Contraindications for the mantoux test and the benefits of the tuberculin test. Mantoux reaction in children, rules for conducting Mantoux test, contraindications

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For many years, the Mantoux test with tuberculin has been a widely used research method that helps detect the entry of tuberculosis antigens into the body. The reaction is carried out to diagnose pathology, assess the effectiveness of treatment, and also before revaccination with BCG. This type of study is also called a tuberculin test due to the use of an extract from mycobacteria, the causative agents of the disease.

Today, tuberculosis is widespread. Cases of the disease occur in all countries of the world, and the pathogen affects people of all ages. age groups. The pathology can be asymptomatic for a very long time, therefore timely diagnosis very important, especially in children.

Why do the research?

The Mantoux test is performed on children to diagnose tuberculosis, which affects not only the lungs, but also other organs and systems. The study consists of introducing small doses of mycobacterial antigens into the body intradermally into the middle third of the forearm. T-lymphocytes accumulate in this place, forming a small compaction. If it large sizes, this means that the body is actively interacting with the pathogen, and in this case additional clinical examination is required.

Sample schedule

Many parents are interested in whether this is a vaccination or not, because the Mantoux reaction is the introduction of pathogens into the child’s body. Medical professionals say this is a type of immunological test that has nothing to do with vaccination. However, due to the introduction of mycobacterial antigens, some experts believe that the Mantoux test can be considered a vaccination, which parents should know everything about, starting with the schedule.

When compiling it, the following factors are taken into account:

• The first Mantoux reaction is given at 1 year of age, and then every 12 months until the end of adolescence.
• Be sure to look at the vaccination calendar: an immunological test is carried out before vaccination, or 1-2 months after it. This is explained possible occurrence body responses, as well as incorrect test results.
• If the child is not vaccinated with BCG, the first Mantoux is given a year, and then every 6 months, taking into account the vaccination schedule.
• Before carrying out the tuberculin reaction, find out whether there are any contraindications.

The Mantoux test to detect tuberculosis is performed in the clinic. This is done by specially trained medical personnel. Parents must be told about possible side effects, allergies, and what to do if complications arise.

Evaluation of results

The Mantoux test result in children is assessed on the 3rd day (72 hours) after the reaction is established. At the site of tuberculin injection, a compaction is formed, surrounded by redness. Using a transparent ruler, only the papule is measured, but not the hyperemic area. After determining the size of the compaction, the result of the Mantoux test in children is assessed.

When performing Mantoux, the medical professional must explain to the mother what a papule is and how to check its size yourself. This will help parents detect any complications or allergies if they arise.

There is also a turn tuberculin test- this is the appearance after the previous ones. It often occurs in children under 5 years of age and indicates infection or a predisposition to pathology.

It is worth noting that the size of the Mantoux in vaccinated children per year is somewhat different from those at an older age. This is explained by the recent introduction of the BCG vaccine and the active production of immunity by the body. Over the years, the size of the papule gradually changes.

The doctor will explain to the mother what the child’s Mantoux should be per year, so that the parents do not have any concerns. Already at 2 years of age, the size of the scar after vaccination does not affect the tuberculin papule. However, it can still remain up to 1–1.5 cm. At 3 years, the size of the seal decreases slightly, and at 5 years it approaches normal, as in adults.

Enlarged papules: possible causes

Having learned what the size of a child’s Mantoux test should be, parents are often interested in what changes in size may indicate. It is worth noting that a positive reaction is not always a pathology.

The main causes of a large Mantoux papule in a child are:

• Infection with mycobacteria.
• Recent immunization with BCG vaccine.
• The body's predisposition to the development of tuberculosis.
• Improper care or allergies.
• Failure of medical personnel to comply with the rules for administering tuberculin, expired drug.

Mantoux test standards show that in some cases the formation of hyperemia without a papule is possible. This result is assessed as negative, requiring revaccination with BCG.

Papule care

It is important for moms and dads to know not only why the Mantoux test is performed, but also how to properly care for the site of tuberculin injection. This has implications for evaluating results.

