Mantoux test in children - to do or not ?What does a positive and a negative Mantoux test in children.
Motherhood / / December 12, 2017
A merciless fight against tuberculosis is not only treatment in specialized clinics suffering from a dangerous ailment, but also an early detection of the propensity to the disease.
This is especially true for toddlers. The Mantoux test successfully copes with the task, which children are starting to do from the age of one year.
Mantoux reaction - what is
More than a hundred years ago, in 1882, mankind learned about the existence of the tuberculosis "Koch sticks", named after the German microbiologist who opened it. In search of an effective remedy for the unknown disease by Robert Koch, as well as other researchers around the world, numerous experiments were conducted, which resulted in the creation of tuberculin. Despite the hopes placed on him, the drug was powerless in the fight against tuberculosis, but his discovery was not in vain. In 1908, a physician from France Charles Mantoux discovered a difference in the response of healthy and sick people with tuberculosis to the administration of the drug. His discovery marked the beginning of the use of tuberculin as a test for the presence of a dangerous rod in the body, and the method of investigation itself called the Mantoux test.
The annual Mantoux test consists of injecting small doses of tuberculin under the baby's skin and tracking the body's response to this procedure. At the injection site, a small inflammation can occur, due to the presence of active lymphocytes. They are responsible for the anti-tuberculosis immunity, and their number affects the response.72 hours after the administration of the drug, the doctor examines the site of the injection and makes its verdict. The result depends on the presence or absence of inflammation and the size of the seal.
How often do Mantoux test for children
On the fourth or seventh day after the birth of a baby, he is administered BCG vaccine, designed to form immunity against tuberculosis. Exactly one year later the first Mantoux reaction is carried out, which shows how the immune system of the child behaves when meeting a tuberculosis infection. Earlier than the kid will celebrate his first birthday, Mantoux's test is not done, as the result may be wrong. In the future, it is held every year, until reaching 14 years of age.
If BCG vaccination was not, for various reasons, done on time, further vaccination depends on the Mantou reaction - a negative result confirms the absence of a tubercle bacillus in the body and indicates the relevance of the BCG vaccination. Positive, if it is within the norm, confirms the fact of meeting with Koch's wand and the won victory over her immune system. In this case, there is no sense in carrying out the vaccination, but Mantoux should preferably be tested on schedule, annually.
How to care for Mantoux test in children
Mantoux sample for children is done in a polyclinic - the drug is injected into the hand. To get the right result, you should follow simple rules. Formed "button" can not:
- stick adhesive plaster;
- grease with grease or hydrogen peroxide;
- tightly pulling clothes or bandage;
- if you accidentally hit water or another liquid with a towel, gently soak it with water.
It is advisable to exclude foods that can cause allergies from the baby's ration - chocolate, lemons, oranges.
What does the Mantoux reaction mean and when should mom worry not?
After three days the doctor will estimate the result. Impatient mother can do this on her own, to cope with the understandable excitement. Several variants of the Mantoux reaction are possible.
Negative Mantoux reaction in children
The Mantoux reaction in children is considered negative if the size of the "button" is not more than 1 mm, and redness around it is not observed. Mom can breathe easily, the baby has an absolutely normal reaction.
Mantoux positive reaction in children
Positive evaluation of the Mantoux reaction in children, in which the seal at the injection site is from 5 to 16 millimeters. Usually this indicates that after immunization with BCG, the immune system responds adequately to the danger. If the baby does not have an inoculation, such a reaction can signal the presence of a tubercle bacillus in the child. Do not panic at once, this fact does not indicate at all that the child is sick and needs to be urgently hospitalized. Just Koch's wand, under certain conditions, can be activated, and then the doctor will need help. Therefore, for such children, observation is necessary, and, if necessary, the pediatrician will send the baby to the phthisiatrician.
Hyperergic Mantoux reaction in children
Hyperergic is a kind of positive reaction. Sealing can reach 17 millimeters or more, and at the site of a prick appear ulcers and abscesses. The result is not very comforting - most likely, a fragile children's organism attacks a huge number of dangerous bacteria. The probability of tuberculosis is very high in this case.
False positive Mantoux reaction in children
False positive - it can scare Mom to death, although the cause may be improper care of the injection site. However, for a more accurate diagnosis, as in the case of a positive reaction, the baby is sent to a TB specialist for consultation and additional examination.
