Mantoux or Diaskintest - which reaction to the test is better

Many parents have a question - which is better, Mantoux or Diaskintest. All normal parents worry about the health of their beloved children. Moreover, no one is left with such a question as tuberculosis. A vaccine for this disease has not yet been invented, but for a hundred years in a row, all children have been given a Mantoux test to check for the presence of Koch bacilli (the causative agent of tuberculosis) in the child’s blood and tissues. But the hundred-year-old technology is long outdated. It has been replaced by a new test, safe and convenient.

So, in 2021, children in Russia began to undergo an alternative test for carriage of the tuberculosis bacillus. Its name is Diaskintest. What kind of test is this? Isn't he dangerous for our children? All these questions made our parents think deeply and for a long time. Is this diagnostic test better than good old Mantoux? Are there any consequences of using Diaskintest?

Description of the technique

As our statistics know, almost all reforms and innovations related to injections and vaccines are disapproved by the majority of conservative parents. There is a risk that the new technique will not pay off. That is why we need to figure out whether the Diaskintest test is suitable instead of Mantu?

To begin with, let’s look at what this very Diaskintest is. There is nothing complicated here. This is just an alternative option for determining the presence of tuberculosis, similar to the now outdated Mantoux.

What you need to know about childhood tuberculosis

Author:

Reznik Irina

7 minutes

5100

Where children encounter tuberculosis, who is at risk, how the Mantoux test differs from Diaskintest, and why refusal of vaccination and screening is so dangerous, said the chief pediatric phthisiatrist of the Ministry of Health of the Russian Federation, Head. Laboratory of Tuberculosis in Children and Adolescents of the Federal State Budgetary Institution "National Medical Research Center for Phthisiopulmonology and Infectious Diseases" Valentina Aksenova.

Why do children get tuberculosis and where do they encounter the infection?

You can become infected with tuberculosis anywhere - in transport, in supermarkets, in any closed spaces with large crowds of people. Even short-term contact with a sick person is dangerous for a child, and the infection is simply in the air. But this does not mean that a healthy child with a normal immune system who catches the infection will definitely get sick - in 9 out of 10 cases, immunity is triggered. An infected child can live safely without tuberculosis throughout his life. However, under certain conditions that reduce the body’s resistance, Koch’s bacillus from the so-called “dormant mycobacterium” becomes active, virulent, and already causes disease. This is how secondary tuberculosis develops.

Primary tuberculosis often affects children who find themselves in a hotbed of infection when mycobacteria are actively released by someone from their close circle - relatives, teachers. It is especially dangerous if it is a drug-resistant bacteria, because the child is immediately infected with the drug-resistant bacterium. Therefore, all measures should be taken to ensure that the child becomes less infected, and if he becomes infected, he does not get sick.

Who's at risk

If social and behavioral factors play a significant role in the development of tuberculosis in adults, then medical factors are more relevant for children. Thus, according to WHO, patients with diabetes mellitus develop tuberculosis 4-5 times more often. The likelihood of getting sick increases in children with chronic diseases of the lungs, gastrointestinal tract, as well as in patients who receive hormonal therapy or drugs that suppress the immune system. Thus, in the Clinical Guidelines for the Treatment of Rheumatoid Arthritis in Children, there is a section regarding the prevention of tuberculosis in children receiving immunosuppressive therapy (for example, genetically engineered drugs). Immunodiagnosis of such children should be carried out at least twice a year. The high-risk group includes children with HIV infection who do not have immune protection - the likelihood of developing tuberculosis with HIV infection increases 30-40 times.

What forms of tuberculosis occur in children

Latent form

In most cases, this is a latent form; the active form at this age occurs in 5-6% of cases. The latent form of tuberculosis can hide the signs of the disease for a long time. Despite the fact that a child with this form of the disease practically does not feel it and is not contagious to others, the infection slowly destroys his body, and the disease enters the chronic stage.

Active form

The specificity of childhood tuberculosis is that in most cases children are not bacteria excretors, since the intrathoracic lymph nodes located inside the body are affected, and not the lungs. The BCG vaccination protects children from generalized forms.

