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Encyclopedia > Mantoux test
The Mantoux skin test consists of an intradermal injection of exactly one tenth of a milliliter (mL) of PPD tuberculin.
The Mantoux skin test consists of an intradermal injection of exactly one tenth of a milliliter (mL) of PPD tuberculin.
The size of induration is measured 48-72 hours later.
The size of induration is measured 48-72 hours later.

The Mantoux test (or Mantoux screening test, Tuberculin Sensitivity Test, Pirquet test, or PPD test for Purified Protein Derivative) is a diagnostic tool for tuberculosis. The Mantoux test is used in the United States and Canada and is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). Multiple puncture tests such as the Tine test are not recommended. The Mantoux test is one of the two major tuberculin skin tests for tuberculosis used in the world. Until 2005, the Heaf test was used in the United Kingdom but the Mantoux test is now used. Image File history File links Mantoux_tuberculin_skin_test. ... Image File history File links Mantoux_tuberculin_skin_test. ... The Mantoux test for tuberculosis diagnosis. ... The Mantoux test for tuberculosis diagnosis. ... Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ... American Thoracic Society (ATS ), established in 1905, is an independently incorporated, international, educational and scientific society, serving its 18,000 members world-wide who are dedicated in respiratory and critical care medicine. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... The Tine test is a multiple puncture tuberculin skin test used to aid in the medical diagnosis of tuberculosis (TB). ... It has been suggested that this article or section be merged with Mantoux test. ... Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ... The Heaf test is a diagnostic skin test performed in order to determine whether or not a child has been exposed to tuberculosis. ...

Contents

History

Tuberculin is a glycerine extract of the tubercule bacilli. Purified protein derivative (PPD) tuberculin is a precipitate of non-species-specific molecules obtained from filtrates of sterilized, concentrated cultures. It was first described by Robert Koch in 1891. The test is named after Charles Mantoux, a French physician who developed on the work of Koch and Clemens von Pirquet to create his test in 1907. It has been suggested that this article or section be merged with Mantoux test. ... Glycerin, also known as glycerine and glycerol, and less commonly as 1,2,3-propanetriol, 1,2,3-trihydroxypropane, glyceritol, and glycyl alcohol is a colorless, odorless, hygroscopic, and sweet tasting viscous liquid. ... For the American lobbyist, see Bobby Koch. ... Charles Mantoux (1877 - 1947) was a French physician. ... Clemens Peter Freiherr (Baron) von Pirquet ( May 12, 1874– February 28, 1929) was an Austrian scientist and pediatrician best known for his contributions to the fields of bacteriology and immunology. ... Year 1907 (MCMVII) was a common year starting on Tuesday (link will display the full calendar) of the Gregorian calendar (or a common year starting on Monday of the 13-day-slower Julian calendar). ...


Procedure

A standard dose of 5 Tuberculin units (0.1 mL)[1] (The standard Mantoux test in the UK consists of an intradermal injection of 2TU of Statens Serum Institute (SSI) tuberculin RT23 in 0.1ml solution for injection. [2]) is injected intradermally (into the skin) and read 48 to 72 hours later. A person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins.


The reaction is read by measuring the diameter of induration (palpable raised hardened area) across the forearm (perpendicular to the long axis) in millimeters. No induration should be recorded as "0 mm". Erythema (redness) should not be measured. Induration (indoo rāshən, -dyoo-), a noun, means, in terms of pathology, (a) hardening of an area of the body as a reaction to inflammation, hyperemia, or neoplastic infiltration, or (b) an area or part of the body that has undergone such a reaction. ...


If a person has had a history of a positive tuberculin skin test, another skin test is not needed.


Classification of tuberculin reaction

The results of this test must be interpreted carefully. The person's medical risk factors determine at which increment (5 mm, 10 mm, or 15 mm) of induration [3] the result is considered positive. A positive result indicates TB exposure.

