What a normal diaskintest should look like. What does Diaskintest look like in children and adults? Positive reaction: necessary measures

What is the norm for diaskintest in children? Children's health is in constant danger from viruses and bacterial infections. Some of these diseases, such as tuberculosis, spread rapidly and take a long time to cure.

To diagnose the presence of Koch's sticks in the human body, various studies are carried out, diaskintest is one of them. This diagnostic method is significantly ahead of its predecessor, the Mantoux test, and is increasingly gaining popularity among patients.

Diaskintest determines the presence of tuberculosis agents in the human body at active and early stages of infection. This method is considered more accurate and reliable than the Mantoux test, since the probability of a false positive result is comparatively lower than that of the analogue.

During a diagnostic event, antigens are injected into the human body to detect the body's response. If the proteins are familiar to the immune system, it means that the body has a tubercle bacillus.

Features of the test:

• antigens are injected subcutaneously;
• the period from setting the test to taking the results is three days;
• the injection is made in the forearm;
• carried out from the age of one year;
• each year the hand on which the test is carried out changes;
• the minimum interval between two studies is two months.

The test is not a vaccine or vaccine, and no disease agent is injected into the child's body during the study. After the test, the person will never get sick with tuberculosis.

How is the research done?

1. Before the injection, the skin area is thoroughly treated with alcohol.
2. The skin is pulled slightly (middle of the forearm).
3. 0.1 ml of diaskintest solution is injected under the skin.
4. After the injection, a slight swelling of up to five millimeters remains on the skin.
5. Even if a pronounced reaction appeared at the injection site in the first two days, the results are removed on the third day.

It is believed that almost every adult on the planet is a carrier of the infection. Koch's bacillus can be in the human body for life, but does not manifest itself as a dangerous disease.

In the early stages, tuberculosis develops without specific symptoms, therefore, timely testing allows you to identify the disease and gain time before the signs of the disease become apparent.

The test is carried out in relation to people of all ages. For children under the age of fourteen, the passage of the Mantoux test and similar techniques is characteristic. After reaching the age of 14, fluorography becomes the main test for tuberculosis.

The reasons for the surveys are:

• detection of tuberculosis;
• determination of the form and stage of the disease;
• checking the effectiveness of the drugs and chemotherapy used during treatment;
• identification of side effects after BCG vaccination.

Previously, the main test for children was the Mantoux test, but this method has a number of drawbacks that Diaskintest successfully compensates for.

Advantages over the Mantoux test:

1. The reaction to Diaskintest does not depend on the previous BCG vaccination due to the antigens used during the diagnosis (different from those used during vaccination).
2. The possibility of detecting a false positive result is much less.
3. The accuracy of the study is 90%.

Based on the above indicators, it is safe to say that the diagnosis is more perfect than the previous analogue. In addition, the possibility of an allergic reaction to the components of the solution is also significantly lower than when setting the Mantoux test.

Test solution composition

The drug is available in a package that includes:

• proteins antigens CFP10, ESAT6;
• phenol as a preservative;
• polysorbate as a stabilizer;
• sodium phosphate;
• potassium phosphate;
• sodium chloride;
• water.

At the moment, the drug is produced in the territory of the Russian Federation.

Before conducting the study, it is necessary to make sure that the child has no contraindications to this diagnostic method.

Like other medicines, the drug has a number of contraindications, in the identification of which it is necessary to choose another research method that is less dangerous for the child.

Contraindications include:

1. Acute forms of diseases, including colds.
2. Acute form of chronic diseases.
3. The presence of skin pathologies.
4. Exacerbation of an allergic reaction.
5. Quarantine assignment during diagnostics (it is necessary to postpone the test until the quarantine is removed).
6. Diagnosed epilepsy.
7. Revealed allergy to the components of the drug.

If contraindications were found in the child, a different diagnostic method must be selected to avoid a false positive reaction or severe side effects.

How often can you do diaskintest

The study is carried out as a planned event and as prescribed by a phthisiatrician:

• carried out as a planned event between the ages of eight and seventeen;
• if a negative result was detected, the next diagnosis is carried out no earlier than two months later;
• if any vaccination has been carried out, the diagnosis is carried out after a month;
• if a person is under observation during anti-tuberculosis therapy, diagnosis is carried out every three to six months;
• testing is prescribed if a positive reaction is detected in a child over the age of one year.

Also, diagnostics can be carried out at the patient's own request in private clinics.

Evaluation of results

Evaluation of the results is carried out seventy-two hours after the injection.

Possible results:

1. Negative (the body is normal).
2. Doubtful.
3. Positive.

The results of diaskintest in children and adults differ significantly.

It is believed that the reaction manifested in the first two days after the test is irrelevant in the diagnosis. If in the first hours or days there is severe redness around the injection site, there is a high probability that a false positive result will appear.

A negative reaction or the norm of a diaskintest given to a child is considered:

• visible trace after the injection;
• the size of the bruise around the injection site does not exceed two millimeters;
• subcutaneous seal at the injection site no more than one centimeter.

A negative result is a test with no signs of severe redness or papules.

False positive result

The result is considered false positive if:

• redness forms around the injection site;
• papule is not formed.

If a false-positive reaction is diagnosed in a child or adult, additional tests and procedures are required, and then a second diaskintest should be performed two months later.

Positive result

A positive diaskintest in a child means that there are agents of tuberculosis in the baby's body, which means that the infection develops.

