Mantu turned red on the first day: what to do?

Large Mantoux means the size of the papule after testing is from 5 mm. All measurements up to 17 mm and without blisters and areas of darkening of the skin must be assessed depending on the time of administration of the BCG vaccine and the previous year's result. There is no cause for concern if there is a consistently large reaction to tuberculin up to 12-14 mm; a sharp increase of 5 mm or more compared to the previous result is more dangerous.

To determine the cause of large Mantoux, you need to undergo examination by a phthisiatrician. He prescribes additional examination for the family and the patient. In addition to infection with tuberculosis, allergies, recent vaccinations and infectious diseases can cause an increase in papule.

Big Mantoux: dimensions, what it means

Large Mantoux means a positive reaction to the introduction of tuberculin (mycobacterium particles) into the skin; the size of the compaction in this case always exceeds 5 mm. The more immune cells in the body that have reacted to contact with the tuberculosis bacillus, the stronger the reaction will be. The following results stand out:

• weakly positive – 5-9 mm;
• medium intensity – 10-14 mm;
• pronounced – 15-16 mm;
• strong (from 17 mm to 18 years and from 21 mm for adults) or any size with bubbles and darkening, compaction of the lymphatic tract, lymph nodes.

In general, the large size of the papule (a raised area on the skin that becomes lighter when pressed) reflects only the state of the immune system in relation to mycobacterium tuberculosis. There are also false positive results, since tuberculin itself is an allergen. Therefore, for a correct diagnosis, consultation with a phthisiatrician is necessary.

We recommend reading about how many days after Mantoux is checked. From the article you will learn about what day Mantoux is tested in a child, when it is done, the reactions of the Mantoux test, how to check the result yourself. And here is more information about alternative methods for diagnosing tuberculosis in children.

How to correctly assess whether a Mantoux is big

Very often, the size of the entire red spot is taken as the sample size or measured not through the center. Even more important is to take into account the time that has passed since the administration of the BCG vaccine. Therefore, there are age standards when following the vaccination calendar: in the maternity hospital, 7 and 14 years (see table), and they are always compared with previous measurements.

After the next vaccination, all standards are repeated again.

What does a large Mantoux mean per year?

A large Mantoux per year is not always a sign of infection. The first test is carried out at 12 months, subject to BCG vaccination in the maternity hospital. It reflects not so much the risk of infection with tuberculosis bacteria, but the immunity formed after vaccination. Therefore, it is very important to correlate the size of the scar on the shoulder and the diameter of the papule (see table).

Determining test results

What should be the reaction and size of the papule in order to give a negative diagnostic result?

After the injection of tuberculin, redness after Mantoux and the appearance of compactions in the tissues near the injection site are possible. The result of the procedure is usually determined seventy-two hours after the introduction of the allergen.

Possible manifestations:

• hyperemia - a condition in which the external deviation from the norm is slight redness of the tissue around the injection;
• infiltration is a condition in which there is slight swelling or compaction of tissue due to stagnation of blood and lymph, often accompanied by inflammatory processes.

The reaction after the injection may vary depending on compliance with the standards of the diagnostic procedure and the general condition of the patient.

Information that can be obtained after the Mantoux test:

1. A negative result is redness around the injection site of no more than one millimeter, without compactions or other undesirable signs.
2. A questionable result is redness around the injection site of no more than four millimeters, without tissue compaction.
3. A positive result is buttons from five to fifteen millimeters with pronounced tissue compaction.
4. A very pronounced result - compaction reaches seventeen millimeters or more.

However, a large Mantoux in a child is not always an accurate diagnosis of tuberculosis. If the Mantoux turns red or signs of swelling appear, there is always the possibility of a false positive result, especially when the baby has previously been vaccinated with BCG.

Assessment of outcome in children

Since the Mantoux test is performed on both children and adults, assessment criteria for people of different ages should also be distinguished.

After the first BCG vaccination, the baby retains a developed immune response to Koch’s bacillus until the age of seven. It is during this period that re-vaccination is carried out.

The reaction rate depending on the child’s age:

• at the age of twelve months (first Mantoux test) to two years, almost all children have a positive or questionable reaction to testing;
• at the age of one year, the size of the button is from five to ten millimeters;
• if at the age of two a child’s vaccination scar reaches eight millimeters, a reaction to a test of up to sixteen millimeters is considered normal;
• at the age of three years and until the age of six, the identification of a questionable reaction continues;
• from four to six years old, the standard sample size is considered to be up to ten millimeters;
• at the age of six to seven years (before re-vaccination with BCG) the reaction is negative;
• from seven to ten years (the first three years after vaccination) a positive result is possible due to the effects of the vaccine;
• upon reaching fourteen years of age the reaction is negative.