Usually, the rules for caring for a papule are explained in the clinic office when the test is performed:

• The area of ​​the formed seal should not be wetted with water or washed with soap solutions.
• Lubricating with brilliant green, peroxide, iodine and other means is prohibited.
• Often, on the second or third day after Mantoux vaccination, children complain that the injection site itches or hurts. Therefore, it is very important to ensure that the child does not touch the papule with his hands, as this can lead to serious consequences.
• You cannot seal the tuberculin injection site with a plaster, even if a crust has formed there.

It is important to remember that due to poor care for Mantoux, the child may experience complications or difficulties in diagnosis. Therefore, it is necessary to adhere to the doctor’s recommendations.

Contraindications to vaccination

There are a number of cases when a reaction cannot be performed, as there is a risk of irreversible consequences. The following situations are contraindications to the Mantoux test:

• The presence of pustular lesions of the skin of any location.
• If the child gets sick, or any chronic infection worsens.
• Defeats nervous system, for example, epilepsy.
• Vaccination completed within the last month.
• Increased body temperature of unknown etiology.

Mantoux vaccination, if there are contraindications, can cause false deviations from the norm in children. Therefore, you should carefully monitor the child’s health, and if there are symptoms of pathology, postpone the study until they completely disappear.

Should I be afraid of a positive reaction?

Many parents, having heard the phrase “positive reaction,” begin to worry that their baby has tuberculosis. But this is a wrong assumption. Normally, the Mantoux test value in a child should be up to 5 mm. This indicates the absence of infection and predisposition to the disease. If the Mantoux papule in a child reaches 10–15 mm, this may indicate improper care, mistakes medical workers when performing a tuberculin test, a tendency to allergies.

Infection can be suspected when the size of the compaction is more than 1.7-1.8 cm, and the doctor determines how long it takes to repeat Mantoux, which specialists to visit and where to take an x-ray if necessary. But if previous tests were normal, then an increase in compaction is not yet a cause for concern.

Sometimes parents complain that the papule is too small after Mantoux or her complete absence. In this case, revaccination with BCG is prescribed.

Side effects

Often after taking a test, especially if this is the first Mantoux, mothers and fathers are afraid of all sorts of adverse reactions from the outside child's body. Parents are interested in whether there may be an allergy and how to reduce the risk of its occurrence. Any manifestations occur when the rules for administering tuberculin are not followed, safety precautions are neglected, and contraindications are ignored. Side effects are expressed by the following symptoms:

• Increased body temperature.
• The appearance of rashes, redness, and peeling on the skin.
• Lethargy, apathy, drowsiness.
• Decreased appetite.

As a rule, manifestations go away on their own within 1–3 days. However, if there are significant deviations, you should consult a doctor to get the necessary recommendations.

Complications after the test

Having found out what the Mantoux vaccination is, parents need to find out about possible complications: it's playing important role in preserving children's health. Severe consequences arise mainly due to weakness of the body or failure of medical personnel to comply with all norms.

Complications after an immune test include:

• Allergic reactions, manifested by changes in the skin, difficulty breathing, disruption of the heart.
• The child feels unwell after the Mantoux test - vomiting, loss of consciousness, convulsions, fever.
• Ulceration of the papule, discharge of pus from it.
• Hemorrhages at the site of tuberculin injection. In this case, the Mantoux reaction can be blue or purple.
• Tissue necrosis.

It is important for parents to know what a papule should look like after performing the Mantoux test. This is necessary for timely detection of complications and adverse reactions. If any pathological symptoms you should go to the hospital as soon as possible.

Carrying out immunological test to detect tuberculosis is an integral part of research into the child’s body. And knowing how to check for pathology using the Mantoux reaction, what the results indicate, and how a papule is measured, helps moms and dads find answers to many questions. All this is important for preserving the health of the child, because a mother who knows all the norms will notice even the slightest deviations in time, taking care of providing timely assistance.

Useful video about mantu sample

The frequency of tuberculosis diagnosis is increasing every year. Since the disease is characterized by high mortality, all newborns are given the BCG vaccine. Vaccination is necessary to determine the body's susceptibility to tuberculosis. A planned control measure before the age of 14 is the Mantoux test, which also has contraindications.

Mantoux - pros and cons

The Mantoux test is a test that determines the presence of tuberculosis infection in a child’s body. A tuberculin test is not a vaccination; it is an examination of a child for the presence of tuberculosis. The Mantoux test indicates the presence of infection. The preventive test allows you to:

• identify the disease at an early stage;
• detect infected children or confirm the presence of the disease;
• establish the symptoms of latent tuberculosis.

