparently due to a higher degree of development of the immune system. In children, this effect is less pronounced, however, performing the Mantoux test more often than once a year is not advisable.

To exclude a booster effect in those infected with mycobacteria (in the presence of obvious risk factors for infection and no reaction to the Mantoux test), in the USA it is recommended to repeat the test after 1-3 weeks. In those infected with tuberculin, the reaction becomes sharply positive, the body seems to “remember” its sensitivity to tuberculin.

Positive Mantoux test: BCG vaccination and or infection?

Since in Russia and other CIS countries vaccination is mandatory and universal, it is necessary to be able to distinguish between a positive Mantoux test result due to post-vaccination immunity and tuberculosis infection.

In order to differentiate one from the other, it is necessary to know the size of the skin scar (post-vaccination sign) after BCG immunization, the time that has passed since vaccination or revaccination, the results of previous tests and the current size of the papule.

The scar left after BCG vaccination is located on the left shoulder, on the border of the upper and middle third. As a rule, it has a round shape, its dimensions range from 2 to 10 mm, the average size– 4-6 mm.

There is a connection between the size of the scar and the duration of post-vaccination immunity. So, with a scar size of 5-8 mm, the duration of immunity in most children is 5-7 years, and with a scar diameter of 2-4 mm - 3-4 years.

In the absence of a scar, if in the first 2 years of life the Mantoux test result is 10 mm, this speaks in favor of infection. Determining positive reactions for the first time in these children and adolescents is not hampered by post-vaccination immunity, and with systematic repetition of the Mantoux test it is easy to detect the transition from a negative to a positive reaction (papule 5 mm or more).

1-1.5 years after BCG vaccination, the reaction in the majority (about 60%) of children will be positive, while in others it will be doubtful or negative. The maximum immunity indicators, that is, the maximum sizes of positive Mantoux tests, are recorded 2 years after vaccination.

The size of the papules in the first two years of life can reach 16 mm. Average values ​​range from 5-11 mm. An indicator of 12-16 mm is recorded in children with a post-vaccination scar diameter of 6-10 mm.

However, over time, post-vaccination immunity fades and 3-5 years after vaccination (or revaccination with BCG), the Mantoux reaction, with an infiltrate of 12 mm, will already indicate infection. After 6-7 years, most children (in the absence of infection) will already have doubtful and negative reactions.

An important sign, which makes it possible to distinguish between post-vaccination immunity and infection as the causes of a positive reaction, is the presence of pigmentation (brownish coloring of the place where the papule was) 1-2 weeks after the Mantoux test.

The papule that appears after vaccination usually does not have clear contours, is pale pink and does not leave pigmentation. The post-infectious papule is more intensely colored, has clear contours and leaves pigmentation that lasts about 2 weeks.

When differentiating, the following signs speak in favor of primary infection with mycobacterium tuberculosis:

• first identified, after doubtful and negative reactions, papules measuring 5 mm or more;
• an increase in the result compared to last year by 6 mm, if it was positive and caused by BCG vaccination;
• persistent (for 3-5 years) persistent reaction with an infiltrate of 10 mm or more;
• hyperergic reaction regardless of the timing of vaccination;
• infiltrate larger than 12 mm or more 3-4 years after vaccination;
• the presence of predisposing factors: presence in the family of people who have had (or are suffering from) tuberculosis, extra-family contact with tuberculosis-infected people, being in an endemic region, low socioeconomic status, low level parental education.

If infection is suspected, the child or adolescent is immediately referred for consultation to a phthisiatrician.

If it is still not possible to determine whether a positive test result is a consequence of vaccination or infection, a preliminary conclusion is made about unknown etiology positive test result, and after six months the test is repeated.

If, upon repeated testing, the result is again positive or increases, then a conclusion is made about infection. When the size of the papule decreases, a conclusion is drawn about the post-vaccination nature of the positive result of the previous test.

Positive Mantoux test, what follows from this?