To diagnose a positive reaction in an adult, it is necessary that:

• the size of the papule was up to five millimeters - a weak amount;
• papule size up to nine millimeters - medium or moderate amount;
• if the size of the papule exceeds ten millimeters, the amount of the pathogen is pronounced.

What should be the reaction to see a doctor? In the event of a questionable or positive reaction to the study, it is necessary to consult a phthisiatrician as soon as possible to prescribe additional tests and therapy.

The spread of the technique is increasing every year, and if earlier testing could only be done in private clinics, now the technique is being carried out:

• in preschool institutions up to 7 years old;
• in educational institutions for children from 7 to 17 years old;
• in the vaccination room of the pediatric department;
• on the territory of tuberculosis dispensaries;
• in municipal and private clinics;
• in tuberculosis research centers and scientific institutes.

Children of preschool and school age are constantly in a large crowd of people, they are exposed to stress and infectious diseases, while their immune system is just beginning to develop. For this reason, being diagnosed for tuberculosis is considered a necessary and regular procedure to maintain the health of children.

For adults, annual fluorography is performed, but, in addition to a planned event, it is recommended to undergo diagnostics after any contact with carriers of the infection, especially people with a low level of immune defense and pregnant women.

Like any medicine, Diaskintest has side effects and complications that appear in the event of a violation of the technique or ignoring information about contraindications. In the absence of contraindications, the drug is safe for people of any age.

Complications after the study include:

1. The appearance of a general intoxication of the body.
2. Increased body temperature.
3. Weakness and malaise.
4. Painful sensations in the head area.

These signs are considered to be natural side effects after the administration of a biologically active agent.

In addition to the listed complications, the manifestation of a hyperergic reaction is possible.

Its features include:

• the formation of large papules, more than 1.5 centimeters;
• severe irritation and inflammation are observed around the papule.

Nevertheless, the formation of a small bruise after the injection is considered a symptom within the normal range.

Also, the emergence of a strong allergic response is a possible complication. That is why during seasonal exacerbations of allergies, diaskintest is not recommended.

What to do after the injection

Diaskintest has rules that must be followed for a successful diagnosis.

These include:

1. Until the results are taken, it is forbidden to influence the injection site with chemical detergents or cosmetics.
2. Treat the injection site with antiseptics and other medications.
3. Comb and rub the injection site.
4. Bandage the hand in the area of ​​the injection or seal with a medical tape.
5. After the test, it is not forbidden to wet the injection site, but prolonged exposure to water is also not recommended.
6. There are no restrictions related to food (except for foods that can provoke a strong allergic response in the patient).

These rules are necessary so that the wound remains intact and no foreign infection gets into it. When a diaskintest is placed, the child needs to be explained the importance of the event so that he does not scratch the injection site.

An inflammatory process due to an introduced infection can provoke a false-positive test result.

Modern analogues of the test for tuberculosis

Medicine is moving forward quickly and confidently, which increases the percentage of patients who successfully receive treatment for tuberculosis.

Treatment depends on many factors, such as the living conditions of a person, the stage of the disease, the form of the disease, the general condition of the body, but every year more and more people are saved from the disease thanks to the latest methods and medicines.

In Western countries, the percentage of patients with tuberculosis has significantly decreased, but in Russia the infection still poses a great threat to the population, which means that timely diagnosis of the disease is necessary to save people's lives.

At the moment, two analogues of Diaskintest are considered leading in terms of the quality of diagnostics:

• tubinferon;
• quantiferon test.

These techniques have their own strengths and weaknesses, but both are significantly superior to their predecessor, the Mantoux test.

The test method for tubinferon is similar to that of diaskintest. The test is carried out subcutaneously, and the substance for research is also produced in Russia.

This technique is less widespread, but is in no way inferior in terms of the qualities and capabilities of determining the agents of tuberculosis in the human body.

The preparation contains:

• protein component ESAT-6;
• protein component CFP-10;
• tuberculin (which makes it average in the method of exposure between diaskintest and Mantoux test).

The proteins used during the study belong to a different strain of the tubercle bacillus, which makes the result independent of previous BCG vaccinations.

The quantiferon test is a modern diagnostic method most widespread in the western hemisphere of the planet. The main difference between the study is the absence of physical contact with human skin and the analysis is carried out in laboratory conditions.

This quality allows people with skin diseases to be diagnosed for tuberculosis, which was impossible for previous types of testing.

The sequence of the event:

1. The preliminary preparation of the test is the collection of the patient's venous blood in three tubes.
2. The first tube is necessary for the analysis itself, and for this, tuberculosis antigens are added to it.
3. The remaining two tubes are used as controls.

The antigens used for the quantiferon test also differ from the strains used during BCG vaccination.

The technique is optimal for conducting research in the active and asymptomatic stages of tuberculosis, which makes it possible to identify the disease before the onset of an active inflammatory process in the internal organs of a person.

Unfortunately, testing by this method on the territory of the Russian Federation is poorly developed and has some difficulties, such as the need to bring already taken blood to the research laboratories (carried out in private clinics) and the localization of the main points of the test in Moscow and St. Petersburg. The test has a high cost, which also limits its mass consumption. However, these shortcomings do not diminish its important qualities in the diagnosis of a dangerous disease - tuberculosis.