Interesting fact! R. Koch invented the substance in 1890, and C. Mantoux proposed diagnosing children using this vaccine in 1908.

To conduct an immunological study, children are injected with tuberculin, a solution of tuberculosis allergens. The procedure can only be performed after BCG vaccination. If the child has not been vaccinated, then tuberculosis testing is carried out 2 times a year.

Normal reaction to the Mantoux test

A tuberculin injection is administered under the skin of the inner forearms. The test result can be assessed 3 days after the injection. A swollen papule with infiltrate forms at the puncture site. The doctor visually assesses the condition of the skin, guided by the requirements of the World Health Organization.

A negative tuberculin test reaction without enlargement of the papule is normal. The size of the button should not exceed 1 mm, redness is not allowed skin. In order not to distort the reaction, it is forbidden to wash or scratch the button. During this period, it is necessary to exclude allergenic products from the diet.

A negative reaction also indicates the absence of an immune response against tuberculosis. In this case, parents are offered a second vaccination. With a scar whose size does not exceed 2 mm, immunity lasts 3 years, up to next vaccination at 7 years of age, protection remains with a scar of 8 mm.

Tuberculosis infection is diagnosed when a hyperergic reaction occurs, when the papule grows to 16 mm or more. A questionable or positive tuberculin test is detected in most children under 7 years of age. In a 6-year-old child, a weakly positive reaction is considered a good result when the BCG scar reaches a large size.

The cause for concern is sharp increase papules throughout the year. Even if last year the result was negative, then a swelling of 7 mm becomes a reason for examining a small patient at a TB clinic. Such indicators may indicate infection.

Temporary and absolute contraindications to vaccination

The tuberculin test is a completely safe procedure for healthy children. The presence of somatic pathology is not a contraindication to the Mantoux test.

Note! The results of a preventive test may be distorted by a recent history of infectious disease, another vaccination, chronic disease.

The Mantoux reaction is characterized by the presence of 2 categories of contraindications.

Absolute, at which it is prohibited to conduct a test. If the prohibition is ignored, Mantoux leads to irreversible consequences. The doctor’s responsibility is to study the child’s chart before the procedure.

Temporary, the presence of which prohibits the administration of the vaccine at the time of their relevance. After a certain time period, the test can be carried out. The specialist must assess the child’s health status before performing the manipulation.

This group includes the following prohibitions:

• individual intolerance to the components of the drug;
• the presence of serious consequences as a result of the BCG vaccinations in childhood;
• neurological diseases.

In such cases, they refuse to carry out a tuberculin test so as not to harm the child’s body.

Temporary contraindications

The presence of contraindications of this kind can distort the results and cause complications. The Mantoux reaction is not recommended for the following pathological conditions:

• Elevated temperature. This condition may indicate inflammatory phenomena, exacerbation of chronic diseases.
• Cough. The reflex indicates allergies, bronchitis, colds, asthma. The test is performed after the causes of the cough have been established and it has been eliminated.
• Runny nose. Rhinitis can be a symptom of sinusitis. You should get tested and treat the painful symptom.
• Such pathologies require examination by a dermatologist. The Mantoux test should be postponed for a month.
• It is necessary to identify the exact cause of the malaise, as it may indicate the presence of intestinal infection.
• Tuberculin weakens the child’s body’s defense response. The test is performed 3 weeks after recovery.
• Should be eliminated acute manifestations pathology.
• Recently received another vaccination. Mantoux cannot be combined with other vaccines. Therefore, after vaccination, the test is not carried out for a month.

Only a doctor should decide whether to perform the Mantoux test. The choice is made based on the collected medical history and the test results obtained.

Side effects and complications in children

If the doctor does not take into account the established restrictions or violates the technique of conducting the tuberculin test, this leads to the development of complications. Children may develop the following side effects:

• increase in body temperature;
• headache;
• fast fatiguability;
• exacerbation of diseases;
• allergic manifestations;
• formation of suppuration and ulcers in the papule;
• necrosis of tissue structures.

To avoid such reactions, you should consider individual characteristics child's body. This will reduce the risk of complications after the Mantoux test in children.

