Why and in what cases is the Mantoux test done? Mantoux test in a child: all the questions that concern parents

Unfortunately, today the incidence of tuberculosis in children is growing, while the level of medical literacy of parents is falling. The media launches information about the dangers of vaccination, and people are happy to believe it. Although it would be worth asking in more detail.

The same, alas, applies to awareness of the Mantoux test. Most parents are not even aware of what this test is and why it is needed. And doctors often neglect the need to inform mothers in the maternity hospital.

This is why parents often wonder whether to vaccinate their children with Mantoux. We will consider in detail all the important aspects of this procedure, which will allow us to assess the need for children to undergo it.

About Mantu in simple words

There is a lot of information on the Internet and literature about the Mantoux test for children, but often it is intended not for an ordinary parent, but for a physician. It is quite logical that much remains unclear.

So, first of all, you need to understand that Mantoux is not a vaccine. Vaccination is the inoculation of a disease with for preventive purposes. Mantoux is a determination of the reaction to the introduction of a tuberculosis antigen.

A tuberculin test is an intradermal or cutaneous injection of tuberculin to determine a specific immune response. Now more details.

What is tuberculin? Tuberculin is a certain concentration of antigens three types Mycobacterium tuberculosis. These antibodies are contained in the drug in a quantity that is safe and necessary for testing immunity and does not harm the child.
What is an immune response? This is the body's response to antigens. Human blood contains antibodies, tuberculin contains antigen. When an antigen meets an antibody, an immune reaction occurs. IN in this case it manifests itself in the form of redness and swelling at the site of tuberculin injection - papules.
Where do antibodies to tuberculosis come from in a child’s blood? And it’s true, he wasn’t sick. In the maternity hospital, the baby is vaccinated with BCG, which is a vaccination in its correct sense. With it, the baby is vaccinated with the same antibodies. They allow you to develop natural immunity and significantly reduce the risk of disease. BCG is the vaccine against tuberculosis. And Mantoux simply allows you to determine the presence of these antibodies.

Now main question– should Mantu be given to a child and why? The main goal is early diagnosis tuberculosis. Depending on the concentration of these same antibodies in the blood, the reaction manifests itself to a greater or lesser extent. This measure measures two opposing outcomes—the immune response to the vaccine and to the disease. The first is the norm, the second is a pathology. We regularly come into contact with mycobacterium tuberculosis on the streets and in transport and cannot be sure that there are not a dozen sick people per hundred people in the carriage. There will definitely be one. The Mantoux test is needed in order to notice the disease in its mild form, in a latent asymptomatic phase, and in this case, cure it without consequences for health.

Of course, if making the usual Manta is still a little scary, then there are alternatives, which we will talk about later.

How does the Mantoux test work?

The test is based on the reaction of the antigen-antibody complex (immune reaction). A child with a Mantoux vaccination will have a positive reaction, but within the normal range.

Specific blood cells – T-lymphocytes – are responsible for immunity to tuberculosis. When a person comes into contact with tuberculosis, a certain number of these cells become the very antigens to the disease that form immunity. When an antigen of the tuberculosis bacterium is administered intradermally, a reaction of the antigen to the antibody occurs, “recovered” T-lymphocytes accumulate at the site of injection of the antigen, and the most common inflammation occurs in the skin, which is manifested by redness, itching, swelling and minor pain.

How to care for your sample

Actually no special care is required. Eat general recommendations to avoid distortion of results:

do not smear with any preparations such as brilliant green or peroxide, as they lubricate the reaction, and its results cease to matter at all. The fact is that these drugs have an anti-inflammatory effect;
if a child has allergies, do not allow them to come into contact with allergens, as this can provoke more severe manifestations of the reaction;
It is possible to wet the sample, but it is not recommended to allow strong contact with soap, creams, detergents, oils and talcs, as they change chemical composition exudate (“impregnation” of the skin during inflammation) and the picture may be distorted;
There is no need to seal the Mantoux area for children - perspiration may form under the patch, which will intensify the inflammatory process.

Tryout calendar

There is a schedule for vaccinations and Mantoux for children. The test is carried out annually, starting from twelve months. The last test is carried out at 15 years of age. A prerequisite is permission to conduct a test. There is a certain system - in even years, Manta is done on the right forearm, in odd years, on the left.