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Diaskintest is a modern alternative to the outdated and insufficiently reliable Mantoux test. It is used to accurately diagnose pulmonary tuberculosis in adults and children at any stage. The advantage of this drug is that it only responds to viable Mycobacterium tuberculosis, and not to weakened strains that are injected during BCG vaccination. In other words, with the help of Diaskin, it is possible to establish with high accuracy whether or not a person is infected with mycobacterium tuberculosis (MBT), and if so, then immediately assess the activity of pathogens. For the correct interpretation of the test results from a trained specialist, it is necessary to check Diaskintest no later than 72 hours later.

Diaskintest in its composition and effectiveness differs from the Mantoux test, which is more familiar to the population. But the technology is similar. The drug is also injected intradermally into the right or left forearm. Diaskintest's check is carried out in a medical institution on the third day after the procedure, that is, after 72 hours. The time of onset of symptoms with Diaskintest depends on the number of bacteria in the body and their activity. Normally, the response should improve.

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 an open form appear if the patient is sick with tuberculosis. Immediately after the injection and on the first day at the injection site, redness, slight swelling, bruising may occur - this is considered a normal reaction.

If the procedure was carried out correctly, at the time of the test there were no contraindications, and the person is not allergic to the active substance of the drug, after a while the redness and swelling go away on their own. If the body's response to the tuberculin test begins, it will develop incrementally and reach its peak after 3 days. The final result will be visible in about 72 hours. By this time, it will already be possible to accurately judge by the reaction whether the examined person is infected with Koch's bacillus or not. Then the symptoms will gradually begin to decrease, so the assessment of the reaction results on the 4th day and later cannot be considered reliable.

Sometimes, immediately after the administration of the drug, a patient develops severe hyperemia, a large papule swells, and after 72 hours everything goes away. This indicates a malfunctioning of the immune system. It is urgent to perform an additional analysis on and conduct further thorough research in order to accurately establish the cause of this phenomenon.

Briefly about decoding 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.

1. If there is a speck without infiltration, no more than 0.2 cm in size, or in general there is only a small trace of the injection, Diaskintest is negative. This means that there is nothing to worry about, there are no mycobacteria in the body, or they are negligible and they are in a dormant state.
2. Redness up to 0.5 cm in diameter without pronounced seals speaks of a dubious reaction to Diaskintest. Perhaps the technique of staging Diaskintest was violated, or there were hidden contraindications - for example, the initial stage of a cold or viral infection, which the patient himself did not know about.
3. 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 the condition) - we are talking about a positive reaction. This means that a person is a carrier of a large number of MBTs, 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 not more than 0.5 cm;
• moderately positive - a papule ranging in size from 0.5 to 0.9 cm;
• a pronounced positive reaction - the diameter of the papule is from 1 to 1.5 cm;
• strongly pronounced - the papule is more than 1.5 cm.

A pronounced reaction is also called hyperergic. Often accompanied by inflammation and suppuration of papules at the injection site, a strong increase in body temperature, an increase and soreness of the lymph nodes. In any case, further, deeper studies will be required for the final diagnosis.

The absence of any reaction at all after testing indicates the presence of immunity in tuberculosis in the subject. This happens in cases where a person has already suffered a tuberculosis infection and has been successfully cured, or tuberculosis has passed into a latent form (development).

Is it possible to reduce the result of Diaskintest

If, together with the test, severe redness, swelling occurs, patients are frightened and begin to look for a way to reduce Diaskintest. It is absolutely not worth doing this. If you violated the regimen after the procedure (took a hot shower or bath, injured the injection site), it is wiser to inform your doctor about this and, if necessary, do Diaskintest again.

It is strictly forbidden to wipe the papule with alcohol solutions, smear with ointments, glue, bandage, apply cold or heat. This can lead to increased reactions and false results. If the reaction is pronounced, then there is no point in turning away from this. You should consult a doctor as soon as possible and undergo a course of treatment.

Even if the child is allergic, it is not necessary to 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 adherence to a sparing diet, refusal of sweets, and the like, in contrast to the Mantoux test. All that is required is not to comb, not to warm up and not to smear the papule with anything until the result is assessed. The doctor will tell you what to do next to reduce the flushing.

How reliable is the result of the Diaskntest

The reliability of Diaskintest in comparison with the Mantoux test is an order of magnitude higher. Diaskintest may be mistaken if the sample setting technique was violated or the patient is allergic to Diaskintest. If the tuberculin test was performed correctly, the accuracy of Diaskintest is more than 90%, the sensitivity of the drug is more than 80%.

That is why Diaskintest is recommended to be carried out by everyone who has a dubious or positive Mantoux reaction. The test will allow you to accurately determine whether it was a reaction to BCG or to the presence of a true tuberculosis infection in the body. But at the same time, Diaskintest cannot completely displace and replace the Mantoux test. With its help, it is impossible to establish whether revaccination against tuberculosis is required at 7 and 14 years old, since the drug simply will not "see" dead MBT strains that are administered during vaccination to form immunity. In these cases, a Mantoux test will still be performed before vaccination.

Is a positive Diaskintest tuberculosis?

Yes, if the reaction was positive, it is almost 100% an indicator that a person has tuberculosis. Don't panic. It will be necessary to conduct additional examination and determine the course of treatment as soon as possible. In the initial stages, with the help of antibacterial drugs, you can get rid of tuberculosis in 3-4 months.

Doubtful Diaskintest - what should be done?

The accuracy of the Diaskintest result is much higher in comparison with the traditional Mantoux test. This is not a vaccine, as many uninformed parents believe. And just an immunological test, checking how closely the body came across mycobacterium tuberculosis. Diaskintest allows you to determine almost 100% whether a person is sick with tuberculosis or not, as well as to determine with great certainty the risk of developing the disease in the next 12-24 months.