Tuberculosis – dangerous disease, affecting the respiratory system. The disease is transmitted by airborne droplets, therefore, to protect the fragile child’s body from the effects of the virus, vaccination is carried out. Vaccination against tuberculosis (BCG) is done upon discharge from the maternity hospital, on days 3-7 from birth. Starting from the age of one year, every year the child is given a Mantoux test, the results of which determine the presence of Koch bacillus in the body. Despite its undoubted benefits, the procedure has a number of contraindications that parents need to be aware of.

Composition of the Mantoux sample

The Mantoux test is not a vaccination, as some parents mistakenly believe, but a way to diagnose the disease in children. The first time it is given to a child is 12 months after the BCG vaccination, i.e. at the age of 1 year.

To determine the absence of pathogens in the body, it is necessary to administer the drug subcutaneously. The result is determined after three days by the size of the “button” formed at the injection site. For reliable results, during this period your hand should not be wetted or scratched.

The composition of the drug includes:

• tuberculin – processed and neutralized fragments of tuberculosis bacteria;
• phenol is a toxic drug that, in case of overdose, can negatively affect health, reduce immunity, and disrupt heart function (its meager content in the injection makes the procedure safe);
• Polysorbate Tween-80 – used as a stabilizer, in large quantities can cause hormonal imbalance by increasing estrogen levels (safety is achieved by reducing the dose of the drug in injection);
• phosphate salts - necessary to weaken pathogens;
• saline solution - used to provide a convenient form of injection, safe, does not cause allergies.

Contraindications

Before administering the Mantoux vaccination, it is necessary to undergo an examination by a pediatrician every year to exclude the presence of contraindications. A correctly performed procedure guarantees an accurate diagnostic result.

There are contraindications to the procedure:

• Absolute. Before the Mantoux test, the doctor must study the child’s chart, since the administration of the drug with absolute contraindications provokes development serious problems with health.
• Temporary. If they are present, the Mantoux test should be postponed.

In what cases is tuberculin diagnostics prohibited? The Mantoux test is not performed if there is the following diseases and states:

• complications after BCG vaccination;
• epilepsy;
• bronchial asthma.

Temporary contraindications include:

Colds

The presence of colds in children, including those occurring without an increase in body temperature, is a reason to postpone the analysis. If the child has a cough, the procedure is postponed until full recovery and eliminating symptoms. If you have a runny nose, tuberculin testing should be postponed for a month.

Before the procedure, you should take a blood and urine test; this action is necessary to exclude possible illness. If Mantoux is administered for colds, this leads to complications, since the vaccine has an additional effect on the immune system. In addition, the result of the study may be incorrect.

Temperature increase

A slight increase in body temperature indicates the presence of an inflammatory or infectious process in the body in the acute phase. The forces of the immune system are aimed at combating pathogens; an additional load in the form of a Mantoux test aggravates the situation and affects the reliability of the result. In this case, the procedure is postponed for 2-3 weeks and is carried out after the tests have been completed.

Diarrhea

Diarrhea can be caused by severe poisoning or an intestinal infection. If diarrhea is present, it is necessary to determine the causes of its occurrence. If diarrhea began as a result of eating stale food, the Mantoux test can be done seven days after the symptoms have resolved. If you have an intestinal infection, you need to undergo a full course of treatment and undergo tests before the procedure. A tuberculin test is not performed in case of severe gas formation, nausea and vomiting.

Neurological diseases

Depending on the type neurological disease The Mantoux test is canceled for an indefinite period of time or not performed at all. Before the procedure, you should consult with your pediatrician about possible consequences, get examined. A tuberculin test is done if there is no risk of developing complications of existing diseases. For some types of diseases, a medical exemption lasts for life.

Skin diseases

In the presence of skin rashes In any form, diagnosis should be postponed. Parents should report pathology before the procedure if the stains are not visible under clothing.

In order for the result to be true, the tuberculin test is performed on clean skin, without traces of insect bites or scratching. The introduction of the drug in this case aggravates the situation.

Presence of allergic reactions

Exacerbation of allergies several days before the Mantoux reaction is a contraindication. ABOUT possible allergies It is necessary to notify the pediatrician, the doctor will determine the need and possibility of conducting a tuberculin test. Administration of a vaccine during an exacerbation of allergies gives false positive. If necessary, before the procedure, you can give the child antihistamine.