Petrificate

Sometimes a child’s body copes with the disease on its own, and its local form does not result in a major disease. Doctors can already see traces of tuberculosis in the form of calcifications in the lung tissue on photographs after the fact. But this is still not a complete cure - a so-called petrificate forms in the child’s lung - a focus that is a dormant mycobacterium covered with a calcareous shell. And as soon as some changes occur in the body, and immunity drops, the infection becomes more active. This is especially dangerous for teenagers, in whom tuberculosis progresses very rapidly due to hormonal changes.

Clinical manifestations

Obvious symptoms of tuberculosis - cough, hemoptysis - indicate that this is already a far advanced stage, destruction has occurred and the lung tissue is disintegrating. And at the initial stage the disease passes hidden. The very first manifestations are completely unremarkable and are characteristic of many diseases - this is causeless weight loss, lack of or decreased appetite, weakness, malaise. Sometimes signs similar to the symptoms of a cold may appear. Parents should be alerted to a cough that, despite treatment, lasts longer than 2-3 weeks. As well as any signs of intoxication - fever, night sweats, prolonged catarrhal symptoms. If this condition does not go away within 7-14 days, it is worth doing Diaskintest. A positive test result serves as the main signal of the presence of the disease.

Screening

Skin tests are also carried out for screening observation, which is necessary in order to timely detect the fact of infection. Regular screening - identification of live (awakened or recently entered the body) mycobacteria is also very important because tuberculosis in children is asymptomatic for a long time. And screening allows you to catch the moment when a child has already come into contact with Mycobacterium tuberculosis, and take the necessary preventive measures, as well as select children for in-depth diagnostics to identify an already developed disease in its initial stage.

The oldest screening method, which remained the only one for a long time, is the well-known Mantoux test. Today, another method of screening observation using skin tests has appeared - Diaskintest. The new skin test is more specific than the Mantoux test, which reacts both to the tuberculosis infection itself and to the BCG vaccine (post-vaccination allergy), and sometimes to another infection present in the body. The Mantoux test is very sensitive, but gives many false positive results. But Diaskintest helps to identify only the active, multiplying virulent tuberculosis infection itself. And this is its value.

Why is the Mantoux test not cancelled?

Today, the country has Order No. 124n of the Ministry of Health, according to which all schoolchildren from the age of 7 should undergo Diaskintest annually. But for children under 7 years of age, the Mantoux test remains, which is necessary to decide on revaccination. The fact is that after a newborn is vaccinated with BCG, post-vaccination immunity is formed in the child’s body. This immunity gradually fades away. But until it has completely died out, revaccination should under no circumstances be carried out. The presence of this immunity in a child can only be determined by the Mantoux test (it will be positive).

Diaskintest will remain negative in patients who have received the BCG vaccine, because, unlike Mantoux, it does not react to it. Diaskintest reacts only if there are infectious bacteria in the body that can cause the disease, and not the bacteria contained in the vaccine. That is, using Diaskintest it is impossible to judge whether a child needs revaccination or not.

Three situations are possible:

If both the Diaskintest and the Mantoux test are negative in a child aged 6-7 years, it means that the body has no protection against infection, and there are no Koch bacilli - that is, revaccination is necessary.
If the Diaskintest is negative and the Mantoux test is positive, then the child’s body has protection against infection and there is no need for additional revaccination.
If the Diaskintest is positive, then the child has a latent tuberculosis infection, that is, the body contains Mycobacterium tuberculosis that can cause the disease and there is a high probability of developing the disease. Revaccination is contraindicated; additional examination, observation by a TB specialist, and preventive treatment are necessary after excluding an active disease.

Since revaccination is not carried out after 7 years of age, there is no need to do a Mantoux test after 7 years of age.

Differential diagnosis

The final diagnosis is not easy to make and is very dependent on the phase of the disease. But first, a differential diagnosis is carried out in order to finally make sure that it is tuberculosis and not something else. And also, in order not to miss the disease if the results of other diagnostic tests are negative (for autoimmune diseases or immunosuppressive therapy). Usually this is the T-SPOT.TB test (using blood from a vein) and multislice computed tomography.

There is another alternative diagnostic test, QuantiFERON. However, it is inferior to T-SPOT.TB, especially in complex cases (when examining young children, the elderly, HIV-infected people, during immunosuppressive therapy). These tests can also be performed as a screening examination. And this opportunity can be used at will (and at their own expense) by parents who do not want to do skin tests for their children. In the general medical network, priority is given to simpler and more accessible methods.