Who said that it is impossible to cure tuberculosis?

If the treatment of doctors does not help to completely get rid of tuberculosis. I have to drink more and more pills. Complications from antibiotics have joined the tuberculosis, but there is no result. Find out how our readers beat tuberculosis ...

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Until 2009, in Russia, diagnostic tests for detecting tuberculosis were fluorography and tuberculin diagnostics (Mantoux test). Currently, in addition to them, more modern methods are used, one of which is the diaskintest for tuberculosis.

Active substance: synthesized proteins of tuberculosis bacteria CFP10 ESAT6.

Auxiliary:

• phenol;
• sodium and potassium phosphate;
• polysorbate 80;
• sodium chloride;
• distilled water.

Purpose and instructions for use

The Diaskintest test is assigned to adults and children after a year to determine:

• the presence of tuberculosis infection;
• the stage of the disease, if any;
• the presence of an allergy to the administration of the vaccine;
• control the treatment process.

Contraindications

Contraindications to Diaskintest are as follows:

• infectious diseases in acute form, if there is no suspicion of tuberculosis;
• other diseases in an aggravated form;
• the presence of skin diseases;
• allergic reactions;
• colds, acute respiratory pathology;
• runny nose (rhinitis) and cough (tonsillitis), since these are infectious diseases, and therefore, neither a child nor an adult should be tested.

Important! If the school or kindergarten is in quarantine, the test is done only after it has been canceled.

Administration technique and dosage

The Diaskintest test instructions for use oblige to do only after a doctor's prescription. It is carried out by a medical professional who is authorized to conduct such tests.

1. The injection site is the middle third of the forearm.
2. The test is placed on a less active hand (for a right-hander - on the left, for a left-hander - on the right). Variants are possible when Mantoux is placed on the left forearm at the same time, and Diaskintest is placed on the right.
3. The injection site is wiped with seventy percent ethyl alcohol.
4. A special tuberculin syringe with a thin needle is injected intradermally.
5. The dose is 0.1 milliliter.

Diaskintest technique

The need for

Parents are concerned about the safety and need for Diaskintest for their children. On this point, it can be said, in his defense, the following:

Ninety-five percent of the adult population carry Koch's bacillus, that is, they have a latent tuberculosis form and can infect a child. This form is hidden, but under unfavorable conditions it can be activated. Therefore, a previously identified pathogen, with the help of diagnostics, will not allow the disease to manifest itself, and the identification of a hidden infectious process will increase the chance of recovery.

Diagnostic sites

The Diaskintest test is carried out by the following institutions:

• schools;
• kindergartens;
• polyclinics;
• anti-tuberculosis dispensaries and institutes.

Conducting frequency

The Ministry of Health of the Russian Federation recommends that a sample be given to school-age children every year.

The norms for conducting Diaskentest are guided by the following rules:

• The test can be repeated only after two months.
• After an acute infection - one month.
• Any vaccination is one month.
• Controls with a positive test result - every three to six months.

In children, it is possible to test after one year if Mantoux was positive.

Results and their evaluation

Assessment of the results of Diaskintest in children and adults takes place after three days. This is done exclusively by a specialist. He looks at the reaction of the body at the injection site. The indicators of the disease depend on how this trace looks. They are distributed according to three criteria:

1. in the absence of redness, and if the speck is not more than two millimeters, it is negative (the norm in children and adults);
2. with severe redness, but there is no infiltration - doubtful (false positive);
3. a visible seal (infiltration) is formed - positive.

The result of the diaskintest begins on the first day. In the next three days, the process increases, giving the maximum effect. Then it begins to decline, at this time it is no longer possible to correctly assess it.

Negative

The norm of diaskintest is a negative result. Possible manifestations:

• the presence of a small trace from the injection;
• the presence of a millimeter bruise;
• centimeter seal, in the form of a "button" or "lemon peel".

That is, with a normal negative result, there should be no redness or papules.

Doubtful

A dubious manifestation is the presence of redness at the site of the test, but the absence of papules.

If Diaskintest gave a false-positive result, the patient is referred to an anti-tuberculosis institution. There he undergoes additional diagnostics, tests, and X-ray examination. According to the rules, after two months, the diaskintest can be repeated.

Positive

Diaskintest positive result - the presence of an inflamed papule. This indicates the presence of tuberculous mycobacteria.

Adults

With a positive test in adults, the size of the infiltrate depends on the amount of the pathogen in the body:

• no more than five millimeters - small;
• no more than nine - moderate;
• from ten to fifteen - expressed;
• more than fifteen - hyperergic.

It is necessary to register with a TB dispensary and undergo adequate treatment.

Children

Children. in whom Diaskintest gave a positive result, it is necessary to undergo additional diagnostics to determine the activity of the disease. But even if the disease is in a latent form, treatment is still carried out for three months, with anti-tuberculosis drugs (Isoniazid).

False result

Sometimes, a questionable result or positive, Diaskintest can give in the absence of infection. This happens in the following cases:

• If no diseases were found for which the test is contraindicated. For example: the presence of a viral infection of an unexpressed nature, autoimmune diseases.
• An unexpected reaction to any allergen, therefore, the test is carried out in allergy sufferers only together with antihistamines prescribed by a doctor.
• Infection at the injection site, especially in children.