Doubtful Mantoux reaction
A reaction is considered doubtful when there is only redness of the skin or an increase in compaction to 4 millimeters. Further annual monitoring will lead to the correct conclusion. While there is nothing to worry about.
Warning! You do not need to measure the entire reddened area, but only the "button".
A lot of factors can affect the result of a Mantoux test: depletion, the presence of parasites, the recently transferred disease, the presence of allergies. Therefore, it should be done no earlier than one month after any acute illness and removal of quarantine in a kindergarten. It is also believed that a positive Mantoux reaction during the first three years of life is a completely acceptable phenomenon and is associated with the vaccination of BCG.Gradually it decreases and comes to naught. If the Mantoux reaction is negative by the age of 7, the BCG is re-inoculated.
Side effects of Mantoux test in children
As a rule, against a background of a recent illness or with the presence of an allergy, an unexpected reaction to the Mantoux test may occur. Usually symptoms occur suddenly:
- high fever, sometimes up to 40 degrees, and fever;
- skin rashes - can be not only on the hand, but also in the groin, on the ass, under the knees, on the face;
- refusal to eat;
- itching in the area of injection;
In such a situation, it is necessary to call a doctor at home, he will examine the baby and prescribe histamine preparations.
Mantoux reaction - do or refuse
Mantoux test is not an inoculation, so parents can refuse it if they want. It should be well to weigh all the pros and cons, because your choice depends on the health of the child. The risk of contracting a dangerous illness is quite real, therefore, when deciding to give up Mantoux's reaction, try to find an alternative. In many private clinics, a special blood test is made-the immunoglobulin AMg for tuberculosis. Of course, he will have to pay for it, but still it's better than leaving the baby alone with a possible formidable disease.
Sometimes the Mantoux test is not done for medical reasons. The doctor refuses to hold it if the baby has:
- cough and runny nose;
- skin diseases;
- exacerbation of chronic disease;
- is an acute infectious disease.
Mantoux should not be given to a child at the same time as other vaccinations, otherwise the result may be false positive.
There are a number of conditions in which a child can be included in a so-called risk group for tuberculosis after a Mantoux reaction. This does not mean that he is sick, but the baby needs additional examination and supervision of the phthisiatrician. Indications:
1. Hyperergic reaction;
2. Sealing on the site of injection of 5-16 millimeters combined with a reddish trace along the lymphatic vessel or a vial at the injection site;
3. No reduction in Mantoux sample with age;
4. The size of the "button" significantly increased compared to last year.
Pre-examination will help confirm or disprove the development of tuberculosis.
Mantoux test - is there an alternative to
Some mummies heard about the appearance of a new drug, which, it is supposed, is a substitute for the Mantoux test. Diaskintest appeared several years ago and is successfully used in the diagnosis of tuberculosis. However, this is just an additional method of examination, in no way replacing the long-proven method. The drug is not able to assess the effect of the immune system after BCG vaccination, can not tell the need for a second vaccination at seven, does not respond to bovine mycobacteria. In addition, if the Mantoux reaction is positive already at the stage of Koch's wand introduction, Diaskintest reacts only to its activation in the body and changes in the lymph nodes and lungs. When the question is about a formidable and dangerous disease, you can not waste precious time. Therefore, the Mantoux test is used throughout the world for mass screening.
What is said about the Mantoux sample in children Dr. Komarovsky
1. Eugene Komarovsky considers the Mantoux test to be the most effective method for today to determine the presence of a tubercle bacillus, which in no case can not be neglected. He calls the signs of a possible infection:
- a turn of the tuberculin test, when the negative result becomes positive without carrying out vaccination with BCG;
- hyperergic reaction, in which the size of the papule, instead of decreasing, for four consecutive years exceed 12 millimeters.
2. Developing the fears of many mothers about the toxic phenol in tuberculin, he explains that this component is a natural product of human metabolism, so you should not be afraid of it. Moreover, the content of it as a preservative is so miserly that it can not harm the baby. In order for it to really have a toxic effect, it would take a million of Mantoux samples to be done at the same time.
3. Regarding the alternative use of Diaskintest, Dr. Komarovsky stressed that the Mantoux test is used all over the world as the most effective indicator. The new test does not respond to BCG vaccination, so a positive reaction to its conduct indicates exactly the presence of tuberculosis.
4. The doctor categorically rejected the claim that the site of the injection can not be wetted, explaining the association of the erroneous recommendation with the previous reaction to Pirka, when the water was undesirable.