So, the Mantoux test showed a positive result, all influencing factors were excluded - vaccination with BCG and other vaccines, recent infection, allergy to tuberculin components.

Since the Mantoux test is an important, but not 100% reliable, means of diagnosing tuberculosis, additional examinations– chest fluorography, microbiological culture of sputum, examination of family members.

Children and adolescents newly diagnosed with tuberculosis have increased risk development of clinically significant tuberculosis - it is believed that 7-10% of such children may develop primary tuberculosis with all the inherent symptoms. Therefore, such children are subject to observation in an anti-tuberculosis dispensary for a year.

Chemoprophylaxis with isoniazid is carried out for three months. At the end of this period, the child is transferred under the supervision of a local pediatrician as “infected for more than one year.”

If such a child, after a year, does not show signs of increased sensitivity to tuberculin and a hyperergic reaction, then he is observed by a pediatrician on a “general basis.” In such children, the results of the annual Mantoux test are carefully monitored. An increase in the reaction of 6 mm or more in such children indicates activation of the infection.

Those infected for more than one year with a hyperergic reaction to tuberculin and an increase in the reaction by 6 mm or more are observed in the tuberculin dispensary. Chemoprophylaxis is carried out for 3 months.

If the child’s test result is positive, but the previous test was carried out not one, but two or more years ago, the child is considered “infected with an unknown period of limitation.” It is recommended to repeat the test after 6 months. Based on the results of the second test, the issue of the need for observation in a tuberculosis clinic and chemoprophylaxis is decided.

American method for assessing the results of the Mantoux test

It should be noted right away that practical use The American methodology for assessing the results of the Mantoux test in Russia and other CIS countries is somewhat controversial, because there is a difference in the test methodology itself - in the USA they use a test with the introduction of 5 TE of tuberculin, while in Russia they administer 2 TE.

Although, on the other hand, the relevance of the infection in the United States is much lower, and this fact is precisely intended to offset the more low dosage. This is reflected in the same (in millimeters) classification of sample results.

The American method has truly valuable points that could help everyone involved in tuberculin diagnostics. In particular, the assessment of the test result depends not only on the size of the papule, but also on the risk factors for infection to which the patient could be exposed. this patient.

Positive test is considered at following conditions:

• A reaction of 5 mm or more is considered positive for:
• HIV-infected
• Having close contacts with tuberculosis infected people
• Having a history of tuberculosis
• Intravenous drug users and those among them whose HIV infection status is unknown

A reaction of 10 mm or more is considered positive for:

• Persons born abroad
• HIV-negative intravenous drug users
• Persons from low-income families
• Persons from institutions long term care
• Persons with predisposing medical factors
• Children under 4 years old
• Persons from other risk groups identified by local health authorities

A reaction of 15 mm or more is considered positive for individuals who do not have risk factors for tuberculosis infection.

The Pirquet test is one of the most common methods for determining the presence of mycobacteria in the body that provoke the occurrence of tuberculosis.

The Pirquet test is performed using dry and purified tuberculin to determine whether a person has anti-tuberculosis immunity. The reaction is widely used among children, allowing the detection of tuberculosis infection even at the earliest stages.

Indications and contraindications

Highlight the following readings for the procedure:

• Age up to three years. The presence of a positive reaction indicates that the child is infected with tuberculosis, and the disease is already in the active stage.
• Children over 3 years of age and adolescence. The analysis determines the primary infection. To stop the progression of the disease, patients are prescribed anti-tuberculosis drugs. antibacterial drugs, and treatment is carried out in a hospital setting.
• The presence in the body of mycobacteria that provoke the occurrence of tuberculosis. In this situation, the procedure is carried out to determine the allergic reactions of the body.

A contraindication to performing the analysis is the presence of all kinds of skin diseases, somatic and infectious diseases in the acute stage.

In addition, people with the following pathologies should avoid the procedure:

• frequent epileptic seizures;
• bronchial type asthma;
• acute manifestations of allergies.