Additional side effects

The Diaskintest tuberculosis test is sometimes accompanied by rare manifestations:

• an increase in temperature;
• weakness;
• headache.

In this case, you do not need to worry. The immune system responds normally to the drug.

Before and after sample

In order for the Diaskintest test not to give a false result, you must adhere to some rules:

• you can not do it if there are contraindications;
• adults need to refrain from alcohol;
• do not smear the injection site with various means;
• do not scratch;
• do not cover the injection site with a bandage or plaster.

According to Dr. Komarovsky, the injection site can be wetted, but you should refrain from bathing the child.

Benefits and comparison with other tests

The advantage of the test over such diagnostic methods as X-ray, fluorography, computed tomography, is that when it is carried out, the human body is not exposed to radiation.

Mantoux test and Diaskintest differences:

• diaskintest contains only synthetic antigens, so the possibility of contracting tuberculosis is zero;
• it can be used by a child from one year old;
• reacts only to active mycobacteria, and only those causing tuberculosis;
• according to the degree of accuracy of the results (Mantoux's accuracy is fifty-seventy percent, and Diaskintest's is ninety).

But at the same time, it cannot be said unequivocally that Diaskintest or mantu is better. They are not interchangeable. The test is often prescribed to a child if the Mantoux test is positive, as it can give a false reaction to other mycobacteria that do not cause tuberculosis, or to the BCG vaccine. But at the same time, it may not show infection for a bovine strain of tuberculosis. Therefore, first, they still carry out the Mantoux test, and in case of doubt, Diaskintest.

It is used mainly in children, although in some cases it is also indicated for adults.

The technique has become widespread relatively recently. The impetus for its creation was the fact that the Mantoux reaction did not provide accurate information as to which antibodies to which strain of mycobacterium are in the body (since it determines the sensitivity to two subspecies - human and bovine mycobacterium).

The specificity of the injection is almost 90 percent, while the sensitivity of the tuberculin test does not exceed 50. Because of this, the occurrence of false and incorrect results is high.

It is necessary to understand how the diaskintest is carried out, and also to determine the contingent to whom this reaction is shown.

How is the procedure carried out?

Diaskintest itself, reviews of which are currently mostly positive, does not differ in any way from the Mantoux reaction. The test is performed on the inside of the forearm. The needle is inserted intradermally a few millimeters. After the injection, a papule with a "lemon peel" surface is formed at the injection site. After some time (usually after two days), the formed papule is assessed.

Diaskintest for tuberculosis must be carried out in specially equipped rooms or it is forbidden to inject at home, as well as by untrained personnel without created conditions of sterility. This can lead to the development of complications after the procedure.

To determine the results of the study, the changes in the area where the diaskintest was carried out are assessed.

The test results are assessed according to certain criteria. If a negative result is obtained (none of the criteria has been identified), the study is repeated or sent for additional examination to specialized institutions.

What signs are used to assess the effectiveness of the procedure and the state of health?

Criteria for evaluation

After the diaskintest was carried out, the results are assessed by the presence of changes in the injection zone.

Normally, a zone of hyperemia should form at the injection site. Its appearance is due to increased blood flow to the injection site, as well as a local allergic reaction.

The size of the papule depends on the degree of the immune response. The larger the diameter of the formed papule, the stronger the reaction of the immune system. However, too small or, on the contrary, excessively large papule size are unfavorable signs, since they indicate a weakened or overly active immune system and its response to the introduction of foreign antigens.

In addition, the formed papule is compared with previous results, determining the dynamics of changes. If there is a positive reaction to Diaskintest, the photo and size of the papule must be compared with the previous results. It is quite possible that for a given period of time (a year since the previous reaction) a person had contact with a patient with tuberculosis. In this case, comparison with past results is required.

Diaskintest for tuberculosis is considered carried out in accordance with all the rules and regulations if there are two of the above criteria.

Interpretation of results

How can one judge the presence of antibodies to mycobacterium?

Diaskintest is assessed according to two criteria - redness in the injection area and size.

If there is no zone of hyperemia at the injection site of the drug, this indicates that either the procedure was performed incorrectly, or the immunity is so weak that it cannot respond to the introduction of antigens. This is also evidenced by the absence of papules at the injection site.

If there is hyperemia, and the papule is small (up to 4 mm), a weak immune system is judged. A similar result may indicate that there are very few antibodies, and the body, if mycobacterium enters it, will not be able to cope with it.

What is the result of a healthy person on Diaskintest? Its norm is from 4 to 12 mm, which indicates the normal function of the immune system and the presence of the necessary antibodies.

If suddenly a papule more than 12 mm in size forms at the injection site, this indicates a hyperreactivity of the immune system, i.e. in response to the penetration of mycobacteria, an allergic reaction may develop.

However, it should be remembered that the results in adults and children may differ slightly from each other. In adults who received Diaskintest, the norm will be slightly higher - from 4 to 16 mm. This phenomenon is observed due to the fact that there are more antibodies in the body of an adult than in a child. Some of them can be activated in the presence of antigenic mimicry - the antigen of mycobacteria can be recognized as a foreign protein of another microorganism, and in response to this, other cells can be activated, which somewhat intensifies the allergic reaction.

Sometimes the absence of a papule or its large size may indicate that the procedure was performed incorrectly. Be sure to carry out one more to clarify. With a repeated result (repeated negative or positive diaskintest), a consultation with a phthisiatrician is indicated.

The surveyed contingent

To whom is this procedure indicated?