According to the vaccination calendar, the test is carried out for all children aged from one to 15. If there are no contraindications, children receive BCG vaccine, therefore the first test follows 12 months after vaccination - Mantoux is given to one-year-old children. For children who have not been vaccinated against tuberculosis, the test is done twice a year in the absence of contraindications specified medical certificate. With the same frequency, tuberculin diagnostics are carried out for children with chronic nonspecific diseases and diabetes mellitus, which may affect the risk of the disease.

What might be the reaction to the Mantoux test?

The result of tuberculin diagnostics is assessed 48–72 hours after tuberculin administration. Two types of reactions are possible: papule and hyperemia. A papule is an elevation above the skin level with or without a change in color. Another name is infiltration. People call the papule a “button”.

Hyperemia is redness. It may be swollen or flush with the skin. The result is assessed by measuring the diameter of the papule or redness using a transparent ruler.

There are the following reaction options for the Mantoux test:

A negative result is that the papule or hyperemia has a diameter of 0–1 mm, which indicates the absence of contact with Mycobacterium tuberculosis.
A questionable result is an infiltrate with a diameter of 2–4 mm or redness of any size without infiltration. This result is common in vaccinated children.
Positive result - any manifestation more than 5 mm in diameter - screenings (rashes away from the test site), pathologies from the lymph nodes, vesicular rash at the injection site. This option has three degrees of severity:

- weakly positive – skin reaction with a diameter of 5–9 mm;
- medium positive – 10–14 mm;
- pronounced sample - 15–16 mm;
- hyperergic test – 16 or more millimeters, vesicular-necrotic changes (ulcers, tissue destruction).

Positive results indicate a very sensitive immune system or exposure to a pathogen varying degrees expressiveness. A cause for concern is a pronounced and hyperergic test result.

Are there any contraindications?

In certain conditions of the body, the Mantoux test in a child can give hypersensitive reactions. Therefore, it is not advisable to do it at this time. These conditions include:

various skin diseases;
acute diseases;
chronic diseases in the acute stage;
epilepsy;
acute allergic reactions.

After recovery, both vaccination and Mantoux can be given to children on the 5th–6th day of a healthy state.

Should you make Manta for your child?

The forums are full of horror stories about terrible allergies and the lack of need for Mantoux and BCG. The main argument for this is the independent development of immunity without vaccination. The whole point is that without vaccination, immunity can only be gained after an illness. To produce it, the body needs contact with the pathogen and recognition by blood cells.

The latter, after contact, become reactive antibodies against tuberculosis antigens. Vaccination gives safe dose antigen to develop immunity. As for the Mantoux reaction, it is indicative of 50%. Weakly positive and then on a positive scale helps to establish the risk of a disease or its fact. Pronounced reactions are indicators of the disease and are 70% reliable. Therefore, the answer to the question “should Mantoux be given to a child” is obvious.

If you are concerned about the possibility of your child contracting tuberculosis, which is common today and very serious illness– it’s still worth getting vaccinations, and Mantoux is still worth it.

Alternative

The only alternative to this method of tuberculin diagnostics are two modern methods– Diaskintest and Quantifiron test.

Diaskintest is a highly sensitive intradermal test that allows you to accurately and safely diagnose tuberculosis. The principle of interaction is the same - a highly specific protein in the diagnostic drug causes a skin reaction, the intensity of which determines the presence of a possible infection.

Quantiferon test , otherwise the interferon test is one of the latest developments in the diagnosis of tuberculosis. It is based on the determination of interferon specific for those in contact with mycobacterium tuberculosis, which is produced by the same T-lymphocytes.

In terms of safety, they are approximately equal to Mantoux. When a reaction to tuberculosis is given to children, the effectiveness is the same both in Mantoux and in alternative ways diagnostics

Thus, the Mantoux reaction is indeed the right way monitor the risk of tuberculosis in a child. With a responsible approach to the procedure and sterility, the Mantoux test does not pose any danger and will help control the disease. We must not forget that one hundred percent protection against tuberculosis does not exist, because Koch bacilli are very tenacious and extremely difficult to kill. Carriers of the disease do not always go to hospitals, much less try to protect others. Protecting your child from this disease is vaccination and regular monitoring using the Mantoux test.

Educational video with the participation of specialists

IN modern world The problem is very serious. The rate of spread increases every year and, unfortunately, is accompanied by a fairly high mortality rate. In our country, BCG vaccination in newborns is carried out en masse, unless there are contraindications. To date this is the most effective method prevent tuberculosis infection.