When else can you not do the Mantoux test?

Before the procedure, you must sign a consent form. If parents still have doubts about the child’s health or the literacy of the staff, it is better to refuse the test. In this case, you must draw up a written refusal. You should coordinate your decisions with your pediatrician in order to reduce the development of adverse reactions and not harm the baby by refusing a tuberculosis test.

Vaccination and revaccination

The tuberculin test cannot be done together with vaccination and revaccination. Since introduction last vaccination at least a month must pass if injections with killed viruses were used. When introducing live bacteria, the withdrawal period increases to 2 months. This is necessary to restore the body's defenses. After vaccination the immune system fights incoming viruses, and if tuberculin is administered at this time, the body may produce an unexpected reaction.

Quarantine in a child care facility

Availability of quarantine in kindergarten or friend educational institution which the child is visiting is a contraindication to performing a tuberculosis test. If the defenses have coped with the viruses and the baby does not get sick, the bacteria can still be in the body, but their growth is suppressed by the immune system. A tuberculin test administered at this time can reduce the protective properties, provoking the development of the disease.

In addition, during the quarantine period, the disease may be incubation stage, i.e. the child is already sick, but the virus does not manifest itself in any way. In this case, the Mantoux test disrupts the immune system, contributing to the appearance of symptoms (cough, runny nose). Diagnostics are allowed to be carried out no less than 30 days after quarantine is lifted.

Side effects

Side effects are caused by individual components of the drug (tuberculin or phenol). These include:

Harm is caused to the body when Mantoux is given in the presence of diseases. Most often, diagnosis is carried out in the fall, during the period of exacerbation of colds. Parents should inform the doctor during the examination about the detected symptoms, since it is difficult to identify the disease in the early stages. Measures to prevent side effects:

• do not feed your baby new foods 3 days before and after the procedure;
• avoid visiting places where large numbers of people gather;
• give an antihistamine if there is a risk of developing an allergy;
• exclude physical exercise, let the child sleep before the procedure.

Possible complications

In rare cases, complications may occur after the procedure:

1. Obtaining a false positive or false negative result. If the test gives a positive reaction in the absence of disease, the child is prescribed unnecessary treatment with the use of strong drugs. They can cause serious harm to the body. To clarify the diagnosis, an X-ray examination is performed, which can result in a harmful dose of radiation. If the reaction is negative, if the baby is sick, he does not receive the necessary therapy.
2. Tuberculin in large quantities causes abnormalities in cell division, such an effect destroys the genetic apparatus.
3. The occurrence of a disease in which the number of platelets in the blood decreases. With absence necessary treatment this can lead to cerebral hemorrhage and death.
4. Pathologies reproductive organs under the influence of phenol.
5. Development of a strong allergic reaction in the form of pustules, spots, rashes, enlarged lymph nodes.

The cause of complications after Mantoux may be illiterate actions. medical personnel during the procedure. The test must be done following the following rules:

• Give the injection with a sterile needle and syringe. The packaging is printed immediately before the procedure.
• Only immerse the needle in the solution.
• The injection site must be disinfected with alcohol.
• Change gloves before each patient.

• How does the body react to the Mantoux test?

Many parents behave warily when they find out that their child needs to undergo the Mantoux test; there are contraindications to this procedure. Diagnosis of tuberculosis is very important, it is done in order to identify the disease. As for vaccinations, the child receives them at at different ages.

They are often prescribed to newborns. Vaccination against tuberculosis is important; it is done on the fourth day after the baby is born; the injection is also needed for children aged 7 and 14 years. Before the last vaccination, a test should be carried out; its results will show whether there is an infection in the body and whether Mantoux needs to be done.

During the injection process, a special substance is introduced - tuberculin: it is necessary to detect the disease.

A famous French doctor suggested using tuberculin. Today this diagnostic method is one of the most common. The Mantoux reaction is preventive method effects on the body, it cannot be called a vaccination. Some parents believe that during diagnosis, the child may be infected with tuberculosis. As practice shows, such accusations are unjustified. The substance is administered for the purpose of detecting disease. When vaccination or diagnosis is carried out on time, tuberculosis is easier to detect. Treatment will be prescribed in a timely manner.