This study is mandatory for children under 17 years of age. This is because the main method of screening for tuberculosis - fluorography - is associated with X-rays, which can affect the development of the child's body. That is why preference is given to the introduction of antigens, rather than radiation.

The injection is carried out to children about six months after the introduction. During this time, antibodies to the antigens of mycobacteria have time to form, which makes the study expedient.

In addition, it is imperative to carry out the procedure for people who are registered with an endocrinologist for diabetes mellitus.

Everyone, without exception, undergoes a diaskintest in the presence of significant changes in the papule in comparison with the previous study (the procedure is performed once a year, but an unscheduled study can be carried out up to 3 times).

A positive diaskintest is often determined in people serving sentences (in prisons, colonies), therefore, they are examined several times a year.

Indications

Diaskintest, like the Mantoux reaction, is a purely diagnostic procedure aimed at mass monitoring of the development of tuberculosis in childhood.

Usually this study is carried out as planned, but there are some indications for its extraordinary conduct.

Such predisposing factors are the turn of the Mantoux reaction, a significant change in the formed papule in comparison with previous results. In children with a prolonged (more than a month) subfebrile condition and the presence of a dry cough, it is imperative to re-examine, including diaskintest. In this case, a photo of the chest organs (fluorogram) is taken with the permission of the child's parents and is used to clarify the diagnosis.

In addition, the study is mandatory in children and adults with diabetes mellitus (since this disease provokes the development of immunodeficiency, facilitates the penetration of the pathogen into the body and the development of the infectious process).

An unscheduled test is mandatory for children whose parents have been diagnosed with tuberculosis.

Contraindications

Like any procedure, Diaskintest has some contraindications for carrying out. These include hypersensitivity to the constituent components of the drug, as well as the presence of an active infectious process in the study area (diaskintest is somewhat limited in use, since the injection is carried out on the forearm, where the skin is rather thin, which allows the formation of papules. always succeeds in obtaining the required results).

There is also some age restriction. The procedure is not performed on newborns and children who have not previously received BCG vaccination.

The study is carried out with caution in people with immunodeficiency, since the introduction of antigens can provoke an incorrect response of the body.

Diaskintest advantages

As you know, diaskintest replaced the Mantoux reaction. This was due to the fact that the Mantoux reaction does not give accurate results regarding antibody production against human mycobacterium tuberculosis (determines the presence of antibodies against two strains of mycobacterium). Diaskintest, reviews of phthisiatricians about which are mostly positive, is a more narrowly targeted procedure, since the injected drug contains only m. Tuberculosis.

There are isolated cases when active tuberculosis developed after injection during the Mantoux reaction. In epidemiological terms, Diaskintest is safer, since it does not contain active mycobacteria, but only their antigens, which contribute to antibody formation. A hypersensitivity reaction almost never develops with the introduction of the drug.

Since the procedure is no different from standard tuberculin diagnostics, most trained procedural nurses can do it.

Opinions of patients and doctors

For the short time that Diaskintest is used, he received a considerable amount of feedback from both patients and doctors.

When studying most of the forums on which patients with tuberculosis or their relatives who have undergone a diaskintest communicate, reviews in most cases were positive. According to people, the procedure is quite simple to implement, it does not require any preparation from them.

What do doctors think about this? Many phthisiatricians are inclined to believe that Diaskintest is a more universal procedure than the Mantoux or cutaneous reaction (currently not used). The high specificity of the drug makes it possible to confirm with almost 100% certainty the presence of mycobacteria in the body and to start treatment in a timely manner. Many agitate patients to give preference not to a fluorogram (which allows only the disease itself to be detected), but to undergo a diaskintest. The doctors' comments on the procedure are almost always positive, only a small part of them prefer radiography or Mantoux.

Where can you get the procedure?

If you suspect that you have tuberculosis, the question often arises of where to go. Such thoughts usually appear after the radiologist noticed a shadow in the lung image, or you cough for a long time, feel weak and weak. All this indicates the possible presence of active tuberculosis, and it is impossible to hesitate with the diagnosis.

First of all, diaskintest can be passed in specialized institutions - anti-tuberculosis dispensaries or polyclinics. Usually, the procedure is carried out by everyone for a fee, although it is possible and even necessary to apply there and in a referral from a local therapist.

In addition, you can go to regional health centers (for example, district hospitals) or the health service for this procedure. Usually, there must be at least one phthisiatrician in the area who can competently examine you and, if necessary, diagnose tuberculosis with the help of Diaskintest.

In fact, preventing infection with a dangerous infection is one of the main tasks of public health; massive preventive measures are being taken in the country. In recent years, in addition to the usual Mantoux reaction, Diaskintest has been used to detect tuberculosis, which raises many questions from parents. To understand whether vaccinations and tests for tuberculosis are needed, you need to understand the main ways to prevent infection.

About tuberculosis

Infection with a dangerous infection develops after ingestion of mycobacteria, which are also called "tubercle bacillus", or Koch's bacillus. Under favorable conditions, the microorganism multiplies rapidly and most often affects the lungs of the patient. But sometimes the infection does not affect the respiratory system, but spreads to bones and joints, skin, nervous tissue and other organs.

The incidence of tuberculosis in Russia remains high, and the number of infected children has doubled over the past decade. About 2% of the total number of children in the population are registered annually at anti-tuberculosis dispensaries.