However, it is not a 100% guarantee. Therefore, in order not to miss the problem, they use a so-called test that allows you to determine the presence of the above-mentioned infection. This test is called: Mantoux test, or Mantoux vaccination.

important The essence of the procedure is the subcutaneous injection of a drug - tuberculin, artificially created with the content of tuberculosis microbacteria. Excessive redness or swelling at the injection site is a reaction that indicates the presence of dangerous bacteria in organism.

Mantoux vaccinations for children help control the spread of infection among the “younger” population.

When is the Mantoux test done?

The first time this vaccination is given is 12 months after birth. It is simply pointless to do it before a year, because the results of the reaction are different and cannot be completely trusted. Upon reaching the age of 2, the child is vaccinated with Mantoux every year, regardless of previous results.

You need to know that the test should not be carried out on the same day as other vaccinations that are given to develop immunity, because It is known that this test will give a false positive reaction. However, after receiving the test results, vaccinations can be carried out in the required quantity even on the same day.

Vaccination against various diseases before the sample must be delivered, an interval of at least 4-6 weeks is required (this depends on the vaccine: inactivated or live).

Mantoux vaccination is done with a special tuberculin syringe once a year intradermally, in the area of the middle third inner surface forearms.
The dose volume administered is 0.1 ml, or two tuberculosis units (TU).
The procedure is performed by specialists who insert the needle with the bevel upward to the required depth so that the hole is completely immersed in the skin, but at the same time does not go under the skin. To do this, pulling skin covering, the needle is slightly raised.
A specific swelling, called “buttoning,” of the upper layer of the skin is a normal reaction to the injection of tuberculin.

There are other methods for performing the Mantoux test: cutaneously (Pirquet reaction), and with plastic applicators, thanks to which not only tuberculin, but also other tests can be applied to the pointed ends. The number of TEs can also be different: for example, in the USA they introduce 5, but then the conclusions are drawn differently.

results

information Within two to three days after Mantoux vaccination, a lump called a “papule” may form at the injection site. Externally, it represents a rounded area rising above the skin.

The resulting papule is the result of saturation of the skin with cells: sensitized lymphocytes. If you press it lightly with your finger and release it, or press it with a transparent ruler, you will notice a whitish tint.

The dimensions of the Mantoux graft are determined under high-quality lighting 48-72 hours after the test. The ruler is installed transversely to the longitudinal axis of the forearm to measure only the size of the seal. Redness surrounding the infiltrate cannot be considered an infection or a sign of immunity to tuberculosis, although when there is no “papule”, it is definitely recorded. Depending on the result, we can talk about different types reactions:

negative: 0-1 mm;
dubious: 2-4 mm;
positive: 5 mm or more:
- weakly positive: 5-9 mm;
- medium intensity: 10-14 mm;
- pronounced: 15-16 mm.
- hyperergic: 17 mm or more;
vesiculo-necrotic(formation of pustules and the appearance of areas of necrosis): regardless of the diameter of the infiltrate, a reaction accompanied by regional lymphadenitis (enlarged lymph nodes), lymphangitis, and daughter screenings;
false negative: some patients infected with the tuberculosis bacillus have a negative reaction (this may be due to anergy, when the immune system is not able to respond to tuberculin);
false positive: reaction in uninfected patients (one of the most common reasons the presence of mycobacteria is considered to be of non-tuberculous etiology, but there may be allergic disorders, a recent infection, or a vaccination that was given a month ago).

The reaction to Mantoux vaccination may have a “turn”: an increase in the diameter of the infiltrate compared to last year by 5 mm or more (for example: 12, 12, 12, 17 mm).

information This is very valuable for specialists. diagnostic sign, which allows the doctor to draw a conclusion about the infection that occurred during the last year.

In this case, it is necessary to exclude all influencing factors: allergies, recent infection, recent BCG vaccination or another vaccine less than one month old and the like.

When you can't vaccinate

It should be said that this test is not dangerous for any healthy body child, nor for children who have any somatic diseases. However, there are a number of reasons why Manta needs to be postponed:

age up to 12 months;
period of acute diseases, both of non-infectious origin;
quarantine area for some disease;
allergic manifestations;
epileptic seizures;
less than 4 weeks after the previous vaccination.

Parents should be aware of these features, and then the Mantoux vaccination will not cause concern if there are no specified contraindications for this. The test can be performed a month after the reasons that prevented this have disappeared.