The presented procedure is prohibited from being performed in kindergartens where quarantine has been introduced as a result of mass infection with infectious diseases. In this situation, the test is carried out immediately after quarantine or when all manifestations of the disease disappear in children.

After performing a biological test or hemoglobin injection, the Pirquet test can only be performed after a month.

Technology

The peculiarity of the test is that medicine is applied to the skin, active substance which is tuberculin. At the very beginning, the skin of the shoulders and forearm is thoroughly disinfected with carbolic acid (preparations containing alcohol cannot be used, otherwise deviations in the results may be observed). Next, incisions about 5 millimeters deep are made on the epithelium using a scarifier. Then the patient needs to wait until the solution is completely absorbed and remove its remains with a napkin. After the procedure, the person is under the supervision of doctors for two days, and his reaction to the drug is carefully analyzed.

As a result of the introduction of the presented substance, an inflammatory process of a specific type is formed in the area of ​​the incisions, which is caused by the grouping of T-lymphocytes. Exactly these blood cells responsible for a person’s immunity to tuberculosis pathogens. In the area of ​​inflammation, the epithelium can change density and color.

Graduated sample

Today, the graduated skin test developed by Grinchar and Karpilovsky is recognized as a more informative replacement for the Pirquet test. To carry out the procedure, a tuberculin solution with a concentration of 100, 25, 5 and 1% is used. The solutions are applied in drops to the forearm area, and then using special tweezers, small incisions are made through the drop on the skin. After the “white roller” appears, the remaining substance is removed with a napkin.

In most cases, this procedure is performed to evaluate the effectiveness of tuberculosis therapy.

Calibrated sample results

The results of the procedure are studied after 2–3 days.

The following types of manifestations of the body at the indicated concentrations of tuberculin are distinguished:

• anergic – no reaction;
• nonspecific - there is only slight redness in the area of ​​administration of the substance with 100% concentration;
• normergic - the body reacts moderately to the administered substance, there is no reaction to a solution at a concentration of 5 and 1%;
• hyperergic – there is a response to all variants of solutions, and the higher the concentration of the substance, the brighter the reaction;
• equalizing - on all incisions made, the same degree of inflammatory process and identical skin color are observed;
• paradoxical - there is a brighter reaction in the area of ​​​​introduction of a substance with 100% concentration.

The Pirquet test is one of the most common methods for determining the presence of mycobacteria in the body that provoke the occurrence of tuberculosis.

The Pirquet test is performed using dry and purified tuberculin to determine whether a person has anti-tuberculosis immunity. The reaction is widely used among children, allowing the detection of tuberculosis infection even at the earliest stages.

Indications and contraindications

The following indications for the procedure are distinguished:

• Age up to three years. The presence of a positive reaction indicates that the child is infected with tuberculosis, and the disease is already in the active stage.
• Children over 3 years of age and adolescence. The analysis determines the primary infection. To stop the progression of the disease, patients are prescribed anti-tuberculosis antibacterial drugs, and treatment is carried out in a hospital setting.
• The presence in the body of mycobacteria that provoke the occurrence of tuberculosis. In this situation, the procedure is carried out to determine the allergic reactions of the body.

A contraindication to performing the analysis is the presence of all kinds of skin diseases, somatic and infectious diseases in the acute stage.

In addition, people with the following pathologies should avoid the procedure:

• frequent epileptic seizures;
• bronchial type asthma;
• acute manifestations of allergies.

The presented procedure is prohibited from being performed in kindergartens where quarantine has been introduced as a result of mass infection with infectious diseases. In this situation, the test is carried out immediately after quarantine or when all manifestations of the disease disappear in children.

After performing a biological test or hemoglobin injection, the Pirquet test can only be performed after a month.

