Manta reaction in children

Mantoux test has nothing to do with vaccination. This is a kind of skin allergy test that has specific patterns depending on whether the organism is infected with mycobacteria tuberculosis or not.

During the test, Mantoux is administered tuberculin. Tuberculin prepared and applied Robert Koch back in 1890. Koch, however, thought that with this tuberculin he could cure tuberculosis, but it did not work out …

Tuberculin – is a mixture of organic substances of varying degrees of complexity, obtained from mycobacteria.

There are two drugs tuberculin.

1. Old Koch tuberculin (alt tuberculin, ATK) – extract of mycobacteria that are rendered harmless by heating. The main drawback of the old tuberculin is a large amount of impurities, so it is not always possible to understand what, in fact, the body reacts to: mycobacterial antigens or to the remnants of the nutrient medium in which mycobacteria were grown.

2. Purified Standard Tuberculin (Purified Prolein Derivative, PPD) is a preparation purified from protein contaminants of the nutrient medium.

Currently, in most countries and in most medical institutions, only purified tuberculin is used.

For mass tuberculin diagnostics, a standard dilution of the preparation is used: 0.1 ml of solution contains 2 TE (tuberculin units). 2 TE – this is the usual dose that is injected intracutaneously, and this introduction is called Mantoux breakdown[one].

Intracutaneous administration of tuberculin leads to a local allergic reaction. The severity of the reaction depends on whether the body has “experience” with a tubercle bacillus or not. If contact with mycobacterium took place, the formation of specific lymphocytes will be the result of this contact, and it is these lymphocytes that will cause a local allergic reaction after intradermal administration of tuberculin.

  • mass – conducted for all children in countries with a high incidence of tuberculosis;
  • individual – is carried out to individual patients when indications arise.

The main tasks of tuberculin diagnosis:

  • timely detection of tuberculosis in children and adolescents;
  • identification of children to be vaccinated and revaccination.

Mass testing of Mantoux children vaccinated with BCG vaccine is carried out annually, starting at the age of 12 months. Children who are not vaccinated with BCG, Mantoux test is carried out twice a year. Also twice a year, it is recommended to test Mantoux for children who have not had a local reaction after BCG vaccination.

Mantoux test is carried out before prophylactic vaccinations.

If any vaccination is carried out, the Mantoux test is carried out no earlier than 1 month after it.

If blood preparations were used (immunoglobulins, etc.), then the Mantoux test is carried out no earlier than 2 weeks later.

It is recommended that the sample be carried out at the same time of the year (optimally in the fall).

It is recommended to inject tuberculin alternately in the right and left hand (in even years, the right hand, in odd years – the left hand).

Mantoux test is carried out in the middle third of the inner surface of the forearm.


After intradermal administration of tuberculin, this place can’t:

  • to rub;
  • to scratch;
  • process disinfectant solutions;
  • stick with adhesive plaster;
  • bandage

Bathe (drench, dive, wash) after the Mantoux test can.

Reaction accounting carried out in 72 hours. Reaction to tuberculin is possible in two versions:

  • skin redness – hyperemia;
  • education papules. The papule is a rounded area of ​​increased density (infiltrate) rising above the skin.

The Mantoux test is a measurement of papule size and an assessment of the severity of hyperemia.

The measurement is carried out in the direction transverse to the axis of the arm, under good lighting conditions, with a transparent ruler. The result is indicated in mm.

Please note: it is not the size of the redness that is measured, but the size of the seal!

If there are no papules, indicate the size of the hyperemia.

Reaction options:

  • negative – there are no changes on the skin;
  • doubtful – there is a reddening of any size without a papule or the size of a papule does not exceed 2-4 mm;
  • positive mild – papule diameter 5-9 mm;
  • positive medium intensity – papule diameter 10-14 mm;
  • positive pronounced – papule diameter 15-16 mm;
  • excessive (hyperergic) – papule diameter exceeds 17 mm or there are pronounced signs of inflammation (lymph node reaction, skin ulceration, etc.).

Virage tuberculin test – is the transition of a negative Mantoux reaction to a positive (not associated with previous vaccination) or an increase in the diameter of the papule compared with the result of the previous sample by 6 mm or more.

Contraindications for tuberculin diagnosis:

  • skin diseases;
  • acute infectious diseases;
  • chronic diseases in the period of exacerbation;
  • allergic conditions, rheumatism, bronchial asthma;
  • quarantine in the children’s team.

The basic principles of the interpretation of the results of the Mantoux test:

  • a negative Mantoux test indicates that there are no lymphocytes in the body that have experience in communicating with a tuberculosis bacterium: no infection, no reaction to BCG vaccination;
  • doubtful sample is equivalent to negative;
  • a positive test can be a consequence of BCG vaccination, and a sign of infection;
  • The signs of infection based on the results of tuberculin diagnosis include:

– bend tuberculin test;

– persistently (over 4 years) persisting reaction with papule 12 mm or more;

– gradual, for several years, increased sensitivity to tuberculin with the formation of infiltrate with dimensions of 12 mm or more.

Mantoux test results can be affected by:

  • the mode of transportation and storage of tuberculin;
  • technical errors in the formulation of the sample;
  • technical errors of reaction counting;
  • the presence of chronic diseases;
  • tendency to allergic reactions;
  • individual skin sensitivity;
  • skin contact with other allergens (clothing, detergents, etc.);
  • ambient temperature and humidity;
  • phase of the menstrual cycle;
  • radiation background and other environmental factors;
  • medication, etc.


The Mantoux test is an indicative diagnostic test.

Mantoux test without taking into account many other factors is not a reason for the diagnosis of tuberculosis and any treatment.

A Mantoux test is additional information for the doctor to consider.

Tuberculin preparations:

Allergen tuberculosis purified liquid in standard dilution (purified tuberculin in standard dilution) – (CJSC Biolek, Ukraine, CJSC Immunoteks, Russia).

Purified Lyophilized Tuberculin (Sanofi Pasteur, France).

[1] Charles Mantu is a French scientist who proposed intradermal administration of tuberculin for diagnostic purposes in 1908.

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