  • 5 mm or more is positive in
    • HIV-positive person
    • Recent contacts of TB case
    • Persons with nodular or fibrotic changes on chest x-ray consistent with old healed TB
    • Patients with organ transplants and other immunosuppressed patients
  • 10 mm or more is positive in
    • Recent arrivals (less than 5 years) from high-prevalence countries
    • Injection drug users
    • Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
    • Mycobacteriology lab personnel
    • Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc)
    • Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories
  • 15 mm or more is positive in
    • Persons with no known risk factors for TB
    • (Note: Targeted skin testing programs should only be conducted among high-risk groups)

A tuberculin test conversion is defined as an increase of 10 mm or more within a 2-year period, regardless of age Species see text Mycobacterium is the a genus of actinobacteria, given its own family, the Mycobacteriaceae. ... This article is about the disease that features high blood sugar. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Leukemia or leukaemia(Greek leukos λευκός, “white”; aima αίμα, “blood”) (see spelling differences) is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes). ... Renal failure is the condition in which the kidneys fail to function properly. ... Malabsorption is the state of impaired absorption of nutrients in the small intestine. ...


False positive result

False positive result may be caused by nontuberculous mycobacteria or previous BCG vaccine. Prior BCG may result in a false-positive result for many years afterwards[4]. Nontuberculous mycobacteria (NTM), or atypical mycobacteria or mycobacteria other than tuberculosis (MOTT), are mycobacteria which do not cause tuberculosis or Hansens disease (leprosy). ... BCG stands for Bacillus of Calmette and Guérin vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis that have lost their virulence in humans by specially culturing in artificial medium for years. ... BCG stands for Bacillus of Calmette and Guérin vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis that have lost their virulence in humans by specially culturing in artificial medium for years. ...


BCG vaccine and the Mantoux test

There is disagreement about the role of Mantoux testing in people who have been vaccinated. The US recommendation is that tuberculin skin testing is not contraindicated for BCG-vaccinated persons and that prior BCG vaccination should not influence the interpretation of the test. The UK recommendation is that interferon-γ testing should be used to help interpret positive Mantoux tests, and that serial tuberculin skin testing must not be done in people who have had prior BCG vaccination. Please refer to the chapter on latent tuberculosis for a discussion of the two approaches. In general, the US recommendation results in a much larger number of people being falsely diagnosed with latent tuberculosis, while the UK approach probably misses patients with latent tuberculosis who should be treated. An apparatus (4-5 cm length, with nine short needles) used for BCG vaccination in Japan. ... Also called latent tuberculosis infection, latent TB or LTBI. Latent tuberculosis is where a patient is infected with Mycobacterium tuberculosis, but does not have active tuberculosis disease. ...


According to the US guidelines, latent TB infection (LTBI) diagnosis and treatment for LTBI is considered for any BCG-vaccinated person whose skin test is 10 mm or greater, if any of these circumstances are present:

  • Was in contact with another person with infectious TB
  • Was born or has lived in a high TB prevalence country
  • Is continually exposed to populations where TB prevalence is high.

Anergy testing

In principle, in cases of anergy, a lack of reaction by the body's defence mechanisms when foreign substances come into contact with the body, the tuberculin reaction will occur weakly, thus compromising the value of Mantoux testing. Anergy is present, for example, in AIDS, a disease which strongly depresses the immune system. Therefore, anergy testing is advised in cases where suspicion is warranted that it is present. However, routine anergy skin testing is not recommended. [1] Anergy is a theory in immunobiology in which there is a lack of reaction by the bodys defence mechanisms when foreign substances come into contact with the body. ... For other uses, see AIDS (disambiguation). ...


Two-step testing

Some people with LTBI may have negative skin test reaction when tested years after the infection. Initial skin test may stimulate (boost) the ability to react to tuberculin. Positive reactions to subsequent tests may be misinterpreted as a new infection.


Use two-step testing for initial skin testing of adults who will be retested periodically (e.g., health care workers).

