Diagnostics
Fluorography is used to detect pathology in adults. It is not done for children, so all that remains is to use Diaskintest. Compared to the Mantoux reaction, it gives a positive result only in the presence of active tuberculosis pathogens.
Interpretation of the results is carried out only after three days, although the body’s reaction will be noticeable almost immediately. The picture will change over the course of several days.
Prevention of this disease is carried out in all children's educational institutions (kindergartens and schools).
What is the Mantoux test?
The Mantoux test (tuberculin test) is a subcutaneous injection of tuberculin and a further assessment of the immune response to it. If the reaction to the administered drug is pronounced, this means that the immune system is already familiar with the causative agent of tuberculosis and reacts to it. Tuberculin is an extract of mycobacteria, which are the causative agents of tuberculosis.
The test result is usually assessed on the third day. It is not redness that is being studied, but a compaction, a papule (the so-called button). Depending on its size, the sample result can be positive, negative, false positive or doubtful. The pediatrician evaluates the results and records them in the outpatient and vaccination records. In some cases, it is possible to refer the child to an appointment with a TB specialist to confirm or refute tuberculosis.
Responsibilities of schools and kindergartens
The school’s responsibilities include organizing preventive measures to prevent the incidence of tuberculosis in the school. In particular, regular Mantoux tests (Diaksintest) are carried out at schools.
This test is performed on all children annually, starting at 12 months, and every year thereafter. The school administration and medical workers are obliged to organize such a test for all students at the specified frequency, on the basis of the Federal Law of March 30, 1999 No. 52-FZ (as amended on August 3, 2018) “On the sanitary and epidemiological welfare of the population.”
The responsibilities of school staff include preventing a child who has been diagnosed with an active form of tuberculosis from studying and joining the team, since this disease can actively spread bacteria and infect other children.
In addition, if a student with tuberculosis is identified, measures must be taken to immediately isolate him from other schoolchildren and disinfect the premises. Sometimes the school may even be closed for several days for this, but quarantine is usually not required.
How many hours later is the reaction to Diaskintest checked?
Diaskintest differs in its composition and effectiveness from the Mantoux test, which is more familiar to the population. But the execution technology is similar. The drug is also administered intradermally into the right or left forearm. Diaskintest testing is carried out in a medical institution on the third day after the procedure, that is, after 72 hours. The time for symptoms to appear with Diaskintest depends on the number of bacteria in the body and their activity. Normally, the reaction should improve day by day after the test.
Why Diaskintest is checked after 72 hours
The sample is checked after 72 hours, since it is after this period of time that the first signs of the open form appear if the patient is sick with tuberculosis. Immediately after the injection and on the first day, redness, slight swelling, and bruising may occur at the injection site - this is considered a normal reaction.
If the procedure was carried out correctly, there were no contraindications at the time of the test, and the person is not allergic to the active substance of the drug, after some time the redness and swelling go away on their own. If the body’s response to the tuberculin test begins, it will develop progressively and reach its peak after 3 days. The final result will be visible in approximately 72 hours. By this point, it will be possible to accurately judge by the reaction whether the person being examined is infected with Koch’s bacillus or not. Then the symptoms will gradually begin to decrease, so the assessment of the results of the reaction on the 4th day and later cannot be considered reliable.
Sometimes, immediately after administration of the drug, the patient experiences severe hyperemia, a large papule swells, and after 72 hours everything goes away. This indicates that the immune system is not functioning properly. It is urgent to perform additional testing for HIV infection and conduct further thorough research to accurately establish the cause of this phenomenon.
Briefly about deciphering the test result
The reaction results are assessed similarly to the Mantoux test. First of all, the size of the papule is taken into account.
- If the spot is without infiltration, no larger than 0.2 cm in size, or there is only a small mark from the injection, the Diaskintest is negative. This means that there is nothing to worry about, there are no mycobacteria in the body, or there are negligible numbers of them and they are dormant.
- Redness up to 0.5 cm in diameter without pronounced induration indicates a questionable reaction to Diaskintest. Perhaps the technique for placing Diaskintest was broken or there were hidden contraindications - for example, the initial stage of a cold or viral infection, which the patient himself did not know about.