The reaction to the test depends on many factors, but BCG remains the main cause of false-positive results in young and middle-aged children. Therefore, after determining a positive reaction, it is necessary to undergo additional research methods.

Outcome assessment in adults

After reaching the age of fourteen, it is customary to undergo fluorography to diagnose tuberculosis, and the Mantoux test is prescribed as an additional diagnostic method.

Normal for an adult:

• negative reaction;
• slight redness regardless of diameter;
• swelling up to four millimeters.

Also, in addition to the Mantoux reaction, various laboratory research methods are used to diagnose tuberculosis in adults.

Changes in reaction by day after injection

Rate of change:

1. The reddened button increased in size on the second day and turned red.
2. Maximum redness and swelling is achieved on the third day.

Due to the fact that the maximum size of the reaction occurs on the third day after the injection, the measurement is prescribed seventy-two hours after the event.

What, besides a large Mantoux in a child, should alert

When assessing a large Mantoux test in a child, the following are considered warning signs:

• sweating, worse at night;
• general weakness, malaise;
• loss of appetite;
• lethargy;
• anxiety, tearfulness;
• slight cough;
• headache;
• increased heart rate;
• temperature rise to 37.2-37.5 degrees;
• weight loss or no weight gain;
• frequent bronchitis, viral infections.

Their complete absence cannot be considered evidence that the disease has been excluded, since the first months after infection occur without any symptoms. There are no exact (specific) symptoms of tuberculosis infection; they can mean any disease of the respiratory tract.

The most dangerous is considered not just a large Mantoux, but its sharp increase compared to the previous (last year) result:

• transition from negative or doubtful to positive;
• papule grows from 5 mm in diameter;
• 12 mm 3-4 years after vaccination;
• blisters, blackened areas, pustules at the test site;
• from 17 mm, regardless of vaccination.

Watch this video on how to protect your child from tuberculosis:

Enlarged Mantoux in a child: reasons, if on the first, second day

To accurately assess whether a child has enlarged Mantoux, it is very important to take measurements strictly on the third day, that is, the first and second are skipped, and measurements are needed after 48-72 hours. It is advisable to maintain the same interval annually and record the result in medical documentation. In case of a doubtful or positive reaction, it is better for parents to keep their notes indicating the time of the test and the interval before the assessment.

What day should the biggest one be on?

The largest Mantu can be on any day before the results are assessed, but all changes before the third day are not taken into account. They can then change either down or up. This is explained by the different speed of formation of the immune response in the child. All intermediate measurements are not needed for diagnosis, because the standard response to tuberculin injection is considered to be only a papule from 48 to 72 hours.

If every year there is a bad reaction

If every year the Mantoux test is positive or doubtful, which parents consider a bad result, then in fact there is no reason to worry. This means that the child’s immunity is sufficiently developed after vaccination. When he is in contact with a patient with tuberculosis, T-lymphocytes will correctly respond to the penetration of mycobacteria into the body.

The truly alarming result is the dramatic change in size compared to the past. You can think about possible infection, for example, if a child had a Mantoux of 12 mm for 2 or more years, and when a new test was performed, the papule became 17 mm in size.

Allergy to Mantoux

It is not always possible to detect an exacerbation of an allergic reaction to tuberculin before diagnosis. In such cases, an allergic response to Mantoux occurs on the first day and you must consult a doctor to confirm.

Allergies can occur due to:

• individual intolerance to components in the serum;
• hereditary intolerance;
• complications due to chronic diseases;
• dermatitis.

As a rule, in children who are not prone to allergies, an acute reaction to serum components does not occur.

Signs of an allergic reaction:

1. Weakness, nausea.
2. Vomiting.
3. Loose stools.
4. Increased body temperature of the child.
5. Severe hyperemia.

Also, a change in reaction is possible if precautions are not observed and due to insufficient attention to contraindications.

Antiallergic drugs are a means to combat the disease, but for the safety of the baby it is necessary to undergo alternative diagnostics.[/attention]

Big Mantoux in a child: what to do

When Mantoux major is detected for the first time in a child, it is necessary to undergo an examination by a phthisiatrician. It usually focuses on:

• interviewing parents about possible contact with a patient with tuberculosis;
• epidemiological situation (that is, the number of newly identified cases of infection) and the number of children with a sharp increase in Mantoux tests;
• recorded diagnoses: allergy, recent infection;
• date of vaccination against other diseases.

Since the Mantoux test cannot be 100% reliable, additional examination is usually prescribed:

• fluorography for parents,
• X-ray of the child's lungs,
• sputum culture,
• blood tests.

