Mantu sample (sample pirk, tuberculin test, tuberculinidiagnostics) - method of studying the intensity of immunity to the pathogen of tuberculosis by assessing the reaction to the special preparation of mycobacteria, tuberculin. What you need to know about the sample manta?
Content
History of tuberculinidiagnostics
Tuberculin
Its classically invented in 1890 famous German physicians
Robert Koh, whose name is called and the pathogen of tuberculosis –
Koha stick.
Authorship method
tuberculinidiagnostics, that is, the use of Tuborkulin Koch with a view to
diagnostics belongs to the pitch, which in 1907 first suggested
Apply tuberculin to diagnose tuberculosis. On damaged
Special Borik skin applied tuberculin. Later this method was
Modified and skin damage (scarification) began to produce
Special Lancetom. Approximately in this form of the trial of the pitch reached and
until today.
Somewhat later French
Mantoux Doctor (Mantoux) offered another sample modification – intradermal
Introduction Tuberculina. Sample in manta modifications is applied since 1965.
What is Tuberculin?
Meaning
Tuberculina – «denote» In the body the presence of tuberculosis
Sticks so that the body's response can be estimated
(qualitatively and quantitatively) «presence». In this sense
Tuberculin copes perfectly with his task – It is throughout this
The reason the drug was never subjected to indigenous recycling and now
more than 100 years, to the present day is one of the fixed assets
Tuberculosis diagnostics.
And again a little history.
Tuberculin (accurate name «Alttoberkulin», AT) Koch – This «Hood»,
Lisate from mycobacterium tuberculosis inactivated by heating.
The classic drug, in addition to the Tuberculina itself, contained a lot
impurities – The remains of the nutrient medium on which bacteria grown,
salts and other substances that influenced the purity of the reaction and impede
Evaluation of the results of samples.
Since the late 60s of the XX century were
Developed cleaner Tuberculin preparations, so-called PPD
PURIFIED PROTEIN DERIVATE – peeled protein derivative), which
Apply to this day. The drug PPD-L, T.E. purified
Tuberculin, obtained by Russian scientists Lynnikova in 1965.
The modern Tuberculin preparation, in addition to the Tuberculina itself, contains
Salts of phosphate buffer solutions, sodium chloride, stabilizer
Twin-80, and phenol as a preservative. Mostly the drug is delighted
from ballast impurities, but it may contain them in trace
quantities that can affect the result of the reaction.
but
still unknown with Tuberculina's interaction mechanism with
immune system. On the one hand, lysat proteins (peptides,
amino acids) can not be a full-fledged antigen. And really,
Tuberculin does not cause the formation of immunity. But this point of view is not
Explains strengthening, as at vaccination, reaction with frequent formulation
Sample – T.N. «Booster effect» Mantu samples. So what is
tuberculin? Most likely, tuberculin can be described as
Heterogeneous mixture of organic substances of different degrees of complexity,
obtained from mycobacterial.
What is the reaction of manta?
Reaction
Mantu – This is the body's reaction to the introduction of tuberculin. At the place of administration
The drug in the skin arises specific inflammation caused by
T-lymphocyte infiltration – specific blood cells,
responsible for cellular immunity (in contrast to the antician
Immune response, in which proteins antibodies play the main role).
Fragments of mycobacteria as if attracting lymphocytes from
Blood vessels running nearby. But the game takes not
all T-lymphocytes, but only those that are already fully or partially «familiar»
with koche stick.
If the body has already had a chance
«will meet» with real mycobacterium tuberculosis, then such
lymphocytes will be more inflammation intense, and the reaction will be
«Positive» (There is infection with koche stick). Naturally,
A positive reaction means that inflammation exceeds,
caused by the hoist and some diagnostic threshold. Measuring ruler
Papula diameter (inflammatory «Blyakh» or «Buttons») You can evaluate
Immunity tension to tuberculosis stick.