Technology

The peculiarity of the test is that a medicine is applied to the skin, the active ingredient of which is tuberculin. At the very beginning, the skin of the shoulders and forearm is thoroughly disinfected with carbolic acid (preparations containing alcohol cannot be used, otherwise deviations in the results may be observed). Next, incisions about 5 millimeters deep are made on the epithelium using a scarifier. Then the patient needs to wait until the solution is completely absorbed and remove its remains with a napkin. After the procedure, the person is under the supervision of doctors for two days, and his reaction to the drug is carefully analyzed.

As a result of the introduction of the presented substance, an inflammatory process of a specific type is formed in the area of ​​the incisions, which is caused by the grouping of T-lymphocytes. It is these blood cells that are responsible for a person’s immunity to tuberculosis pathogens. In the area of ​​inflammation, the epithelium can change density and color.

Graduated sample

Today, the graduated skin test developed by Grinchar and Karpilovsky is recognized as a more informative replacement for the Pirquet test. To carry out the procedure, a tuberculin solution with a concentration of 100, 25, 5 and 1% is used. The solutions are applied in drops to the forearm area, and then using special tweezers, small incisions are made through the drop on the skin. After the “white roller” appears, the remaining substance is removed with a napkin.

In most cases, this procedure is performed to evaluate the effectiveness of tuberculosis therapy.

Calibrated sample results

The results of the procedure are studied after 2–3 days.

The following types of manifestations of the body at the indicated concentrations of tuberculin are distinguished:

• anergic – no reaction;
• nonspecific - there is only slight redness in the area of ​​administration of the substance with 100% concentration;
• normergic - the body reacts moderately to the administered substance, there is no reaction to a solution at a concentration of 5 and 1%;
• hyperergic – there is a response to all variants of solutions, and the higher the concentration of the substance, the brighter the reaction;
• equalizing - on all incisions made, the same degree of inflammatory process and identical skin color are observed;
• paradoxical - there is a brighter reaction in the area of ​​​​introduction of a substance with 100% concentration.

Collapse

Diagnosis of tuberculosis is the main measure, which becomes not only a guarantee successful treatment, but also a way to prevent an epidemic, since in fact one sick person can infect an entire team. For this reason, it is worth regularly carrying out diagnostics for preventive purposes. This is why tuberculin tests are carried out in children's institutions. This article describes what a tuberculin test is, how informative it is and what consequences it can have.

What is a tuberculin test?

Children are regularly tested for tuberculin; this right is enshrined in legislative level. What it is? This test, carried out in most cases, is a subcutaneous injection of a tuberculin preparation of natural or synthetic origin, depending on the type of sample. Usually, the drug is injected under the skin in the wrist area, but it can also be injected into other places, for example, in newborns.

Action this drug causes a local reaction on the skin - first redness appears and swelling forms, after a day a papule begins to form. Based on the size of this papule, the doctor makes a conclusion about whether the patient is sick. What types of reactions can there be?

• A positive reaction is observed when a large papule has formed after 72 hours. This indicates that the causative agent of tuberculosis is present in the body. The patient is sent for mandatory examination;
• Doubtful. There is a papule, but its size is not sufficient to diagnose the presence of tuberculosis. It may appear if a natural vaccine against this disease was recently introduced. With this result, the patient is most often referred for examination;
• A negative reaction is one in which there is a complete absence of any changes in skin. She speaks of the absence of a pathological process. But it can also indicate that the patient is not vaccinated against the disease or the vaccine “did not work,” that is, immunity was not formed.

Thus, deciphering the research results does not cause any significant difficulties.

In itself, the reaction develops because the administered drug causes a reaction of the immune system and in the presence of tuberculosis pathogens, the immune reaction will be stronger, that is, the volume of the papule will become larger. Whereas, if there is no pathogen in the body, then the immune system has not developed the appropriate antibodies and does not react in any way to the pathogen entering the bloodstream as part of the sample. Of course, such a small volume of an inactive pathogen cannot cause infection.