The course of the disease in children differs from the classic development of the disease. Small and uncomplicated forms of tuberculosis, lesions of the intrathoracic lymph nodes are more typical for children. Extrapulmonary manifestations do not exceed 10% of the total number of cases of infection.

Almost all adults are carriers of Mycobacterium tuberculosis, but only a small number of infected people develop the disease. For the reproduction of the tubercle bacillus, certain conditions are needed, one of which is reduced immunity. Among children under 14 years of age, the infection rate is, according to various sources, from 15 to 60%. Therefore, it is important to identify the first signs of a dangerous disease and take action in time.

About vaccines and diagnostic tests

• vaccination against tuberculosis.

BCG belongs to vaccines and is created on the basis of the "bovine" type of tuberculosis bacteria. The introduced microorganism, although alive, is weakened so much that the baby's immunity can easily cope with it. After vaccination, the child retains reliable protection, and the Mantoux test may become positive.

Vaccination is carried out for all newborns according to the calendar of preventive vaccinations on the 3rd - 7th day after birth. Repeated vaccine administrations are possible at the age of 7 and 14 years if the child has indications;

• Mantoux test and its meaning.

This test is performed using tuberculin, a special extract obtained from killed bacteria. This substance is an allergen and causes a response in carriers of mycobacteria and people vaccinated against tuberculosis. A positive Mantoux test result indicates an infection of the child, but this does not always mean that the disease has developed.

Despite its name, tuberculin itself contains no bacteria, neither living nor dead.

• Diaskintest for tuberculosis, what is it?

The diagnostic test contains special proteins called antigens that trigger an immune response in the body when infected with mycobacterium. These substances are absent in the tuberculosis vaccine, therefore Diaskintest is considered more specific than the Mantoux reaction.

Due to its unique composition, Diaskintest reacts only to mycobacterium tuberculosis, without causing false positive reactions associated with the introduction of tuberculin during the Mantoux reaction.

It turns out that this test is more selective, and its positive result indicates the infection of the baby with a dangerous bacterium, the development of the disease. But why didn't Diasintest completely replace the Mantoux test? It turns out that due to its specificity, the reaction itself cannot be used in the selection of children for repeated BCG vaccinations, but can serve as an addition to the intradermal tuberculin test.

The test effectively complements the Mantoux reaction, but cannot be used on its own. Both tests are of great importance in the diagnosis of tuberculosis and should be prescribed by a phthisiatrician. Only a doctor can determine which of the reactions the child needs to carry out, and correctly assess the result of the test.

General indications for Diaskintest

• identification of a frolicking lung disease;
• assessment of the severity of tuberculosis;

Thanks to this method, it is possible not only to detect the ill-fated bacterium, but also to determine the degree of activity of the pathogen.

• differential diagnosis of the disease;
• the difference between post-vaccination allergy and an infectious process;
• identification of children at high risk of developing the disease;
• as part of a comprehensive assessment of the effectiveness of the treatment.

Many parents consider Diaskintest to be a vaccine and are afraid of the complications of vaccination. In fact, the differences between vaccination and diagnostic testing are enormous. When vaccinated with BCG, a weakened but living microorganism is injected, which contributes to the development of immunity against tuberculosis. When conducting samples, the reaction to the injected substance is assessed, but no protection against disease is formed. Tests are done intradermally and adverse reactions are extremely rare.

How is Diaskintest carried out?

Before the sample is taken, the child must be consulted by a doctor. The test is identical to the Mantoux test. For this, tuberculin syringes and short needles are also used, and the injection itself is carried out intradermally.

The nurse draws 2 doses of the diagnostic agent into a syringe, one of which is released onto a sterile cotton swab. Thus, a more accurate dosage of the drug is achieved. Then the health worker determines the location of the sample - the middle third of the inner surface of the forearm. The baby's skin is treated with alcohol, after which 0.1 ml of Diaskintest is injected.

At the injection site of the diagnostic substance, a papule appears in the form of a "lemon crust" of whitish color with a diameter of 7 - 10 mm.

The basis of the Diaskintest test is a specific allergic reaction, which makes it possible to identify the body's sensitivity to mycobacteria. Therefore, children prone to the appearance of any type of allergy are shown the use of desensitizing drugs before and after the test.

How to evaluate the reaction to Diaskintest?

To understand how the body responded to the administration of the drug, 72 hours after the sample was placed, the size of the seal is determined with a transparent ruler and the result is evaluated:

1. Negative reaction.

After the prescribed time, traces of the injection are not detected on the child's skin. Formation of a small "prick reaction", up to 2 mm, is acceptable at the place of sample setting. The negative results of Diaskintest indicate the absence of mycobacteria in the child's body, which is the norm in children. The kid does not belong to the risk group for developing tuberculosis.

1. Questionable reaction.

Sometimes redness forms at the injection site, but there is no pronounced tissue compaction. This indicates the need for additional examination of the child, other diagnostic methods.

1. Positive reaction.

If a seal has formed on the child's skin, a papule of any size, we can talk about a positive test result. The larger the value of the element, the more pronounced the reaction is considered.

If the baby is found to have a positive Diaskintest reaction, parents should not despair. Although the test is considered highly informative, there are still cases of false positive test results. In any case, the final diagnosis and the need for treatment are determined by the doctor after additional examination methods.

Contraindications to Diaskintest

But it is not always possible to carry out a diagnostic test. Like any drug, Diaskintest has its own contraindications for use:

• infectious, atopic and malignant skin diseases;
• allergic diseases in the acute stage;
• exacerbation of chronic diseases or acute signs of an illness;
• epilepsy;
• infectious diseases (a test is possible only a month after the patient's clinical recovery);
• the test is contraindicated if less than a month has passed since the last vaccination.

