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The Mantoux test involves injecting a small amount of purified protein derivative under the skin to detect exposure to tuberculosis. The size of induration (hardened area) is measured after 48-72 hours, with no measurement of redness. A positive result indicates exposure to TB depending on the person's risk factors, with higher risk groups having a lower threshold for a positive result. False positives can occur due to BCG vaccination or other medical conditions, while false negatives are possible if the immune system is compromised.
The Mantoux test involves injecting a small amount of purified protein derivative under the skin to detect exposure to tuberculosis. The size of induration (hardened area) is measured after 48-72 hours, with no measurement of redness. A positive result indicates exposure to TB depending on the person's risk factors, with higher risk groups having a lower threshold for a positive result. False positives can occur due to BCG vaccination or other medical conditions, while false negatives are possible if the immune system is compromised.
The Mantoux test involves injecting a small amount of purified protein derivative under the skin to detect exposure to tuberculosis. The size of induration (hardened area) is measured after 48-72 hours, with no measurement of redness. A positive result indicates exposure to TB depending on the person's risk factors, with higher risk groups having a lower threshold for a positive result. False positives can occur due to BCG vaccination or other medical conditions, while false negatives are possible if the immune system is compromised.
The Mantoux skin test consists of an intradermal injection of one-tenth of a milliliter (ml) of PPD tuerculin! The si"e of induration is measured #$%&' hours later! (rythema (redness) should not e measured! Mantoux test injection site in a suject )ithout chronic conditions or in a hi*h-risk *roup clinically dia*nosed as ne*ati+e at ,- hours The Mantoux test or Mendel-Mantoux test (also kno)n as the Mantoux screening test, tuberculin sensitivity test, Pirquet test, or PPD test for purified protein deri+ati+e) is a screenin* tool for tuerculosis (T.)! /t is one of the major tuerculin skin tests used around the )orld, lar*ely replacin* multiple-puncture tests such as the Tine test! The 0eaf test )as used until '--, in the 12, )hen it )as replaced y the Mantoux test! /t is endorsed y the 3merican Thoracic 4ociety and 5enters for Disease 5ontrol and Pre+ention! /t )as also used in the 1446 and is no) pre+alent in most of the former 4o+iet states! Contents 7 0istory ' Procedure 8 5lassification of tuerculin reaction # False positi+e result , False ne*ati+e result 9 .5: +accine and the Mantoux test & 3ner*y testin* $ T)o-step testin* ; 6ecent de+elopments 7- 0eaf test 77 4ee also 7' 6eferences History Tuerculin is a *lycerol extract of the tuercle acillus! Purified protein deri+ati+e (PPD) tuerculin is a precipitate of species-nonspecific molecules otained from filtrates of sterili"ed, concentrated cultures! The tuerculin reaction )as first descried y 6oert 2och in 7$;-! The test )as first de+eloped and descried y the :erman physician Felix Mendel in 7;-$ <7= /t is named after 5harles Mantoux, a French physician )ho uilt on the )ork of 2och and 5lemens +on Pir>uet to create his test in 7;-&! /n 7;8;, M! 3! ?inniko+a in the 1446 created a modified +ersion of PPD! /n 7;,#, the 4o+iet 1nion started mass production of PPD-?, named after ?inniko+a! <citation needed= Procedure 3 standard dose is , tuerculin units (T1 - -!7 ml) <'= (The standard Mantoux test in the 12 consists of an intradermal injection of ' T1 of 4tatens 4erum /nstitute (44/) tuerculin 6T'8 in -!7 ml solution for injection!) <8= is injected intradermally (et)een the layers of dermis) and read #$ to &' hours later! This intradermal injection is termed the Mantoux technique! 