After a small dose of the substance is injected into the wrist area, a corresponding reaction appears on the skin, usually in the form of skin thickening. The compaction is explained by the fact that T-lymphocytes gather near the injection site; they are responsible for the destruction of viruses. If there are a lot of T-lymphocytes, the area around the injection becomes very red. The Mantoux test is negative if the body does not recognize Mycobacterium tuberculosis infection. IN in this case The area of ​​redness is small. If this place has become large, we can conclude that there are mycobacteria, the Mantoux test is considered positive. Judging by the Mantoux test, it is impossible to make an unambiguous conclusion about the presence of tuberculosis. It is necessary to carry out many other tests, thanks to which the picture of the disease will be visible.

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Contraindications for diagnosis

It is important to remember that not everyone can receive the injection. There are indications and contraindications for the Mantoux reaction. If the child has skin diseases, allergic rash, Mantoux cannot be made. In case of epileptic diseases, it is strictly forbidden to carry out this diagnosis. You cannot do the test if the child is this moment suffers from any disease or less than a month has passed since recovery. The rules of the procedure must be followed. No other vaccinations are given a month before the injection. It is strictly forbidden to give another vaccination on the day the injection was given. Contraindications to Mantoux should be known in mandatory.

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About the Mantoux test: identifying results

After the doctor has performed the procedure, a small lump appears on the patient’s skin and looks slightly swollen. On the third day, the doctor takes measurements; he does not take into account the redness that appears near the lump. The size of the redness may vary. A negative Mantoux reaction occurs when the compaction size is less than 1 mm. Thus, the body does not send signals to the injected tuberculin, which indicates that there were no similar bacteria previously. Also, a negative manifestation occurs in children who have weak immunity. What else does Mantoux’s reaction indicate? It may have occurred if the child suffered from tuberculosis and less than three months have passed since the illness. To obtain reliable results, it is necessary to carry out the procedure in accordance with the rules and established standards.

The reaction may be questionable, in this case the size of the seal is less than 4 mm. We can talk about positive when the size of the graft is 5-16 mm. This means that the body has immunity to fight tuberculosis. If the positive reaction is excessively expressed, it is called hyperergic: the compaction becomes very large, its size fluctuates within 17 mm. This indicates that the child is sick with tuberculosis; there may be small ulcers at the site of the compaction. A hyperergic reaction may occur if the child has had a viral infection colds.

Post-vaccination immunity may appear after positive reaction Mantoux in a child, in this case the redness has a pinkish tint without obvious outlines. This redness quickly disappears, after which there is no pigment spot. What is the turn of the Mantoux reaction? This concept implies an increase in the size of the seal compared to the previous procedure. The doctor has the ability to diagnose an infection in a child. In medicine there is the concept of “booster effect”. If the test is carried out more often than once a year, sensitivity to tuberculin increases, the diameter of the compaction becomes relatively large, in this case a false positive reaction appears. If the doctor doubts the accuracy of the result, the child is referred to a TB specialist, and additional examinations are carried out.

Diagnosis of tuberculosis is carried out using different methods, among which special importance is given to tuberculin diagnostics. Tuberculin diagnostics is used in mass examinations for tuberculosis and in clinical practice for diagnostics, differential diagnosis tuberculosis and determining the activity of a specific process.

The main tasks of mass tuberculin diagnostics:

— early detection of tuberculosis;

— identification of persons with increased risk tuberculosis diseases;

— selection of a contingent for BCG revaccination;

— determination of population infection with tuberculosis.

For mass tuberculin diagnostics, currently only the intradermal Mantoux test with 2 TU (tuberculin units) is used. It is carried out with purified tuberculin in standard breeding. Tuberculin is injected intradermally on the inner surface of the lower third of the forearm. A white papule with a diameter of 7-8 mm is formed at the injection site, which quickly resolves. To exclude an extraneous reaction, the patient is warned that the site of tuberculin injection should not be combed or wetted with water.

The results of the Mantoux test are assessed after 72 hours. Redness, papule, and tissue swelling may appear at the injection site. Using a transparent ruler, measure the diameter of the papule perpendicular to the axis of the forearm. Hyperemia, that is, redness of the skin, is taken into account only in the absence of a papule. The following Mantoux test results are possible:

1. Negative – complete absence of papules or only a trace of the injection field up to 1 mm in size,
2. Doubtful - a papule with a diameter of 2-4 mm or only hyperemia of any size.
3. Positive – a papule measuring 5 mm or more.
4. Hyperergic - in children and adolescents the papule is 17 mm or more, in adults - 21 mm or more. Reactions with the presence of vesicles, necrosis or lymphangitis are also considered hyperergic, regardless of the size of the infiltrate.