After vaccination It is not recommended to treat the area with anything until the results have been assessed. If the reaction is negative and the injection site looks neat on the outside, it does not need to be treated. If this area of skin has any unpleasant symptoms for you external manifestations(ulcers or pustules), then after the result obtained you can take care of them, as with ordinary wounds.

important When caring for the injection site, it is very important that the child does not scratch it or wet it prematurely with water. It is not recommended to cover this area with adhesive tape, as the skin underneath may sweat and this can lead to irritation.

The child needs early years instill a culture of attitude towards vaccinations - it should be explained that incorrect behavior can give false results.

What to do if the Mantoux test is positive

The Mantoux test is not one hundred percent proof of the presence of tuberculosis infection, although it is indeed a very important criterion. There are other diagnostic methods:

examination of all family members;
sputum culture;
fluorography.

Children's cases of primary detection of infection are accompanied in 7-10% of patients with symptoms characteristic of tuberculosis. Such children require medical observation and accompaniment in an anti-tuberculosis dispensary for a year. Moreover, for the first 3 months, patients undergo chemoprophylaxis with isoniazid, and then are transferred under the control of a local pediatrician.

If after a year signs of increased sensitivity to tuberculin do not appear and there is no hyperergic reaction, then the child is accompanied by a doctor, like other children. But the results of subsequent annual tests must be treated even more carefully. If the infection has been observed for more than a year, then mandatory observation at a tuberculosis dispensary is necessary, where, taking into account the individual characteristics of the hyperergic reaction to tuberculin, a treatment regimen is prescribed.

important A serious attitude towards the injection site is required not when there is redness, but when the size of the “papule” reaches more than 6 mm, because this indicates activation of the infection, and in the case of 15 mm, immediate appointment is necessary effective treatment.

To vaccinate or not to vaccinate

Unfortunately, not all parents understand the degree of responsibility that they place, first of all, on themselves and their child for Mantoux vaccination. At the same time, they cannot give themselves an answer to the question “why?” In fact, this test does not harm the body, but on the contrary helps to find an infection if it is present there.

Mantoux vaccination is very necessary before. After all, it is this test that can relatively accurately determine the need for repeated administration of the Calmette-Guerin vaccine (BCG), since children with a positive Mantoux test or a history of a tuberculin test are not recommended re-vaccination BCG at the age of 7 years.

All adults remember how at school they were injected with some substance into their hands, after which they could not wash themselves for a period of time. three days. Until now, many people think that such manipulations were carried out to protect the child from tuberculosis, that is, to vaccinate him. In fact, this is just a way to find out how the immune system reacts to the vaccine and whether a person is infected with tuberculosis.

Why is Mantu made? What indicators of this reaction are considered normal and are there any contraindications to it? How should a child behave to receive reliable result? Let's find out everything about this test for tuberculosis.

What is a tuberculin test

The development of tuberculosis in all countries is being closely monitored. Therefore, in addition to universal vaccination, children are regularly monitored in order to find out how the body reacts to this infection.

Mantoux - what is it and should parents and children be afraid of this test? No, this is just an attempt to determine the immune capabilities of the child’s body.

Is Mantoux a vaccine or not? To fully answer this question, you need to remember a little about all the stages of immunization against tuberculosis.

In the first days after birth, if there are no contraindications, children are given BCG. This is a vaccine against tuberculosis, its composition is weakened (in medicine they are called attenuated) tuberculosis bacilli from cows. Children are revaccinated after 6 years. The body’s reaction to the introduction of albeit weakened, but still living, microorganisms is unpredictable. Therefore, at school, children undergo tuberculin tests before vaccination.

What does the Mantoux reaction show? Normally, it means how ready the child’s body is to face tuberculosis. That is, thanks to the test, they determine whether the child has tuberculosis and how ready the child’s body is to meet this microorganism in real conditions.

There is no need to be afraid of the Mantoux test process. In most cases it does not give adverse reaction, and difficulties always lie in the individual characteristics of children. At any age, they cannot always resist touching the injection site.

What you need to know about the Mantoux reaction

The extract of mycobacteria (this is a tuberculosis microorganism) is called tuberculin. Simply put, it is a waste product of a microorganism that does not contain either live or killed tuberculosis bacilli. Therefore, the drug is absolutely safe for the child. They cannot become infected or cause the development of a disease. The composition of Mantoux is two tuberculin units.

Basically, the Mantoux test is done for children, since in most cases tuberculosis in adults is diagnosed by others available methods:

using an annual fluorographic examination;
thanks to x-ray;
examine sputum for the presence of Mycobacterium tuberculosis;
A complete blood count also helps;
if necessary, tomography is performed.

