Mantoux test-

method,indications,pitfalls
Method
• The Mantoux tuberculin skin test (TST) is one method of determining
whether a person is infected with Mycobacterium tuberculosis
• The Mantoux test is carried out by injecting 1TU of PPD in 0.1ml
intradermally on the flexor surface of the left forearm ,midway
between elbow and wrist .
• The injection should be made with a tuberculin syringe,with the needle
bevel facing upwards .
• When placed correctly ,injection produce a pale wheal of the skin,6-
10mm in diameter .
• The result of the test is read after 48-96 hours but 72 hours is the deal
Indications
Who can receive TST ??????????
• Done in the high-risk population to treat the latent or active disease if
detected.
• According to 2019 CDC recommendations for TB screening for
healthcare personnel, individual baseline TB risk assessment should be
done, with no routine annual screening unless any occupational risk or
exposure.
• According to 2017 guidelines for active or latent TB diagnosis,
published by CDC, ATS, and IDSA, indications for TB screening include:
1. New infection risk due to exposure to TB
• Employees and residents of homeless shelters and correctional
facilities and some healthcare workers (pulmonologists, respiratory
therapists) require serial testing, given their high risk of exposure
• .Close and casual (less than 4 hours/week contact) contacts of
untreated, active TB require a single test
2. LTBI individuals with increased risk of disease progression.
• High risk of reactivation (six times higher risk compared to normal). Severe
immunocompromised conditions (malignancy, chemotherapy, organ transplant,
HIV infection, immunosuppressive therapies) and evidence of healed TB on chest
radiograph.
• Moderate risk of reactivation (3 to 6 times risk compared to normal)-Individuals
with diabetes and corticosteroid therapy with a high prevalence of TB, i.e.,
homeless, iv drug users, immigrants from high prevalence areas, active TB contacts
• Slightly increased risk of reactivation (1.5 to 3 times risk compared to normal)-
underweight individuals, smokers, and with evidence of small granulomas on chest
radiograph.
 TST in children
• TST is the recommended method of testing for children younger than
5 years of age.
• The American Academy of Pediatrics (AAP) recommends that either a
TST or TB blood test (interferon-gamma release assay [IGRA]), can be
used in children 2 years and older.
In children previously vaccinated with BCG, a TB blood test is
preferred to avoid a false-positive TST result caused by a previous
vaccination with BCG.
Pitfalls
• TST is contraindicated only for persons who have had a severe
reaction (e.g., necrosis, blistering, anaphylactic shock, or ulcerations)
to a previous TST.
• It is not contraindicated for any other persons, including infants,
children, pregnant women, or persons living with HIV.
• However, TB blood tests are the preferred method of testing for
people who have received the BCG TB vaccine.
THANK
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