- A pronounced red papule with a diameter of more than 0.5 cm, infiltration, the presence of other symptoms (fever, weakness, rash, general deterioration of condition) – we are talking about a positive reaction. This means that a person is a carrier of a large number of MBT, and they are active.
A positive reaction is also divided into several categories depending on the size of the papule and other signs.
- weakly positive – papule no more than 0.5 cm;
- moderately positive – papule measuring from 0.5 to 0.9 cm;
- pronounced positive reaction - papule diameter from 1 to 1.5 cm;
- strongly expressed - papule more than 1.5 cm.
A strongly expressed reaction is also called hyperergic. It is often accompanied by inflammation and suppuration of the papules at the site of drug administration, a strong increase in body temperature, and enlarged and painful lymph nodes. In any case, further, more in-depth studies will be required to make a final diagnosis.
The absence of any reaction at all after testing indicates the presence of immunity to tuberculosis in the subject. This happens in cases where a person has already suffered a tuberculosis infection and was successfully cured, or tuberculosis has passed into a latent form (the development of tuberculoma).
Is it possible to reduce the result of Diaskintest?
If, after performing the test, severe redness and swelling occur, patients get scared and begin to look for a way to reduce Diaskintest. You should absolutely not do this. If you violated the regime after the procedure (took a hot shower or bath, injured the injection site), it is wiser to inform the doctor about this and, if necessary, do the Diaskintest again.
It is strictly forbidden to wipe the papule with alcohol solutions, smear it with ointments, glue it, bandage it, apply cold or heat. This may lead to increased reactions and false results. If the reaction is pronounced, then there is no point in turning away from it. You should consult a doctor as soon as possible and undergo a course of treatment.
Even if a child is allergic, you should not give him antihistamines before the test - after all, an allergen is introduced into the body, and with the help of antiallergic drugs you deliberately distort the reliability of the results. Carrying out Diaskintest does not require following a gentle diet, giving up sweets, etc., unlike the Mantoux test. All that is required is not to comb, warm or smear the papule with anything until the result is assessed. Your doctor will tell you what to do next to reduce hyperemia.
Parents' refusal to vaccinate their children
In paragraph 1 of Art. 5 Federal Law No. 157 “On Immunoprophylaxis of Infectious Diseases” states that parents have the right to obtain all the necessary information from medical workers and write a refusal to be vaccinated.
In paragraph 2 of Art. 5 of the Law “On Immunoprophylaxis” states that unvaccinated children are temporarily suspended from school or kindergarten visits. But this can only happen if there is an epidemiological outbreak of another infectious disease in the city.
There are many parents who have experienced first-hand a negative reaction of the child’s body to preventive vaccinations, and periodically information appears in the media about another victim who, after this “harmless” procedure, became disabled.
Refusal of Mantoux at school often threatens the student with restrictions on participation in various events (Olympiads, sports competitions, thematic rallies, etc.). It is a serious violation of human rights when there are no symptoms indicating a threat to others. A child of any age can be isolated from the team only if the diagnosis of tuberculosis is confirmed.
Question #34802 Refusal of vaccination (Diaskintest)
The Mantoux test (Diaskintest) is a diagnostic test for tuberculosis, and therefore is aimed at identifying the disease. In accordance with Art. 1 Federal Law “On preventing the spread of tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ: “anti-tuberculosis care is a set of social, medical, sanitary-hygienic and anti-epidemic measures aimed at identifying, examining and treating, including mandatory examination and treatment, dispensary observation and rehabilitation of patients with tuberculosis and carried out in a hospital and (or) on an outpatient basis in the manner established by this Federal Law, other federal laws and other regulatory legal acts of the Russian Federation, as well as laws and other regulatory legal acts of the constituent entities of the Russian Federation"; — from which it follows that tuberculin diagnostics (Mantoux test, Diaskin test) is included in the concept of anti-tuberculosis care. In accordance with Art. 7 Federal Law “On preventing the spread of tuberculosis in the Russian Federation” dated June 18, 2001 No. 77-FZ - anti-tuberculosis care is provided to minors with the consent of their legal representatives (parents). Thus, parents have the right, on the basis of the law, to refuse both the Mantoux test (Diaskintest) in relation to their child and X-rays.