Until what age is Mantu made? - children are often under 16 years of age, but in rare cases it is done before 18 (but adults are also sometimes given tuberculin diagnostics). This is due to the incidence of disease in a particular region or the body’s reaction to the Mantoux test, when the readings change sharply (the test was negative, but became positive).

How many times a year can you make Mantoux? As a rule, it is done once a year to determine the incidence of tuberculosis. But when positive reaction for the administration of tuberculin or in regions at risk for tuberculosis, the tests are repeated. They are done a maximum of three times a year. How often can Mantoux be given to a child? - usually, if a positive result is detected for the injection, it is repeated a few days later. Then, if necessary, the child or adult is referred to a consultation with a phthisiatrician. Experts conduct more in-depth research using other methods.

The drug is administered intradermally into the forearm area childhood. IN exceptional cases adults are also advised to administer tuberculin. For example, when a person is admitted to the hospital with suspected pneumonia and needs to be differential diagnosis with pulmonary tuberculosis. In this case, the norm of the Mantoux reaction in adults is the same as in children.

There are very important indicator- a turn thanks to which doctors can make a diagnosis or determine which group of patients a child belongs to. Mantoux turn what is it? - this is an upward change in the test result compared to last year. Phthisiatricians will pay attention to the child if there is a significant increase in the papule.

Features of the Mantoux test

In addition to the moral preparation of adults for the upcoming event and communication with the child on issues of correct behavior after diagnosis, there is no need to conduct specific preparation. But there are points that it is advisable to take into account before the Mantoux test. There are several questions that arise for parents.

How to measure Mantoux and make the right conclusion

To make a diagnosis, you need to not just inject 2 tuberculin units into the child’s forearm - you need to correctly “read” the data obtained. How to measure Mantoux correctly? There is nothing special here; the measurement is most often carried out by a nurse at a kindergarten, school or clinic. Take a regular ruler, a transparent one is more suitable, apply it to the injection site and measure the papule. What is a papule during Mantoux? It is this change in the skin that has diagnostic significance. This is a small red bump, that is, swelling at the injection site. They do not measure the entire area of redness (it can be very large), but only the papule that appears a few days later.

After how many days is Mantoux checked? The result is assessed after 48–72 hours. This time is enough for the child’s body to react to the administered drug. The data obtained for each child is recorded and compared with the results of previous indicators.

How to understand what the next result means?

The Mantoux norm for children is 5 mm, but 2–3 years after vaccination against tuberculosis, the papule can be within 12 mm and it is not considered a sign of infection of the child; it is rather an active reaction of the body to BCG when antibodies are produced.
A papule size of 10 mm indicates a possible infection of the child or contact with people with this disease.
If, when performing the Mantoux test and assessing the result, a lump of more than 15 mm was found in children or ulcers formed at the injection site, this indicates infection with tuberculosis.

Reaction to Mantoux

What reaction is possible and should be to the Mantoux test? In medical sources you can find a description of several options for the body’s response to the Mantoux test. There are several types of reaction.

It is not always clear how to behave when a health worker reads the results. Many data simply confuse the child and parents. Eg, negative reaction Is mantoux good or bad? On the one hand, this is good, because the body is not infected with tuberculosis. On the other hand, he does not have the ability to respond to the appearance and presence of a tuberculosis infection, and this is bad.

What not to do after performing Mantoux

As with the introduction of vaccinations into the body, there are rules here that it is advisable to follow so as not to spoil the results.

Is it possible to walk after Mantoux? Yes, you can, walks are not contraindicated, but, on the contrary, they should be done. Tuberculin diagnosis is not a burden on the immune system, it is a kind of test for the presence of the disease.
What happens if you scratch Mantu? This is definitely not worth doing - any physical impact on the injection site will lead to a false positive result. Scratching, rubbing, wearing rough clothes, which also lead to this, are contraindicated.
Is it possible for a child to wash himself after performing Mantoux? And what happens if you wet Mantu on the first day? If you just wet it, most likely nothing will happen. But if you wash your hand and rub the site of tuberculin injection, even with the softest sponge, while combing, then the body’s reaction will not be long in coming. In this case, you should not be surprised if the child’s Mantoux increases, because he is guaranteed a hyperergic reaction. The same can happen if you use soap or wet your hand with river or lake water - it often contains particles that irritate the skin, and detergents may be allergenic. That is, many conditions must be met for the reaction to be correct after washing. Therefore, doctors recommend avoiding water procedures.
Should I follow a special diet that limits certain foods? - there is no such need. After all, the products will not affect the presence of tuberculosis in the body. A special diet will not help make the correct diagnosis.