Adverse reactions to Diaskintest

The test is well tolerated by children, and adverse reactions occur in very rare cases. Of the possible negative manifestations, the manufacturer of the drug indicates a headache, weakness, an increase in body temperature. In some cases, a hematoma forms at the injection site. A bruise interferes with the assessment of test results and increases the risk of diagnostic errors. The formation of a hematoma is usually associated with an incorrect sample setting technique.

Frequently Asked Doctor Questions

Since Diaskintest is used relatively recently, parents of young patients have many questions about the diagnostic test. Let's consider the most common ones:

1. At what age is it allowed to carry out Diaskintest?

The manufacturer notes the possibility of using an intradermal test in all age groups, indicates the absence of any age restrictions.

According to the clinical recommendations of Russian health care, all babies from one to seven years old are recommended to conduct an annual Mantoux test. In the absence of a child, a diagnostic test is carried out 2 times a year, starting from 6 months, until the moment of vaccination against tuberculosis.

If a baby under 7 years old has a positive reaction to the Mantoux test, the phthisiatrician may recommend an additional setting of Diaskintest. After the child reaches the age of 8 years and up to 17, Diaskintest is shown to be carried out every year.

1. Can both diagnostic tests be done on the same day?

If the phthisiatrician doubts the reliability of the Mantoux test, the doctor may recommend doing both reactions. Experts allow the simultaneous execution of the Mantoux and Diaskintest test, provided that the tests are performed on different hands.

1. Is it dangerous for water to enter the sample location?

Everyone has heard that it is not worth wetting the Mantoux sample, but what about Diaskintest? Although water, in most cases, does not have any negative effect and does not affect the results of both samples, it is still worthwhile to exercise caution.

Swimming in the pool, active hand washing with detergents, use of a plaster - can cause irritation and itching, and then - nonspecific allergies. In this case, it will not be possible to correctly assess the result. Therefore, doctors recommend that parents be attentive to children, do not allow scratching the injection site and do not use products that cause irritation and allergies.

1. Is it possible to combine the Diaskintest test and vaccinations?

The diagnostic test must be assessed before the next vaccination is administered, so it is better to first diagnose and then vaccinate according to the calendar. If the baby was recently vaccinated, the diagnosis of tuberculosis should be postponed for a month. After this period, it is worthwhile to conduct a Diaskintest, then its results will be reliable.

1. What if it's time to do the test and the baby is sick?

If the child is prone to allergic reactions, you need to prepare in advance for the test - give the baby desensitizing drugs 5 days before the test and 2 days after it. If the child is registered with an allergist, for example, with, it is imperative to consult a doctor before diagnosing.

1. Is it allowed to test the child in the clinic if the kindergarten is closed for quarantine?

If an infectious disease is detected in a preschool institution, quarantine measures are taken. Even if the baby looks healthy, you need to wait until the end of the forced break and then conduct a test.

1. Should you stick to a diet while diagnosing tuberculosis?

The manufacturer of the drug does not indicate the need to limit any products when administering Diaskintest. Doctors advise against eating food that can provoke allergic reactions in a child. Any contact with potentially hazardous substances must be avoided, not only in products but also in the environment. This is especially true for children prone to manifestations of hypersensitivity.

1. Is it safe to use Diaskintest in children's practice?

In the case of correct administration of the drug, adherence to the correct dosage, the sample does not have a negative effect on the health of the baby. Parents should understand that Diaskintest, like any antigen, can cause general reactions in the form of weakness, headache, fever. But such manifestations occur in rare cases and do not cause harm to the body.

1. What should be the test result in a healthy person?

The reaction to Diaskintest should be negative, regardless of the age and the fact of the child's immunization. With Mantoux, things are different - in a baby who has not yet been vaccinated with BCG, the tuberculin test must be negative. After vaccination, the reaction becomes weakly positive or positive, which indicates the formation of immunity against tuberculosis.

An increase in papules from a Mantoux test can occur immediately after BCG and is considered a post-vaccination reaction. If several years have passed after the vaccination, and the test result has changed dramatically, the baby needs additional examination, testing and chest x-ray.

1. Is it possible to prescribe prophylactic treatment against tuberculosis on the basis of diagnostic tests?

With the advent of a new diagnostic test, the number of unnecessarily prescribed treatment has decreased. Children with a positive Mantoux test and a negative Diaskintest are absolutely healthy, and their immunity is working.

The massive use of anti-tuberculosis drugs leads to an increase in the resistance of mycobacteria and the development of especially dangerous forms of the disease. Preventive treatment should be prescribed by a phthisiatrician after a thorough laboratory and instrumental examination of the child.

Conclusion

Much attention is paid to the prevention of tuberculosis in our country. And it is not surprising, because the disease is much easier to prevent, and in case of infection, the proper treatment must be prescribed in time. Therefore, all babies are vaccinated with BCG and diagnostic tests.

The use of a new type of diagnosis - Diaskintest allows you to more accurately identify the disease. This method is quite specific, and its reliability is close to 100%, which helps to identify tuberculosis in the early stages and to understand the need for treatment of an infectious disease. Understanding the importance of diagnostic tests and vaccinations, knowing what Diaskintest and vaccinations are, parents will be able to protect their child from such a dangerous disease as tuberculosis.