Dr. Komarovsky about the Mantoux test

Renowned pediatrician Dr. Komarovsky frequently offers helpful guidance on a range of health-related subjects, such as immunizations and diagnostic exams. The Mantoux test, sometimes referred to as the tuberculin skin test, is one test that is regularly brought up in conversations. This examination determines whether a subject has been exposed to tuberculosis (TB). It’s useful to comprehend Dr. Komarovsky’s viewpoint on it given its significance in TB diagnosis and prevention.

In an easy-to-understand manner, Dr. Komarovsky describes the goal, methodology, and significance of the Mantoux test results. Knowing these details can help many parents feel more at ease and make sense of the test’s place in their child’s medical care. Dr. Komarovsky highlights the test’s efficacy in early tuberculosis detection, which is essential for prompt treatment and stopping the disease’s spread.

For ensuring that children receive the right care and navigating the occasionally perplexing world of medical testing, Dr. Komarovsky’s insights are invaluable. He helps parents make educated decisions about their child’s health by simplifying the Mantoux test.

What is it

The tuberculin test is a diagnostic method, a test for the presence in the body of a microbe that causes tuberculosis – the tuberculosis bacillus. For these purposes, the child is injected subcutaneously with a special drug, which is based on the microenvironment of the habitat of the causative agent of the disease – tuberculin. Then specialists evaluate the body"s reaction to the introduced substance. The fact is that people suffering from tuberculosis, infected, and those who are healthy, react to tuberculin in diametrically opposite ways. This reaction is similar to the manifestations of allergies: if a person has a microbe that causes tuberculosis, tuberculin causes a certain inadequate allergic (immune) response, if the child does not have the causative bacillus, nothing happens.

In the upcoming video, Dr. Komarovsky will go over every question regarding the Mantoux test for kids in greater detail.

Today, the Mantoux test is considered an effective diagnostic method all over the world. Alternative ways to find out whether a child has tuberculosis also exist, but there are few of them. One of the modern tests – "Diaskintest" is still being introduced. In Russia, the drug is registered and certified completely officially. Its diagnostic action is based on the release of some specific antigen proteins that are sensitive only to the aggressive tuberculosis pathogen. If the usual Mantoux test can give a reaction to the components of the BCG vaccine, then the "Diaskintest" gives a positive reaction exclusively to microbes that are pathogenic. From this point of view, the new test is more perfect. If it is negative – there is no disease, if positive – there is a disease.

Why do this

In the maternity hospital, the vaccination intended to guarantee that the child develops immunity against tuberculosis is administered. It goes by the name BCG. Though the vaccine greatly lowers the likelihood, the child may still contract tuberculosis despite receiving the vaccination. The progressive decline in antibodies against the tuberculosis bacillus is the cause of this. After the first vaccination, if the child shows no signs of immunity, he receives a second shot before starting school at age 7.

Because the Russian government’s policy does not mandate the strict isolation of individuals with such a diagnosis from society, we constantly come across people who are carriers of the tuberculosis bacillus in our daily lives. We see these people in stores, on the street, and in transportation.

As soon as the child turns one year old, the Mantoux test should be conducted once a year. In the event that the test yields a negative result, it is understood to mean that immunity to the tuberculosis bacillus has not developed following the maternity hospital vaccination. In this scenario, the physician is authorized to suggest that these children get tested for tuberculin twice a year in order to prevent them from "missing" the illness.

Tests ought to be conducted in separate arms in accordance with current regulations. If the child was tested in the left arm this year, the test should be administered in the right arm the following year. The middle third of the inner surface of the forearm is the same location for tuberculin injections every time. You cannot rely on the accurate result if you observe that the test was administered in the other third of the forearm.

Rules for performing the test

As with the vaccination, you should check the baby’s health approximately a month prior to the Mantoux test. He needs to be in good health and not suffer from any allergies or severe illnesses. It is preferable to move the test to a later time if the child has a fever.

If the child has a history of being diagnosed with "bronchial asthma" or "rheumatism," is experiencing an exacerbation of their skin disease, or if a quarantine has been imposed in their children’s group, the test should not be conducted. There are strict contraindications to each of these.

It is recommended that the Mantoux test be conducted at least one month following any regular calendar vaccination. Additionally, the illness should have passed more than 30 days ago. The diagnostic test’s results are less likely to be inaccurate or false if you prepare for it properly.