How the body tolerates the Mantoux test

In addition to the expected reaction, in the form of a papule in the area where the drug was administered, sometimes the child’s body reacts differently. It is important to remember that Mantoux is not a vaccine. The main reaction that should appear is the appearance of a papule.

But other reactions also happen.

Many reactions are accidental due to the banal inattention of parents or health workers to the child’s condition. Therefore, if a child reported that a Mantoux test was being carried out at school the other day, just watch your child.

What not to do?

When should you not give Mantoux to a child? If there was an allergic reaction to the previous administration of tuberculin, even in the form of widespread urticaria. This time the result of the body's reaction may be disastrous. It is necessary to warn the health worker what happened last year, because nurses often change, and records may accidentally get lost.
Is it possible to make Mantu for a cold? If this is a routine diagnosis, it is better to wait until full recovery, but you cannot refuse at all, because the Mantoux test is carried out in the interests of the child. IN emergency situations The test is carried out even during exacerbation of chronic skin diseases.
Under normal conditions heat, acute illness, exacerbation chronic infection- this is a temporary contraindication for the Mantoux reaction.

How to behave correctly after the Mantoux test

Forced repeat testing or referral to a TB specialist causes a storm negative emotions in the child and parents. But you shouldn’t be afraid of this, since this is only the beginning of the diagnosis. Let's look at several situations and what needs to be done.

Possible difficulties in diagnosing Mantoux

Many parents wonder whether this diagnosis is necessary, because to get a good result many conditions must be met:

do not wet;
do not rub;
do not scratch the tuberculin injection site;

During the Mantoux test, you have to closely monitor the child, which is not always possible, especially for very busy parents. In addition, this diagnostic method is extended over time.

All these difficulties lead to a completely reasonable question: is it necessary to expose a child to suffering? Yes, you can’t do without the Mantoux test. Mantoux is the only tuberculosis diagnosis that is practically safe for children. It is necessary to clearly know the time when the child’s body first encountered tuberculosis for adequate and rapid response. Tuberculosis is incurable; the disease affects every system in the body. Complications sometimes frighten even medical workers. Therefore, one small injection once a year is nothing compared to possible infection.

The Mantoux test still remains one of the most effective and relatively safe methods definitions of tuberculosis. Small disadvantages of diagnostics do not reduce its real merits.

Judging by your diet, you don’t care about your immune system or your body at all. You are very susceptible to diseases of the lungs and other organs! It's time to love yourself and start improving. It is urgent to adjust your diet, to minimize fatty, starchy, sweet and alcoholic foods. Eat more vegetables and fruits, dairy products. Nourish your body by taking vitamins and drinking more water(precisely purified, mineral). Strengthen your body and reduce the amount of stress in your life.

You are susceptible to moderate lung diseases.

So far it’s good, but if you don’t start taking care of her more carefully, then diseases of the lungs and other organs won’t keep you waiting (if the prerequisites haven’t already existed). And frequent colds, intestinal problems and other “delights” of life and accompany weak immunity. You should think about your diet, minimize fatty, flour, sweets and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, do not forget that you need to drink a lot of water (precisely purified, mineral water). Strengthen your body, reduce the amount of stress in your life, think more positively and your immune system will be strong for many years to come.

Congratulations! Keep it up!

Do you care about your nutrition, health and immune system. Keep up the good work and there will be more problems with your lungs and health in general. long years will not disturb you. Don't forget that this is mainly due to the fact that you eat right and lead healthy image life. Eat proper and healthy food (fruits, vegetables, dairy products), do not forget to consume a large number of purified water, harden your body, think positively. Just love yourself and your body, take care of it and it will definitely reciprocate your feelings.

Which raises more and more questions among parents. Why does the "button" increase - or not increase? Why is it that with a “bad” Mantoux the child is certainly sent to a phthisiatrician? These and other questions will be answered within the framework of the VI All-Russian Scientific and Practical Conference " Current issues prevention, diagnosis and treatment of tuberculosis in children and adolescents,” answered the country’s leading pediatric phthisiatricians.

Why is the Mantoux reaction needed at all if all children in the maternity hospital are vaccinated against tuberculosis - BCG?