Even if the diagnosis of tuberculosis is excluded at the time of diagnosis, observation by a phthisiatrician for at least a year is necessary in case of a suspicious Mantoux test. If indicated, he prescribes medications that kill mycobacteria for 3 months (chemoprophylaxis). At the end of treatment, a repeat tuberculin test may be performed.

The next year, Mantoux is placed, and if it has not increased or the diameter is 2-5 mm larger, then the child is observed by a pediatrician at the place of residence on a general basis. When the papule is at least 6 mm wider than the previous one, this means that the infection has become more active and treatment is required at a TB clinic.

A special situation arises if a large Mantoux is detected after a break when the child’s reaction to tuberculin has not been tested for a year or two. It is recommended to repeat the diagnosis after six months and based on its results, a conclusion is drawn about the need for chemoprophylaxis.

Could there be an error in the analysis if the Mantoux is large and red

A large and red Mantoux test occurs with tuberculosis infection, but false positive results are also possible due to:

• allergies to tuberculin components;
• tendency to allergic reactions;
• recent infection;
• infection with mycobacterium, but not tuberculosis;
• vaccination performed (BCG or other vaccine);
• exacerbation of chronic inflammation;
• acute stage of internal organ disease;
• helminthic infestation;
• the interval between the previous sample is less than a year.

We recommend reading about the age at which Mantu is made. From the article you will learn how often the Mantoux test is done in kindergarten and school, the test schedule, and alternative diagnostic methods in older age. And here is more information about what you can and cannot eat when performing the Mantoux test.

What you need to know about the Mantoux reaction

An immunological test allows you to accurately determine whether the causative agent of tuberculosis infection is present in the body. Simply put, this is the body's reaction to purified tuberculin. After the injection, a slight swelling forms on the skin, accompanied by slight redness.

Mantoux is not a vaccine, but still occupies one of the first places in the Russian vaccination calendar. Previously, the mixture for injection was an extract from the substrate of Koch bacilli, purified by thermal means. It is known that such a vaccine had a lot of negative aspects, it could cause an allergic reaction, and sometimes gave a false reaction. Today, the mixture for vaccination has been significantly modernized and is a purified tuberculin protein with the addition of sodium chloride and stabilizers. This composition practically does not provoke the occurrence of allergic reactions, and the accuracy of the test increases several times.

Other complications from the test: Mantoux is swollen, a large papule appears, pain

A pronounced reaction to the Mantoux test is manifested in the fact that the skin is swollen, the papule is large and hurts when pressed - this means that the body has been in contact with Mycobacterium tuberculosis, has immunity against infection and increased sensitivity to tuberculin. Less commonly, such complications are possible due to incorrect diagnosis, poor-quality tuberculin, or allergies to components.

The following facts support the risk of infection:

• papule from 17 mm;
• blisters and spot necrosis in the area of ​​tuberculin injection (focal necrosis of the skin);
• visiting an area with high incidence;
• presence of the patient in the immediate environment;
• newly identified large Mantoux after negative results;
• low social status (homeless people living in unfavorable conditions, poor nutrition).

Positive result
In doubtful cases, Diaskintest and immunological blood tests are used.

Large Mantoux occurs when infected with tuberculosis and reacts to the administration of the BCG vaccine. Allergies, other infections, and vaccinations can affect the results. To find out the cause, you need to be examined by a phthisiatrician.

Myths about the reasons for the increase in mantoux and their truthfulness

If everything is simple with the main signs of possible infection, then with the pitfall in the form of allergies and contraindications, everything is not so obvious. After all, in fact, the procedure has no requirements for the patient! Of course, every second parent will say that during the reaction, children should not eat sweets, and it is strictly forbidden to wet the induration. In fact, all these are rumors and speculation. At least part of it.

Early versions of the procedure, called the Pirquet test, did prohibit contact with water. This was due to the fact that the virus was not introduced under the skin, but onto it, through a previously scratched area.

Modern reactions exclude this requirement. Therefore, the increase in induration cannot in any way be associated with contact with moisture.

With sweets, things are also not so clear. This condition does not apply to most children, because sweets in themselves do not affect tuberculin in any way. The situation is completely different with allergy sufferers.

The whole point is that large amounts of sugar and other allergens can cause increased sensitivity of the body - aggravation of the immune system. In such conditions, manta rays are almost guaranteed to grow significantly above normal.

However, this can also serve as a good identifier of the cause of complications. If the induration swells up half the arm, it can't be anything other than an allergic reaction.

In addition, allergies can occur without the help of sweets or citrus fruits.

A small percentage of people who are highly prone to allergic diseases can experience a hyperergic reaction even without exposure to third-party allergens.