Refusal of screening = refusal of treatment

Skin testing is not a vaccination, but merely a screening tool. In this case, neither live nor inactivated microbes are introduced to the child. And even more so, they don’t infect anyone with tuberculosis, as anti-vaxxers like to scare. The composition of tuberculin used in the Mantoux test includes an extract from Mycobacterium tuberculosis, containing proteins, lipids and other components. The drug Diaskintest includes only two proteins - antigens of the causative agent of tuberculosis.

Doctors patiently explain this to parents, but cannot always convince them. Therefore, such people should be aware that by using their right to refuse screening, they are automatically denying their child the right to treatment. How can an undetected disease be treated?

In addition, they limit their child’s access to the children’s group. Clause 5.7 of the SanPiNov in force since August 2014 indicates that children who have not passed immunodiagnosis are not allowed into educational organizations - kindergartens and schools. This does not contradict Federal Law No. 27-FZ on education, which states that when choosing a special type of medical service, parents also choose the corresponding type of educational service. For example, homeschooling.

Why is the first BCG vaccination given to a child already in the maternity hospital?

Refusing to vaccinate young children against tuberculosis immediately after birth is very dangerous - immediately after the birth of a child, his resistance to infection is practically zero. And, upon leaving the maternity hospital, he finds himself in an environment in which he is not protected from encountering infection. In addition, it takes another three months for the immune response to develop. Of course, there are cases when a newborn child has contraindications for vaccination. And then, when he grows up, before the BCG vaccine is administered, the child is given a skin test to find out whether he has already caught the infection. Children can only be vaccinated against tuberculosis up to two years of age. And only after Mantoux with a negative result.

The BCG vaccination does not completely protect against tuberculosis, but it does prevent children from developing its severe, fatal forms. Its goal is to limit the development of the disease by the lymphatic system, which is well developed in young children (the older the child gets, the worse the lymph nodes cope with their protective function, so pulmonary tuberculosis develops in adolescents). Revaccination is carried out at the age of seven. But by this age, no more than half of children have a negative Mantoux test. The rest are no longer subject to revaccination. For the same reason, the BCG vaccination is not given to adults - by the age of 20, almost all people are already infected, and there is no one left to vaccinate.

Contraindications and side effects

The difference is that, unlike the first test, Diaskintest has a very small number of side effects. However, sad as it may be, they are still present. For example, not all categories of children can perform this diagnostic technique. Therefore, such children need to use alternative options for diagnosing tuberculosis. However, all Russian educational institutions are beginning to intensively use Diaskintest. What to expect from him?

At the very beginning, we need to find out who is not recommended to carry out diagnostics in the described way. After all, a person’s individual reaction in this case can be completely unpredictable. Tuberculosis can occur even in a completely healthy person.

Testing for tuberculosis using Diaskintest cannot be carried out:

In people who have severe chronic diseases;
In people whose level of immunity is significantly reduced;
For those who have recently suffered a serious illness, as a result of which immunity is reduced;
For those people who have a negative reaction to injections;
For those people who are seriously ill with serious diseases.
Those who have a fever.

All of the above qualities are direct prohibitions on performing the tuberculosis testing procedure. In this case, it is necessary to wait some time until the causes of the ban are eliminated, or carry out diagnostics in another way. However, even when the Diaskintest analogue is used in healthy people without contraindications, side effects may also occur. Which ones exactly?

Advantage of the new method

Until recently, the Mantoux test was the most effective way to diagnose tuberculosis. But since the test is 70-80% accurate, scientists were looking for new ways to detect the disease. Diaskintest became such a discovery.

Thanks to the unique protein, the accuracy of the study is 90-100%. The procedure eliminates questionable results in those children who were vaccinated with BCG or who became infected but overcame the infection.

A big advantage of the new technique is the ability to detect latent forms of tuberculosis, including those types of infection that are transmitted from animals, for example, bovine tuberculosis.

Therefore, some countries are already using the test instead of Mantoux in full. In addition, the test is used not only as a replacement for Mantoux.

Is it possible to do Mantoux and Diaskintest at the same time? Yes, such a procedure is not prohibited. Both vaccines are administered at once if Mantoux is large. If the Mantoux is positive and the Diaskintest is negative, the child is healthy, but for some reason the immune system is in an active state. There may have been contact with a sick person. It is recommended to give Diaskintest to children who live in areas with a high percentage of tuberculosis patients. The Mantoux reaction in this case is often false positive.