The Mantoux test for mass tuberculin diagnostics can be performed with a needle-free injector. With this method, it is possible to test a large number of children in a short period of time, and the administration of tuberculin itself is almost painless. It should be taken into account that the size of the papule with the needle-free method is 2 mm smaller than with the test performed with a needle, so a reaction starting from 3 mm is considered positive, hyperergic - from 15 mm in children and 19 mm in adults.

The Mantoux test is performed en masse on all children starting from 12 months and is repeated annually, regardless of the results of the previous test. In even years, the sample is carried out on right hand, on odd days - on the left. The need to change the site of intradermal injection of tuberculin is due to the fact that with repeated injection of tuberculin into the same place, the reaction intensifies.

Contraindications for performing the Mantoux test during mass tuberculin diagnostics are: skin diseases, acute infections, exacerbation of chronic (at least 2 months after disappearance clinical symptoms) diseases, allergic conditions, bronchial asthma, individual intolerance various factors with pronounced skin manifestations, rheumatism in the acute and subacute phase, epilepsy. Tuberculin diagnostics are not carried out in children's groups during quarantine. The interval between any preventive vaccination, biological diagnostic test and the Mantoux test must be at least one month.

Mass tuberculin diagnostics are carried out by specially trained teams headed by a pediatrician. The team consists of nurses or paramedics. carried out to organized children in children's groups: kindergartens, schools. For unorganized children, the Mantoux test is performed in a children's clinic, local hospital, or at a medical and obstetric station.

The assessment of the Mantoux test is complicated by the fact that positive reactions can occur both in those infected with mycobacteria, patients with tuberculosis (infectious allergy), and in those immunized with the BCG vaccine (post-vaccination allergy). To correctly assess the reaction, the following points must be taken into account:

— whether the child is vaccinated against tuberculosis, the date of the last revaccination;

— intensity of reaction to tuberculin at the time of the last examination and in previous years;

— the child’s health status and data on his contacts with a patient with tuberculosis.

With a fresh infection with Mycobacterium tuberculosis, a turn is established tuberculin reactions. The change is understood as a change in sensitivity to tuberculin as a result of primary infection of the body. this reaction can be manifested by the transition of a previously negative reaction to tuberculin to a positive one or an increase in sensitivity to tuberculin if infection occurs against the background of a post-vaccination allergy.

When assessing the Mantoux test, the possible influence of various factors that can increase or decrease the body’s sensitivity to tuberculin is taken into account. Special attention focuses on allergenic factors and the presence of foci of chronic infection.

All children with newly diagnosed tuberculosis are subject to careful examination, since it can accompany asymptomatic forms of tuberculosis. Long-term infected children and adolescents with a hyperergic reaction to tuberculin and with a noticeable increase in sensitivity to tuberculin (by 6 mm or more) are also subject to detailed examination. All these children are at increased risk of tuberculosis.

Main features infectious allergies for tuberculosis, confirming infection of the body with tuberculosis:

1. For the first time, determination of a positive reaction (5 mm or more) in children who have not been vaccinated for a year.
2. Persistent persistence of a reaction to tuberculin for several years with a papule size of 12 mm or more.
3. An increase in the intensity of a previously questionable or positive reaction to tuberculin by 6 mm or more, or an increase in the reaction by less than 6 mm, but with the formation of a papule with a diameter of 12 mm or more.
4. Hyperergic reaction.

Mass tuberculin diagnostics is also used to select children for BCG revaccination. This selection is carried out among children aged 7 and 14 years subject to revaccination. Healthy children and adolescents with negative reaction for tuberculin.

Regular tuberculin testing is important for determining the infection rate of the population as an epidemiological indicator. It is determined as the percentage of infected persons to total number examined. Children are born free from tuberculosis infection, so their infection characterizes the epidemiological situation of tuberculosis. The WHO Expert Committee concluded that the elimination of tuberculosis as a public health problem will be achieved when the infection rate in children under 14 years of age does not exceed 1-2%.