Strictly
Speaking, the reaction of the body on Tuberculin is one of
allergy varieties (for Tuberculin itself is not
a full-fledged antigen, but rather an allergen). That is why existing
Allergic diseases can affect the result of the sample Mantu.
Higher
A somewhat simplified biological mechanism of the Mantu reaction is presented.
It should be remembered that the result of the reaction can affect, in addition to
existing allergic diseases, recently transferred infections,
Chronic Pato
Logy, Immunity to Nonuberculosis Mycobacteriums,
age. Other concomitant factors play not the last role:
-
phase of the menstrual cycle in girls;
-
Individual characteristics of skin sensitivity;
-
Balance of child nutrition and pr.
Pronounced
Impact on the results of mass tuberculinidiagnostics have
Adverse Environmental Factors: Elevated Radiation Background,
The presence of harmful emissions of chemical industries and T.D.
On results
tuberculinidiagnostics can also influence various violations in
methodology of it: transportation and storage of tuberculin, with
the use of non-standard and poor-quality tools,
Errors in the technique of setting and reading the reactions of Mantu.
WITH
Accounting of the above factors, in an isolated form by itself
Manta's positive reaction is not 100% proof
infection with tuberculosis. To confirm the diagnosis required
hold a number of other studies – Exception of communication with the Vaccination BCG,
Chest fluorography, microbiological sowing sputum and row
Others. In turn, the negative result does not give 100% warranty
Absence in the body of koche sticks.
Why do you need a test manta?
Rather
So, do you need a manta test at all? At this expense WHO is responsible
Affirmative – Yes, for countries with high relevance of tuberculosis
(these are Ukraine and most of the CIS countries in this
moment) this test is one of the effective measures to control infection.
Even in those countries where the relevance of tuberculosis is small, for example in
USA and France, Mantu sample applies quite actively – To identify
infected with tuberculosis in high-risk groups.
Reaction (sample) Mantu is needed for:
-
identifying primary-infected, that is, those who first identified the fact of infection with a tuberculosis stick;
-
identifying more than one year infected with hypeergic reactions to tuberculin;
-
more than one year infected with an increase in infiltrate by 6 mm and more;
-
Diagnostics
tuberculosis in individuals who are infected with Koha's wand, but do not show,
at the moment, symptoms of the disease; Confirmation of diagnosis
tuberculosis;
-
Selection of contingents of children to be revaccinated against tuberculosis.
Selection
Children and adolescents for revaccination is carried out according to the results of the sample
Mantu in 6–7 and 14–15 years. In areas where epidemiological situation
on tuberculosis is unfavorable, revaccination is carried out in 6–7,
eleven–12 and 16–17 years. BCG revaccination is subject to healthy faces only with
Negative reaction to tuberculin.
Contraindications for the formulation of the sample Mantu
Follow
emphasize that the test manta is harmless to healthy
children and adolescents and for children with various somatic
Diseases. Tuberculin does not contain alive microorganisms, and in
Applied dosage 2 te (0.1 ml) does not affect the immune system
organism, nor on the whole body as a whole.
Staging
Samples does not make sense in children under 12 months, for the result of the sample
will be unreliable or inaccurate, in connection with age characteristics
development of the immune system – The reaction may be false negative. Children
under 6 months are unable to adequately respond to the manta sample.
Contraindications to carrying out tuberculin samples are:
-
skin diseases;
-
sharp
and chronic infectious and somatic diseases in the stage
exacerbations (test manta is placed 1 month after the disappearance of all
clinical symptoms or immediately after filing quarantine);
-
allergic conditions;
-
epilepsy.
Not
Samples are allowed in those teams where there is a quarantine
Children's infections. Manta test is made 1 month after
disappearances of all clinical symptoms or immediately after removal
quarantine.
Mantu and Vaccination Reaction
In view of
the fact that immunity generated by vaccinations can affect
on the result of the sample Mantu, its setting should not be carried out in one
day with whatever vaccinations. Otherwise
The risk of false positive reactions increases.