Can you swim

It’s common knowledge that a child should not take a bath for three to four days following the Mantoux test. This is untrue, according to Evgeny Komarovsky, and washing is not at all advised—you can moisten the injection site for TB. However, there are still a lot of limitations and forbidden things with relation to that specific "button":

• The site of tuberculin injection must not be intensively scratched or rubbed (including with a washcloth).
• It is strictly forbidden to lubricate the injection site with antiseptics, iodine, or ointments.
• A plaster, bandage, compresses, or lotions must not be applied to the Mantoux test.
• You cannot put long-sleeved clothing on your child that is not appropriate for the weather, since sweating and friction of the fabric against the test site can cause a pronounced positive erroneous reaction.

Dr. Komarovsky provides insightful explanations of the Mantoux test, highlighting its utility in identifying childhood tuberculosis exposure. Although the test is a widely used diagnostic tool, he clarifies that the results must be carefully interpreted in light of the child’s medical history and general state of health. Komarovsky emphasizes that parents can make educated decisions about their child’s health and follow-up care by having a clear understanding of the test’s operation and the significance of the results.

Test results

The body’s response to tuberculin should be assessed by a licensed healthcare professional. On the other hand, mothers are typically keen to learn the nuances of diagnosis on their own. According to Evgeny Komarovsky, their desire is perfectly reasonable. He clarifies what the Mantoux reaction can indicate, particularly for fathers and mothers.

Registration takes place seventy-two hours following the exam. Thus, Friday is the most convenient day for diagnostics; most Russian clinics select this day so that the physician can assess the outcome precisely 72 hours later (on Monday). During this period, the injection site for tuberculin changes. Hyperemia, or redness, can occasionally be seen. At the injection site, there is frequently some swelling, enlargement, and compaction; this is referred to as a papule. The health professional uses a transparent ruler to measure the enlarged papule rather than its redness.

The response could go like this:

• Negative. If there is no redness, enlargement in the injection area.
• Doubtful, controversial. If there is redness (hyperemia) or a papule no larger than 2-4 mm. In this situation, the doctor, assessing the general condition of the child and looking at his medical card, can both equate the result with the negative and prescribe additional diagnostic studies.
• Positive. A weak result is determined if the size of the papule is from 5 to 9 mm. A moderate result – the papule has a size from 10 to 14 mm. A pronounced result – the papule is more than 15-16 mm in diameter.
• Excessive. The size of the papule with this result is always more than 17 mm. In addition, a general reaction of the body is observed – an increase in lymph nodes, the appearance of ulcers on the skin, signs of an inflammatory process in the papule itself. Such a result in a high degree of probability may indicate developing tuberculosis.

Alarming results

When a test that was previously always negative becomes positive (and there was no BCG vaccination), parents may occasionally find themselves in this scenario. This phenomenon is known as "a turn in the tuberculin test" in medicine. If it does, it could indicate that the child has contracted a bacillus that causes tuberculosis. The child will be given a prescription for a doctor’s consultation, an X-ray, and further testing before receiving a prescription for medication.

A potentially fatal illness can also be suspected if, following a positive test result (following the BCG vaccination), the Mantoux test results yearly declined gradually before abruptly increasing (from 5 mm to 9 mm). Such alterations in the papule’s size also warrant further testing and, if required, medical intervention.

A 4-5 year period during which the Mantoux test is prominent (measured transversely by more than 12 mm), may also signal the onset of pulmonary tuberculosis.

If parents refuse the test

Regarding the harm caused by the Mantoux test, a lot of unprofessional and untrustworthy information has surfaced recently. For instance, terrifying tales regarding the phenol content of this diagnostic test and its potential toxicity are "walking" across social media platforms. As a result, the percentage of parents who object to their kids being tested has gone up multiple times. According to Evgeny Komarovsky, there is no risk to the child involved in the introduction of tuberculin.

The intradermal medication does, in fact, contain phenol as a preservative, albeit in very small amounts (roughly the same amount is contained in 5–6 ml of urine). By the way, phenol is a naturally occurring substance in the human body and is eliminated in the urine as a byproduct of the breakdown of specific compounds. A child would require approximately a thousand doses of tuberculin per day to be exposed to its toxic effects!

The viewpoint offered by Dr. Komarovsky regarding the Mantoux test offers significant understanding of its function in observing and defending the health of children. His method places a strong emphasis on viewing the test as a tool rather than a final solution. It is imperative that parents approach the Mantoux test understanding its limitations and intended use.

Dr. Komarovsky states that the main purpose of the Mantoux test is to identify possible tuberculosis exposure. Though helpful as a diagnostic tool, it should always be weighed in conjunction with other medical assessments. Whether the result is positive or negative, parents shouldn’t freak out; instead, they should use it as a springboard for additional research, if necessary.

In the end, Dr. Komarovsky suggests that managing any concerns can be facilitated by keeping lines of communication open with medical professionals and being aware of the larger context of the Mantoux test. Families can guarantee their children receive the best care and attention by being involved and informed.

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