  • Return to have first test read 48-72 hours after injection
  • If first test is positive, consider the person infected.
  • If first test is negative, give second test 1-3 weeks after first injection
  • Return to have second test read 48-72 hours after injection
  • If second test is positive, consider person infected
  • If second test is negative, consider person uninfected

A person who is diagnosed as "infected" on two-step testing is called a "tuberculin converter". The US recommendation that prior BCG-vaccination be ignored results in almost universal false diagnosis of tuberculosis infection in people who have had BCG (mostly foreign nationals). Please refer to the chapter on BCG for a discussion of boosting. The UK guidelines avoid this error [5]. BCG stands for Bacillus of Calmette and Guérin vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis that have lost their virulence in humans by specially culturing in artificial medium for years. ... BCG stands for Bacillus of Calmette and Guérin vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis that have lost their virulence in humans by specially culturing in artificial medium for years. ...


Recent developments

As a replacement for the Mantoux test, several other tests are being developed. QuantiFERON-TB Gold is a blood test that measures the patient’s immune reactivity to the TB bacteria and is useful for initial and serial testing of persons with an increased risk of latent or active tuberculosis infection. Guidelines for the use of QuantiFERON-TB Gold were released by the CDC in December 2005. QuantiFERON-TB Gold is FDA approved in the United States, has CE Mark approval in Europe and has been approved by the MHLW in Japan. Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ...


Heaf Test

Main article: Heaf test

The Heaf test is a tuberculin skin test formerly used in the United Kingdom, but discontinued in 2005. The Heaf test is a diagnostic skin test performed in order to determine whether or not a child has been exposed to tuberculosis. ... The Heaf test is a diagnostic skin test performed in order to determine whether or not a child has been exposed to tuberculosis. ...


The equivalent Mantoux test positive levels done with 10 TU (0.1 mL 100 TU/mL, 1:1000) are

  • <5 mm induration (Heaf 0-1)
  • 5-15 mm induration (Heaf 2)
  • >15 mm induration (Heaf 3-4)

See also

Binomial name Zopf 1883 Mycobacterium tuberculosis is the bacterium that causes most cases of tuberculosis. ... Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ... Also called latent tuberculosis infection, latent TB or LTBI. Latent tuberculosis is where a patient is infected with Mycobacterium tuberculosis, but does not have active tuberculosis disease. ... The Tine test is a multiple puncture tuberculin skin test used to aid in the medical diagnosis of tuberculosis (TB). ...

References

  1. ^ http://www.cdc.gov/tb/pubs/Mantoux/part1.htm
  2. ^ http://www.immunisation.nhs.uk/files/mantouxtest.pdf
  3. ^ From the CDC team of the CDC team at the Saskatchewan Lung Association, photos of a PPD bump.
  4. ^ Chaturvedi N, Cockcroft A (1992). "Tuberculosis screening among health service employees: who needs chest X-rays?". J Soc Occup Med 42: 179-82. 
  5. ^ National Institute for Health and Clinical Excellence. Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Retrieved on 2006-04-07.
  1. Norman Markowitz; Nellie I. Hansen; Timothy C. Wilcosky; Philip C. Hopewell; Jeffrey Glassroth; Paul A. Kvale; Bonita T. Mangura; Dennis Osmond; Jeanne M. Wallace; Mark J. Rosen; and Lee B. Reichman. Tuberculin and Anergy Testing in HIV-Seropositive and HIV-Seronegative Persons. Annals of Internal Medicine, 1993;119(3):185-193. Full text

  Results from FactBites:
 
Mantoux test (200 words)
In the ordinary test the subject is given a intradermal injection of a standard dose of tuberculin, with the aim of eliciting a skin reaction two to three days later.
A positive reaction ('Mantoux positive' or 'significant') is marked by a induration and erythema of the skin.
The test is named after Charles Mantoux, a French physician who developed on the work of Koch and Clemens von Pirquet[?] to create his test in 1907.
  More results at FactBites »

 
 

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