3 person )ho has een exposed to the acteria is expected to mount an immune response in the skin containin* the acterial proteins! The reaction is read y measurin* the diameter of induration (palpale raised, hardened area) across the forearm (perpendicular to the lon* axis) in millimeters! /f there is no induration, the result should e recorded as @- mm@! (rythema (redness) should not e measured! <citation needed= /f a person has had a history of a positi+e tuerculin skin test, or had a recent tuerculin skin test ()ithin one year), another skin test should e used! <citation needed= Classification of tuberculin reaction The results of this test must e interpreted carefully! The personAs medical risk factors determine at )hich increment (, mm, 7- mm, or 7, mm) of induration the result is considered positi+e! <#= 3 positi+e result indicates T. exposure! , mm or more is positi+e in o 3n 0/B-positi+e person o Persons )ith recent contacts )ith a T. patient o Persons )ith nodular or firotic chan*es on chest C-ray consistent )ith old healed T. o Patients )ith or*an transplants, and other immunosuppressed patients 7- mm or more is positi+e in o 6ecent arri+als (less than fi+e years) from hi*h-pre+alence countries o /njection dru* users o 6esidents and employees of hi*h-risk con*re*ate settin*s (e!*!, prisons, nursin* homes, hospitals, homeless shelters, etc!) o Mycoacteriolo*y la personnel o Persons )ith clinical conditions that place them at hi*h risk (e!*!, diaetes, prolon*ed corticosteroid therapy, leukemia, end-sta*e renal disease, chronic malasorption syndromes, lo) ody )ei*ht, etc!) o 5hildren less than four years of a*e, or children and adolescents exposed to adults in hi*h-risk cate*ories 7, mm or more is positi+e in o Persons )ith no kno)n risk factors for T. <,= (DoteE Tar*eted skin testin* pro*rams should only e conducted amon* hi*h-risk *roups) 3 tuerculin test con+ersion is defined as an increase of 7- mm or more )ithin a t)o-day period, re*ardless of a*e! 3lternate criteria include increases of 9, 7', 7, or 7$ mm! <9= False positive result T4T (Tuerculin skin test) positi+e is measured y si"e of induration! The measurement of the induration is determined to e positi+e dependin* on risk factors! For example, a lo)-risk patient must ha+e a lar*er induration for a positi+e than a hi*h-risk patient! 0i*h-risk *roups include recent contact, 0/B, chest radio*raph )ith firotic chan*es, or*an transplant recipient, and immunosuppression! 3ccordin* to the Fhio Department of 0ealth and 14 Department of 0ealth, the .acillus 5almette%:uGrin (.5:) +accine does not protect a*ainst T. infection! /t does, thou*h, *i+e $-H of children protection a*ainst tuerculous menin*itis and miliary tuerculosis! Therefore, a positi+e T4TIPPD in a person )ho recei+ed .5: +accine is interpreted as latent T. infection (?T./)! <&= Due to the testAs lo) specificity, most positi+e reactions in lo)-risk indi+iduals are false positi+es! <$= 3 false positi+e result may e caused y nontuerculous mycoacteria or pre+ious administration of .5: +accine! Prior +accination )ith .5: may result in a false-positi+e result for many years after)ards! <;= False positi+es can also occur )hen the injected area is touched, causin* s)ellin* and itchin*! 3nother source of false positi+e results can e from aller*ic reaction or hypersensiti+ity! 3lthou*h rare, aout -!