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Mantoux test
*** Shopping-Tip: Mantoux test
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Image:Mantoux_test.jpg thumb|The [[Mantoux test for TB involves intradermally injecting PPD tuberculin and measuring the size of induration 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 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. The
Heaf test is used in the
United Kingdom and is endorsed by the
British Thoracic Society.
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 announced in
1890 by
Robert Koch. 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.
Procedure
A standard dose of 10 Tuberculin units (0.2ml) 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.
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 millimeter of induration the result is positive (5mm, 10mm, or 15mm). A positive result indicates TB infection.
*5mm 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
*10mm 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,
renal failure 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
*15mm 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 10mm or more within a 2-year period, regardless of age.
False negative result
A negative test does not exclude active tuberculosis, especially if the test was done within six to eight weeks of acquiring the infection, if the infection is overwhelming, or if the patient is immunocompromised. Also, very young age less than 6 months old or recent live-virus vaccination (e.g., measles) within 4 to 6 weeks are other factors for possible negative skin test.
False positive result
False positive result may be caused by
nontuberculous mycobacteria or recent BCG vaccine
BCG vaccine and the Mantoux test
Tuberculin skin testing is not contraindicated for
Bacillus Calmette-Guérin BCG-vaccinated persons.
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 comprimising the value of Mantoux testing. Anergy is present, for example, in
AIDS, a disease which strongly depresses the immmune system. Therefore, anergy testing is advised in cases where suspicion is warranted that it is present. Routine anergy skin testing is not recommended, though. [http://www.annals.org/cgi/content/full/119/3/185]
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
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. [http://www.cdc.gov/mmwr/preview/mmw.html/rr5415a4.htm 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.
Heaf Test
The
Heaf test is used in the United Kingdom.
The equivalent Mantoux test positive levels done with 10 TU (0.1ml 100 TU/ml, 1:1000) are
*0-4mm induration (Heaf 0-1)
*5-14mm induration (Heaf 2)
*>15mm induration (Heaf 3-4)
See also
*
Tuberculosis
*
Heaf test
References
# 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. [http://www.annals.org/cgi/content/full/119/3/185 Full text]
Category:Immunology
Category:Eponymous medical tests
Category:Tuberculosis
Category:Dermatology
be:Ð Ñ?акцыÑ? Манту
es:Test de Mantoux
nl:Mantouxtest
pl:Test Mantoux
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