The right to choose a safe method of diagnosing tuberculosis In the explanations of the Chief freelance pediatric specialist phthisiatrician of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor V.A. Aksenova (in response to a request dated March 18, 2015 “On the use of alternative diagnostic methods to obtain permission to visit a child institutions without visiting an anti-tuberculosis institution, conducting tuberculin diagnostics and x-ray examination of the child, according to the sanitary and epidemiological rules SP 3.1.2.3114-13 “Prevention of Tuberculosis”), it is indicated that: “In Russia there are several immunological tests that can be alternative to the generally accepted methods used in currently in our practice. If a Mantoux test is refused, the issue of issuing a conclusion about the absence of tuberculosis in a child is decided individually, based on the results of additional/alternative examination methods (x-ray examination, test with recombinant tuberculosis allergen, blood test for the level of specific gamma-interferon, etc.), if avoiding contact with tuberculosis patients. In many countries around the world, the Quantiferon test is widely used to diagnose tuberculosis. In Russia, it is also widely used to diagnose the disease along with other existing immunological tests (T-SPOT, Tubinferon, Diaskintest). These tests are mandatory only in the algorithm for diagnosing the disease in risk groups and with clinical symptoms. If they do not want to have their child examined using the Mantoux test, parents or legal representatives of the children may indeed not do it by writing a refusal, just like any medical intervention. To visit a child care facility, you must provide a document confirming that there is no tuberculosis patient in the child’s environment. This document can only be obtained by visiting a phthisiatrician and submitting data on the parents’ fluorographic examination in a timely manner in accordance with the legislation of the country.” In the above letter, the Chief Freelance Children's Phthisiologist of Russia makes the right conclusion regarding children's rights: children do not have to undergo the Mantoux test, and generally do not have any tests done without clinical symptoms of the disease. However, the specialist is mistaken regarding the rights of parents: it turns out that in order to obtain a certificate for kindergarten or school, parents now must undergo fluorography.
If parents still want to examine their child for tuberculosis, but refuse Mantoux (Diaskintest), it is worth remembering that safer methods for diagnosing tuberculosis are officially approved for use in the Russian Federation: - Quantifron test; PCR test (Order of the Ministry of Health of the Russian Federation dated October 17, 1997 N 306 “On permission for the medical use of medical immunobiological drugs”); - laboratory diagnostics (molecular biological and bacteriological methods (letter of the Director General of the Ministry of Health of Russia No. 11158 dated September 16, 2014). Based on the foregoing, it is possible to assert the right of parents to both refuse to diagnose a healthy child without symptoms for tuberculosis, and the right to choose safe methods of examination.
From what age and until how many years can Diaskintest be done?
There are certain health care standards adopted in the Russian Federation that clearly define how often a test for identifying tuberculosis bacteria can be done, at what age and up to what age it can be done. Parents must remember:
- Children and adolescents are given Diaskintest from the age of eight to seventeen, unless the doctor has prescribed another method of testing for tuberculosis infection.
- Children over the age of one year are allowed to have Diaskintest if Mantoux was done before and the reaction was positive.
Why is Diaskintest considered better in comparison with Mantoux, but at the same time, Diaskintest can only be given to children from one year old, and then only in extreme cases, and Mantoux - from birth? This is not explained by the toxicity of the new drug; on the contrary, it is of higher quality and safer than its analogues. But, nevertheless, children may become allergic to it, since it contains only pure protein. And protein of any kind is a potential and very powerful allergen, which the newborn’s body is not yet able to cope with. In this case, older children tolerate the test remarkably well; allergies appear in only a few; the cause, as a rule, is an innate tendency to intolerance to drugs or a low-quality drug, for example, if the expiration date is almost expired.
The result of Diaskintest may be influenced by the presence of helminthic infection in a child or adult. Parasitic infection causes allergies. The immune response of an infected person fails. Diaskintest in the presence of worms is often positive. Before the test, take the newest drug against most known Intoxic parasites to be absolutely sure of the reliability of the test result.