-$ reported reactions per million doses of tuerculin, these reactions can e dan*erous and precautions should e taken y ha+in* epinephrin a+ailale! <7-= False negative result The result of PPD or tuerculin test is suppressed y the follo)in* conditionsE /nfectious mononucleosis ?i+e +irus +accine - The test should not e carried out )ithin 8 )eeks of li+e +irus +accination and should e rearran*ed! 4arcoidosis 0od*kinAs disease 5orticosteroid therapyI4teroid use Malnutrition /mmunolo*ically compromised - Those on immuno-suppressi+e treatment or those )ith 0/B and lo) 5D# T cell counts, fre>uently sho) ne*ati+e results from the PPD test! <citation needed= This is ecause the immune system needs to e functional to mount a response to the protein deri+ati+e injected under the skin! 3 false ne*ati+e result may occur in a person )ho has een recently infected )ith T., ut )hose immune system hasnAt yet reacted to the acteria! 1pper respiratory +irus infection /n case a second tuerculin test is necessary it should e carried out in the other arm to a+oid hypersensitisin* the skin! BCG vaccine and the Mantoux test The role of Mantoux testin* in people )ho ha+e een +accinated is disputed! The 14 recommends tuerculin skin testin* is not contraindicated for .5:-+accinated persons, and prior .5: +accination should not influence the interpretation of the test! The 12 recommends interferon-J testin* should e used to help interpret positi+e Mantoux tests, and serial tuerculin skin testin* must not e done in people )ho ha+e had prior .5: +accinations! /n *eneral, the 14 recommendation results in a much lar*er numer of people ein* falsely dia*nosed )ith latent tuerculosis, )hile the 12 approach proaly misses patients )ith latent tuerculosis )ho should e treated! <citation needed= 3ccordin* to the 14 *uidelines, latent tuerculosis infection dia*nosis and treatment is considered for any .5:-+accinated person )hose skin test is 7- mm or *reater, if any of these circumstances are presentE Was in contact )ith another person )ith infectious T. Was orn or has li+ed in a hi*h T. pre+alence country /s continually exposed to populations )here T. pre+alence is hi*h nergy testing /n cases of aner*y, a lack of reaction y the odyAs defence mechanisms )hen it comes into contact )ith forei*n sustances, the tuerculin reaction )ill occur )eakly, thus compromisin* the +alue of Mantoux testin*! For example, aner*y is present in 3/D4, a disease )hich stron*ly depresses the immune system! Therefore, aner*y testin* is ad+ised in cases )here suspicion is )arranted that it is present! 0o)e+er, routine aner*y skin testin* is not recommended! <77= !"o-step testing 4ome people )ho )ere pre+iously infected )ith T. may ha+e a ne*ati+e reaction )hen tested years after infection, as the immune system response may *radually )ane! This initial skin test, thou*h ne*ati+e, may stimulate (oost) the odyAs aility to react to tuerculin in future tests! Thus, a positi+e reaction to a suse>uent test may e misinterpreted as a ne) infection, )hen in fact it is the result of the oosted reaction to an old infection! 1se of t)o-step testin* is recommended for initial skin testin* of adults )ho )ill e retested periodically (e!