History of the appearance of tuberculin

Tuberculin tests are carried out with the substance tuberculin of natural or artificial origin. How did it come about? Tuberculin was discovered by the same scientist who discovered the “Koch stick” - Robert Koch. This happened in 1890. At the very beginning of the 20th century, pediatrician Clemens Pirquet from Austria introduced the concept of allergy into medicine and substantiated the informative value of the tuberculin test. He proposed to carry it out by scarification by skin method– this was the first such test, but it was not widely used due to the inexpediency of the method used.

Very soon, in 1908, Charles Mantoux, on the one hand, improved, and on the other hand, only slightly modified the Pirquet test, proposing to administer a tuberculin solution intradermally. This diagnostic method has become much more widespread, as it has proven its maximum accuracy and efficiency. In this unchanged form, the Mantoux test is carried out in kindergartens and schools to this day.

Until recently, natural tuberculin was used, which includes waste products of the bacteria that cause the disease. But this composition is very allergic, therefore, at the injection site, in addition to an immune reaction, an allergic one also appears, which significantly reduces the information content of the test, since the result can be regarded as a false positive.

Therefore, this drug is gradually being replaced by purified tuberculin (PPD). This type of tuberculin was discovered back in 1934, approved by the World Health Organization in the 1950s, but became widespread relatively recently. The advantage of the new drug is not only its higher specificity and test accuracy, but also that the drugs used are more sterile.

Types of tuberculin tests

Currently, the Mantoux test is widely used, but in addition to it there are also alternative ways administering the drug and assessing the results based on the reaction, since the symptoms also differ. In addition to the Mantoux method, the Koch and Pirquet methods are also implemented. These approaches have various contraindications and indications, features, and therefore can be interchangeable in different conditions.

Subcutaneous Koch test

The indication for such a study is the need to clarify the diagnosis of tuberculosis. The test is very highly sensitive, has greater accuracy than the Mantoux test, but is also more expensive. It is usually performed when the Mantoux reaction is not informative enough.

The drug is administered subcutaneously. The difference is in the dosages and sampling schedule. First, the drug is injected under the skin in a volume of m10-120TE. If no result is obtained, then up to 50 or 100 TE is introduced. After such a volume of the drug, both general and local focal reactions are detected. Such tests are also used in gynecology for suspected urogenital tuberculosis.

The test result is deciphered as follows:

1. No reaction after administration of 100 TU of the drug – no tuberculosis;
2. General reaction (fever, deterioration of health, leukocytes in the blood and ESR increase, etc.) – tuberculosis is present;
3. A focal reaction (observed in the lesion) is established by radiography, sputum examination, etc. - tuberculosis is present, even despite the absence of a general reaction;
4. Local reaction - a papule in the injection area with a diameter of 1.5-2 cm is not informative if there are no other symptoms, that is, if there is a papule, but there are no symptoms, then there is no tuberculosis.

This is a fairly informative and effective test, more effective than the Mantoux test. But it is complex, more expensive, and may also be less tolerated by the patient.

Pirquet skin test

It is carried out if necessary to confirm the diagnosis of tuberculosis. It is used quite rarely, as it is less informative than the Mantoux reaction. Such testing cannot be performed if you have bronchial asthma, allergic reaction, local skin reaction, rashes and skin injuries in the injection area, with bronchitis, acute respiratory infections, acute respiratory viral infections, etc.

This test is done for both children and adults and is performed using the scarification method, that is, just like a traditional allergy test, which is what it is. The site where the drug is applied is disinfected with carbolic acid, usually the product is applied to the forearms. Using a scarifier, small incisions are made on the skin, and then the drug is applied to them.

Within 5-6 minutes, the drug is absorbed into the skin, then its remains are wiped off with a paper napkin. The patient is monitored for 48 hours, during which his body's reaction to the test is monitored.

As a result, several papules are formed. They, as in all other methods, are differentiated by size.