Taking a test during TB treatment can show how effective it is. If the reaction becomes less pronounced, the treatment is working.

Side effects

When this “vaccine” is used, such effects practically do not occur. As a rule, there are none at all. But in medicine it is customary to warn their patients about even the most minimal effects of the procedure.

The very first side effect from the test injection will be the appearance of a mark from the syringe needle. This “side” is the most common. In any case, no matter what vaccine is administered to a person, a trace of the injection will always appear. There is no need to be afraid or worry about this. In just a week, all traces of the injection will disappear, and the skin will be clean and untouched again.

Also, after receiving a “vaccine” injection, a person often experiences a slight swelling at the injection site. Sometimes it looks like a positive diagnostic result. This small reddish lump usually appears within six hours after a dose of the substance is administered.

What should you not be afraid of when swelling occurs?

If there is a slight swelling on the skin in the injection area, there is no need to be afraid. Normally, it is light pink, very similar to the one that occurs when performing the Mantoux reaction. In a good case, there are no traces other than what remains from the injection. However, swelling always occurs. It is necessary to ensure that no papular rash occurs and that the skin tone at the injection site is not bright pink. If such marks are visible, then you should be wary, because they indicate the presence of tuberculosis.

Popular Truth and myths why you should not contact water after Mantoux

Small bruises often appear on the skin after the diagnostic procedure. Their size, as a rule, does not exceed 2-3 centimeters. Even in cases where the bruise is purple or cyanotic in color, there is no need to worry. This is the natural behavior of the body to the test reaction caused by Diaskintest. The most important thing here is to consider the absence of tuberculosis as a result. Then we can fully believe that this disease is unfamiliar to the child’s body.

False positives

When using Diaskintest, you need to take into account that sometimes the test results may be inaccurate. Medical professionals confirm that sometimes after this test, the child’s body can give a false positive reaction. These cases have sometimes been encountered in medical practice; they create a negative aura and a wary attitude towards the drug.

In what cases can you not trust the test result? When a reddened area or papular rash appears at the injection site. Then you need to see a doctor. Using fluorography and some additional examinations, a medical specialist can easily make or reject a terrible diagnosis.

Diaskintest is allowed to be repeated only two months after the first test injection. This is not considered a side effect, but parents should always be aware of it. If we analyze the reviews of parents whose children have already undergone a similar study, we can conclude that this technique is completely safe. It has virtually no side effects, it can be easily performed on both adult patients and children, and the test has a small list of contraindications.

Diagnosis of tuberculosis

Diaskintest, what is it and why is it done? This is a new way of early diagnosis of tuberculosis in children and adults. Carrying out the test is no different from administering the Mantoux test. The child is injected under the skin on his arm with a drug that reacts to the presence of Koch's bacillus in the body.

As in the case of Mantoux, Diaskintest is assessed 72 hours after administration. Depending on the size of the papules, negative, questionable, positive and hyperergic reactions are distinguished. If there is no redness and swelling at the injection site or does not exceed 0.2 cm, the diaskintest is negative. The normal reaction, indicating that the child is healthy, is a negative result. Including children who have been vaccinated with the BCG vaccine.

A questionable result is given when the papule size is from 0.2 to 0.4 cm; redness of more than 0.5 cm means a positive reaction and indicates infection. However, this does not mean that the child has tuberculosis. With a strong enough immune system, the body will be able to cope with the infection. In case of a positive result, observation by a TB specialist and additional examination (X-ray, blood test) are recommended.

A hyperergic reaction indicates the development of tuberculosis. In this case, the papule increases to 1.5 cm, ulcers may appear, and the lymph nodes may become inflamed. This is the difference between the two studies, because even a doubtful Mantoux reaction is considered a positive response.

How do you feel about mandatory vaccination?

Positively, it prevents many diseases. 60%, 2641 votes
2641 votes 60%
2641 votes - 60% of all votes
Negatively, these are all government schemes to make it easier to manage us. 26%, 1157 votes
1157 votes 26%
1157 votes - 26% of all votes
Neutral, I don’t think it has any effect on my health. 13%, 592 votes
592 votes 13%
592 votes - 13% of all votes

Total votes: 4390

Votes: 4365

January 17, 2018

You or from your IP have already voted.