*!, health care )orkers)! This ensures any future positi+e tests can e interpreted as ein* caused y a ne) infection, rather than simply a reaction to an old infection! The first test is read #$%&' hours after injection! o /f the first test is positi+e, consider the person infected! o /f the first test is ne*ati+e, *i+e a second test one to three )eeks after the first injection! The second test is read #$%&' hours after injection! o /f the second test is positi+e, consider the person pre+iously infected! o /f the second test is ne*ati+e, consider the person uninfected! <7'= 3 person )ho is dia*nosed as @infected@ on t)o-step testin* is called a @tuerculin reactor@! The 14 recommendation that prior .5: +accination e i*nored results in almost uni+ersal false dia*nosis of tuerculosis infection in people )ho ha+e had .5: (mostly forei*n nationals)! #ecent develop$ents 3s a replacement for the Mantoux test, se+eral other tests are ein* de+eloped! The KuantiF(6FD-T. :old lood test measures the patientLs immune reacti+ity to the T. acterium, and is useful for initial and serial testin* of persons )ith an increased risk of latent or acti+e tuerculosis infection! :uidelines for its use )ere released y the 5D5 in Decemer '--,! <78= KuantiF(6FD-T. :old is FD3-appro+ed in the 1nited 4tates, has 5( Mark appro+al in (urope and has een appro+ed y the M0?W in Mapan! Heaf test Main articleE 0eaf test The 0eaf tuerculin skin test )as used in the 1nited 2in*dom, ut discontinued in '--,! The e>ui+alent Mantoux test positi+e le+els done )ith 7- T1 (-!7 ml at 7-- T1Iml, 7E7---) are N, mm induration (0eaf --7) ,%7, mm induration (0eaf ') O7, mm induration (0eaf 8-#) %ee also Tuerculosis ?atent tuerculosis KuantiF(6FD Tine test #eferences Wikimedia 5ommons has media related to Mantoux test! 7! F! Mendel! Therapeutische Monatshefte, .erlin, 7;-8, 79E 7&&! Die +on Pir>uetAsche 0autreaktion und die intra+enPse Tuerkulinehandlun*!Medi"inische 2linik, MQnchen, 7;-$, #E #-'-#-#! '! DT.( - Mantoux T. 4kin Test Faciliator :uide - Part 7E 3dministerin* 8! @/mmunisation@, 12 *o+ernment, Department of 0ealth #! From the 5D5 team of the 5D5 team at the 4askatche)an ?un* 3ssociation, photos of a PPD ump! ,! Mantoux Test in eac!int! 9! Men"ies, Dick (7 Manuary 7;;;)! @/nterpretation of 6epeated Tuerculin Tests@! American Journal of Respiratory and Critical Care Medicine &'( (7)E 7,%'7! doiE7-!779#Iajrccm!7,;!7!;$-77'-! PM/D ;$&'$7'! &! /nformation also from FD0 lecture at the Fhio 4tate 1ni+ersity ,I'#I'-7'! $! 4tarke M6 (Mul 7;;9)! @Tuerculosis 4kin Testin*E De) 4chools of Thou*ht@! Journal of the American Academy of Pediatrics () (7)E 7'8%7',! /44D --87-#--,! PM/D $99$8$8! ;! 5hatur+edi D, 5ockcroft 3 (7;;')! @Tuerculosis screenin* amon* health ser+ice employeesE )ho needs chest C-raysR@! J Soc Occup Med *+ (#)E 7&;%$'! doiE7-!7-;8IoccmedI#'!#!7&;! 7-! Mames (! Froeschle, Frederick ?! 6uen, and 3! Michael .loh ('--')! @/mmediate 0ypersensiti+ity 6eactions after 1se of Tuerculin 4kin Testin*@! Clinical Infectious Diseases ,* (7)E e7'%e78! doiE7-!7-$9I8'#,$&! 77! Tuerculin and 3ner*y Testin* in 0/B-4eropositi+e and 0/B-4erone*ati+e Persons - Marko)it" et al! 77; (8)E 7$, - 3nnals of /nternal Medicine 7'! Fffice of 0ealth and 0uman 4er+ices! @.ooster Phenomenon@! 6etrie+ed '--$--&--'! 78! :uidelines for 1sin* the KuantiF(6FD-T. :old Test for Detectin* Mycobacterium tuberculosis /nfection, 1nited 4tates -sho". v t e /$$une disorders0 hypersensitivity and autoi$$une diseases 1+2(3'456 -sho". v t e !uberculosis 5ate*oriesE /mmunolo*ic tests Tuerculosis Dermatolo*ic procedures 7avigation $enu 5reate account ?o* in 3rticle Talk 6ead (dit Bie) history Main pa*e 5ontents Featured content 5urrent e+ents 6andom article Donate to Wikipedia Wikimedia 4hop /nteraction 0elp 3out Wikipedia 5ommunity portal 6ecent chan*es 5ontact pa*e !ools What links here 6elated chan*es 1pload file 4pecial pa*es Permanent link Pa*e information Wikidata item 5ite this pa*e Print8export 5reate a ook Do)nload as PDF Printale +ersion 9anguages STUVWXYZV[ STUVWXYZV[ (\VWV]ZT^_`V) SaUbVWYZc 5atald Deutsch (spaeol Franfais :aeil*e .ahasa /ndonesia /taliano ghijk
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