At the same time, immediately after evaluating the results of the sample, on the same day or later, vaccinations can be carried out without restrictions.
If
Vaccinations are held before sampling, then for exception
Interval inflation between the introduction of inactivated (killed)
vaccines such as against influenza, diphtheria and tetanus and t.NS., and
Mantu reaction formulation should be at least 4 weeks. This is B
Equally applies to the introduction of serums and immunoglobulins. When
carrying vaccinations with alive vaccines (measles, vapotitis, rubella, OPV and
T.NS.) This interval is desirable to increase to 6 weeks.
How is the test manta?
Special
tuberculin syringe intraderially (medium third of the inner
The surface of the forearm) is introduced tuberculin in the recalculation of 2 tuberculosis
Units (those). The volume of the administered dose is 0.1 ml. Needle introduced
cut up to the depth sufficient in order to graduate
The hole completely plunged into the skin.
In order to make sure
that the needle did not penetrate the skin and provide intradermal
Introduction, the needle is slightly lifted by pulling the skin. After
The administration of tuberculin is formed by a specific blowout of the upper layer
skin better known as «Butt».
How to care for «Butt»?
Most
simple answer – no way. In any case, until the results are evaluating.
Do not smear the place of samples of the sample with green, peroxide. Not necessary
Skip the wreky flacoplasty – Under it, the skin can sweat. Not
allow the child to comb «Butt». remember, that
Incorrect departure of the administration of tuberculin may affect
the result of the sample, and this is not necessary to the patient nor a doctor.
After
Estimates of the results, if the guns or an ulcer was formed, it can be
process as any other wound, using all traditional
Tools.
How the results are estimated?
«No matter
As voted, it is important how calculated» – Authorship of this commodity
Positions about the elections are attributed to Stalin. Can not disagree with
Chief – The most important thing in the manta sample is not a formulation, but its assessment
results, and even more important – Conclusions from the results of the sample assessment.
After
administration of tuberculin, 2–3 day a specific seal is formed
Skin – T.N. «papule» (Infiltrate, seal). 
It looks like
Rounded skin Round skin. At easy pressing on
it is a transparent ruler (or if you press and let go of your finger)
Must beat slightly. Unlike simple redness, feel
(although it is not always possible to catch your fingers) Papula is different from
surrounding the skin with its consistency – It is more dense.
WITH
the point of view of the anatomy, this papule is the result of his
kind of skin saturation by cells, namely lymphocytes,
sensitized (that is, sensitive) to koche.
Naturally, the larger in the body «knowledgeable» About mycobacteria
lymphocytes, the more infiltrate (papula).
The size
Papulas are measured with sufficient lighting transparent (so that
The maximum infiltration diameter is visible) for 3 days (after 48–72
hours) after the introduction of Tuberculina. The ruler should be located
transversely to the longitudinal axis of the forearm. It is not allowed to apply for
Measurement Thermometer and others «Screw materials» like a millimeter
Paper and homemade limies from x-ray film. Measured only
Seal size. Redness around the seal is not a sign
Immunity to tuberculosis or infection, but it
registered when there is no papule.
Exist
some «versions» Setting and evaluating the results of the test Mantu. Strictly
Talking, tuberculin can be administered in several ways – OK
(reaction pirch), intradermal (ordinary manta) and with plastic
applicators, at the pointed ends of which tuberculin is applied (in
Supplement can be applied by other substances for simultaneous
sets of other samples).
We will focus on two
approaches to the evaluation of the results – Russian and American. Follow
Immediately emphasize that in addition to the methods of assessment differ and methods
Settings. So in domestic practice, the manta sample is put with 2 Those
while in the US put a sample with 5. American assessment method
Different with taking into account the degree of risk of infection with tuberculosis of this
Patient, depending on this is interpreted and the size of infiltrate.