The purpose of the BCG vaccine is not to protect against tuberculosis infection, but to limit the tuberculosis process at the level lymphatic system, if infection occurs - and it occurs during the life of approximately 70-80% of the population in our country. The purpose of BCG is to prevent severe generalized forms of tuberculosis from developing and to prevent Mycobacterium tuberculosis from infecting the brain and skeletal system.

This makes the vaccine different from others, which create immunity in the body against a particular infection. And they do it on the 3-5th day in the maternity hospital because at this time the newborn is definitely not infected with tuberculosis. Although, according to the latest data, not everyone is vaccinated - on average, about 80% of newborns are vaccinated in the country: some have health contraindications, while parents refuse to vaccinate others.

The Mantoux reaction is not a vaccination, although it introduces the substance tuberculin, a waste product of mycobacteria, into the body. The Mantoux test is a screening (with wide coverage) diagnostic method, an indispensable companion to the BCG vaccine. Based on the size and quality of the papules (“buttons”), it is possible to determine whether the body has encountered Mycobacterium tuberculosis, what kind of encounter it was - BCG vaccination or infection with tuberculosis, can a child be revaccinated with BCG at 7 years old or is further examination for tuberculosis necessary?

Another little-known task of the Mantoux test is the detection of tuberculosis in adults. It is for this purpose that parents and other relatives of a child with a “bad” Mantoux test are asked to do fluorography - most likely, he is infected from them. In this way, it is sometimes possible to detect tuberculosis, for example, in a child’s grandparents who have not been examined for a long time, or in a distant relative who came to visit, and thus stop the spread of tuberculosis.

Thanks to the chief phthisiatrician of Russia and the press, we now know that it is possible to wet Mantu. Where did this recommendation come from, which has been given for decades: not to wet Mantu?

This recommendation comes from the times when tuberculin was injected cutaneously - the so-called Pirquet test was done. They dripped a drop of tuberculin, then a notch was made through this drop - upper layer skin, epidermis, were dissected with a special lancet. They were afraid that if the wounded epidermis gets dirty water, this wound may become infected - hygiene in those days left much to be desired.

After the appearance of the Mantoux reaction, the habit of “not getting wet” was preserved, although it was no longer necessary, because When performing the Mantoux test, tuberculin is injected between the epidermis and dermis, intradermally. And hit clean water no longer plays any role on the skin. But there is no need to injure - rub, comb - this place.

Why is it that one of my children kindergarten They give the Mantoux reaction, and his brother at school is given Diaskintest?

Medical workers act in accordance with the order of the Ministry of Health of the Russian Federation dated March 21, 2017 No. 124n “On approval of the procedure and timing of preventive medical examinations citizens in order to detect tuberculosis." According to this document, children from 1 to 7 years old inclusive, the diagnosis of tuberculosis is carried out using the Mantoux test; for children from 8 to 17 years old, Diaskintest is used.

Both of these studies relate to tuberculin diagnostics, i.e. allow you to find out whether tuberculin, a toxin secreted by mycobacteria, is present in the body. But active substance in the Mantoux test - this is a whole “cocktail” of proteins, which many children today give allergic reaction. Often, only a TB doctor can distinguish it from a positive Mantoux reaction, which means that the body is actively interacting with the causative agent of tuberculosis.

Diaskintest - new drug, it appeared due to the fact that the genome of Mycobacterium tuberculosis was deciphered. As a result, proteins were discovered that are responsible specifically for the development of tuberculosis and do not respond to the BCG vaccine - they became the basis of Diaskintest, a recombinant tuberculosis allergen (this is its medical name).

Diaskintest is an ideal option for diagnosing tuberculosis, early detection children at risk: accessible, inexpensive. Thanks to this diagnostic method, it was possible to reduce the incidence of tuberculosis in last years. But for now National calendar Vaccinations include revaccination with BCG at the age of 7; phthisiatricians are forced to give the child the Mantoux test before this age, look at its results from year to year and decide whether he needs revaccination or not. This is the only way to select children for vaccination.

But in fact, by the age of 7, there is no one to revaccinate with BCG: everyone’s Mantoux test is either positive or doubtful - this was confirmed by a large study done in the Primorsky Territory. Such children are not subject to revaccination, and from now on only Diaskintest is indicated for them.

How exactly does the use of Diaskintest reduce the incidence of tuberculosis?

First, a few numbers about the situation with tuberculosis in Russia. Thanks to government programs in the fight against tuberculosis, the reduction in morbidity and mortality today is proceeding at a pace that has not been observed in any country in the world. Since 2008, the incidence of tuberculosis has decreased by about a third, and mortality by more than 2.5 times. In 2017, morbidity decreased by 9.4%, and mortality by more than 17%.