• A papule up to 3 mm indicates that it is necessary to re-vaccinate, and then repeat the test itself;
• A papule of 3-5 mm in diameter indicates the absence of tuberculosis and normal vaccination effectiveness;
• A papule of 4-10 mm indicates that there may be an infection, or there has been contact with an infected person;
• A papule of 10-15 mm, ulcers, etc. indicate the presence of the disease.

Since several papules are formed, it is possible that they can vary quite significantly in size. In this case, they are evaluated together, depending on which area of ​​what concentration the solution was applied to.

Mantoux test with 2TE PPD-L

Tuberculin test Mantu is mandatory for all children under 15 years of age. These events are organized at schools and kindergartens. Its purpose is diagnostic and preventive. The advantages are that it is as simple as possible, fast, cheap, and is also well tolerated by patients (and therefore can be put on stream). The disadvantages are that the information content is quite low (compared to other methods), and in addition, it is quite difficult for a child to handle.

Such a test cannot be carried out in case of acute respiratory viral infections, acute respiratory infections, inflammatory and infectious processes in the body. The results are also deciphered by assessing the size of the formed papule. But as a result of an allergic reaction, such a test can quite often give a false positive result.

Conclusion

The reaction to tuberculin is the main way to guess or determine for sure whether a person is infected with tuberculosis. Such timely diagnosis on early stage not only guarantees successful treatment, but also prevents the pathology from spreading. For this reason, the mandatory Mantoux test is performed on all children, starting from the maternity hospital until they reach the age of 15 years, because children are the most vulnerable to this disease. However, an adult can also carry out this test if he wishes - his reaction assessment will follow the same principles.

Pirquet's test The test is the cutaneous application of dry purified tuberculin. diluted to a content of 100 thousand TE in 1 ml. A drop of this tuberculin solution applied to the skin is used to scarify the skin. The result is assessed after 48 hours. The subcutaneous tuberculin test, proposed by Koch, consists of injecting 10 - 30 - 50 TE PPD-L under the skin at the lower angle of the scapula. The results of the Koch test are assessed by local, general and focal reactions. At the site of tuberculin injection, an infiltrate with a diameter of 15-20 mm appears after 48-72 hours. The general reaction is characterized by an increase in temperature. body malaise 6 - 12 hours after the administration of tuberculin, and focal - exacerbation of tuberculin. changes (appearance or worsening of cough, infiltration around lesions in the lungs, enlarged lymph nodes with specific lymphadenitis, pain and swelling of the joints with specific arthritis). The test with subcutaneous injection tuberk. at specific eye damage. Indications. During mass tuberculin diagnostics, the Mantoux test with 2 TU is performed on all children and adolescents vaccinated with BCG, regardless of the previous result, once a year. The child receives the first Mantoux test at the age of 12 months. For children who have not been vaccinated with BCG, the Mantoux test is performed from 6 months of age once every six months until the child receives the BCG vaccination, and then according to the generally accepted method once a year. The Mantoux test can also be used for individuals. tuberculin diagnostics. It is carried out in the conditions of a children's clinic, somatic and infectious diseases hospitals for the differential diagnosis of tuberculosis and other diseases, in the presence of chronic diseases with a torpid, undulating course, in the ineffectiveness of traditional methods. methods to treat. and availability of additional risk factors for infection or disease with tuberculosis (contact with a patient with tuberculosis, lack of vaccination against tuberculosis, social risk factors, etc.). In addition, there are groups of children and adolescents who are subject to the Mantoux test 2 times a year in a general medical network: - patients diabetes mellitus, peptic ulcer stomach and duodenum, blood diseases, systemic diseases. HIV-infected people receiving long-term hormone therapy(more than 1 month); with chronic nonspecific diseases (pneumonia, bronchitis, tonsillitis), low-grade fever of unknown etiology; not vaccinated against tuberculosis, regardless of the child’s age; children and teenagers from social risk groups located in institutions (shelters, centers, reception centers) that do not have medical services. documentation (upon admission to the institution, then 2 times a year for 2 years)

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