Russia has developed a draft strategy for eliminating tuberculosis by 2030 as a problem public health. It involves reducing the number of tuberculosis patients to a minimum so that the problem ceases to be global. How to achieve this?

Tuberculosis is an airborne infection that is transmitted from an adult to a child: children, as a rule, are asymptomatic, and in any country they make up only 10% of all patients with tuberculosis.

So, the tuberculosis bacillus is present in the air. It enters the body, infection occurs, but in most cases the body copes - it develops immunity, and the disease does not develop. Diaskintest in this case will be negative. And if it is positive, this means that the tuberculosis bacillus is alive in the body, and it must be combated with the help of preventive treatment.

If this is not done, a tuberculosis process may develop - and more serious treatment. But in children's body Another way is also possible - spontaneous cure, when the focus of tuberculosis is delimited and the so-called petrification is formed (another name is calcification, because a capsule of calcium salts is formed around the affected tissues).

What is the danger of petrification? The fact is that dormant Mycobacterium tuberculosis can manifest itself under unfavorable conditions - and secondary tuberculosis will develop. For example, if a child gets sick with some other infection and his body is severely weakened. Or will it arise in adulthood? chronic illness- For example, peptic ulcer, diabetes. (Such patients are at risk for tuberculosis and undergo immunodiagnosis 2 times a year.) Other risk factors are any decrease in immunity: hormone therapy, HIV infection, antisocial lifestyle.

Diaskintest allows you to identify live mycobacteria before petrification forms. Recent example: in Rostov region In the last few years, schoolchildren have only had Diaskintest. Children have grown up and become teenagers - and they are not diagnosed with tuberculosis. All children at risk were treated until adolescence.

There is a feeling that, based on the results of the Mantoux test, children are referred to a phthisiatrician too often. Is there overdiagnosis here?

Let's look at the entire algorithm for preventing tuberculosis in children in Russia and figure it out.

If a child is vaccinated with BCG in the maternity hospital, then once a year until he is 7 years old, he is given a Mantoux test. If the Mantoux reaction is positive, the pediatrician must rule out an allergic reaction and do a Diaskintest. If the test is positive, the child is referred to a TB specialist for further examination. It may include: T-SPOT.TB (also prescribed instead of Diaskintest for the child’s allergy status, obesity), according to its results - multispiral CT scan(MSCT) of organs chest, which allows you to identify the tuberculosis process in the lungs. MSCT is also performed in children over 8 years of age and adolescents with a positive Diaskintest result.

If the child is not vaccinated in the maternity hospital, he should be given a Mantoux test during the first year of life, and if the result is negative, a vaccination BCG. If the Mantoux reaction is positive, it means that the child is already infected with tuberculosis, he cannot be given BCG, and he is further observed by performing Diaskintest.

On a par with skin tests(Mantoux and Diaskintest reaction) for children with medical contraindications The T-SPOT.TB blood test is eligible for tuberculin diagnostics (and if parents refuse it).

All these diagnostic studies are done in the absence clinical symptoms tuberculosis in children.

What symptoms may indicate that a child may be developing tuberculosis? What should you pay attention to?

Pediatricians know these symptoms well; we will list them for parents. So, it is necessary to exclude tuberculosis with the help additional research(no matter how much time has passed since the previous tuberculin test) in the following cases:

if the child receives adequate treatment with ARVI, pharyngitis, but improvement does not occur within 7-10 days;
if during treatment it lasts more than 2-3 weeks;
long-term manifestations of intoxication: persistent slight increase temperature ( low-grade fever), sweating at night.

These symptoms do not always indicate the development of tuberculosis, but first of all you need to think about it.

Parents' questions were answered:

Valentina Aleksandrovna Aksenova, Doctor of Medical Sciences, Professor, Head. laboratory of tuberculosis in children and adolescents of the Federal State Budgetary Institution "National Medical Research Center phthisiopulmonology and infectious diseases" of the Ministry of Health Russian Federation, chief pediatric TB specialist;

Nadezhda Ivanovna Klevno, Doctor of Medical Sciences, Professor, Leading Researcher of the Laboratory of Tuberculosis in Children and Adolescents of the Federal State Budgetary Institution "National Medical Research Center for Phthisiopulmonology and Infectious Diseases" of the Ministry of Health of the Russian Federation, Chief Freelance Specialist of the Central federal district in pediatric phthisiology;