:Mantoux Test :
The TB skin test, also known as the Mantoux test, tells if your body has been
exposed to the TB germ.
The nurse will inject a small amount of fluid just under the skin of the left forearm.
You will see a little bubble or blister appear right away at the injection site. This is
normal and it will soon disappear.
After 2-3 days, you will be asked to see the nurse to have the area checked and the
reaction measured.
If there is no reaction after 2-3 days, you most probably have not been exposed to
the TB germ.
If there is a reaction, some redness and a small bump will appear on the arm.
A measurement of 10 millimetres or more is "positive", and means you may have
the TB germ in your body. At that point, the nurse will request additional
information and tests, including chest x-ray and the collection of sputum samples.
When results are abnormal, the nurse will then consult with a medical health
officer who may then recommend a further course of action.
What Is a Mantoux Tuberculin Skin Test (2TU)?
The Mantoux Tuberculin Skin Test (2TU) is a standard diagnostic tool used to screen for
exposure to tuberculosis bacteria. Unlike blood-based tests, this procedure involves intra
dermal injection of tuberculin purified protein derivative (PPD) and does not require a
separate biological sample. Instead, a healthcare professional injects a small amount of
tuberculin fluid just under the skin of your forearm. The test helps detect latent TB infection
(where bacteria are present but inactive). A positive test supports, but does not confirm, the
diagnosis of active TB disease.
What Does the Mantoux Tuberculin Skin Test (2TU) Measure?
The Mantoux test measures your immune system's response to tuberculosis
bacteria through several key indicators:
Immune system recognition: It checks if your body has developed
immunity after exposure to TB bacteria.
Skin reaction measurement: The test measures the size of swelling
(induration) that develops at the injection site.
TB exposure indication: A positive reaction indicates prior sensitization
to Mycobacterium tuberculosis antigens, which may result from infection,
BCG vaccination, or exposure to non-tuberculous mycobacteria.
Delayed hypersensitivity response: It evaluates your body's cell-
mediated immune response to tuberculin proteins.
Mantoux Tuberculin Skin Test (2TU): Who Needs It and Why It's Done
What Symptoms May Call for a Mantoux Tuberculin Skin Test (2TU)?
Your doctor may recommend the Mantoux test if you experience symptoms that
could suggest tuberculosis infection:
Persistent cough lasting more than two weeks, sometimes producing
blood-streaked sputum (hemoptysis).
Unexplained fever, particularly in the evening
Significant weight loss and loss of appetite
Night sweats
Chest pain
General fatigue and weakness
Who Should Get a Mantoux Tuberculin Skin Test (2TU)?
Several groups of people benefit from Mantoux testing for early detection and
prevention:
People with TB symptoms: Anyone showing signs mentioned above.
High-risk individuals: Those in close contact with TB patients,
healthcare workers, or people with weakened immune systems.
Immunocompromised patients: Individuals with HIV/AIDS, diabetes,
cancer, or kidney disease
Medication users: People taking immunosuppressant drugs like steroids
or medications for autoimmune conditions.
Preventive screening: Individuals living in high TB prevalence areas or
crowded settings.
Why Is a Mantoux Tuberculin Skin Test (2TU) Done?
The Mantoux test serves as a primary screening tool to identify individuals who
may have TB infection. It allows doctors to proceed with further diagnostic tests
and begin timely treatment to prevent disease progression and spread.
Importance of a Mantoux Tuberculin Skin Test (2TU)
The Mantoux test plays a crucial role in tuberculosis control and public health
management. It provides early detection through simple, cost-effective
screening of large populations, helping identify both active and latent TB
infections.
The test guides further diagnosis by signalling doctors to conduct additional
tests like chest X-rays and sputum analysis when results are positive. Most
importantly, it enables preventive therapy for latent TB infections, significantly
reducing the risk of developing active disease later in life, especially when
immunity weakens.
What is the principle of the Tuberculin sensitivity test (TT) and the
Mantoux test?
1. The Tuberculin test (TT) is important in diagnosing and preventing
tuberculosis.
1. This test is more sensitive than the X-ray chest.
2. This test is done on the patient, in which purified protein derivatives (PPD)
are stabilized by Tween 80 (polysorbate 80-coated nanoparticles) injected
into the skin (Intradermal).
1. The standard test material is intermediate-strength, 5 tuberculin units,
PPD.
3. Lymphocytes will recognize PPD as an antigen and give rise to type IV,
cell-mediated reaction.
4. There will be a local inflammatory reaction in a person who has TB or has
past exposure to TB.
5. This test will give a severe reaction in the case of active TB or patients with
vaccination. The skin may slough.
How would you read the Tuberculin test (TT) or Mantoux test:
1. Read the test area after 48 to 72 hours of the injection.
2. The negative case is when there is no induration.
3. In positive cases, there will be induration at the site of injection appearing in
48 to 72 hours.
Mycobacterium tuberculosis: Tuberculin test, Mantoux skin test (T T)
What are the criteria of the American Thoracic Society and CDC?
1. They suggest the following criteria for different population groups:
2. Induration <5 mm Diameter is seen in:
1. HIV patients or immunodeficiency state.
2. Or a patient with a CMI defect.
3. Close contact with active TB case.
4. The patient had an X-ray finding of old TB.
5. Patients with fibrosis or calcification in the lung suggest previous
pulmonary tuberculosis.
3. Induration >10 mm in Diameter seen in:
1. I/V drug users.
2. Nursing home residents.
3. The traveler from the endemic or high-risk area of Tuberculosis,
prisoners, homeless, I/V drug abusers, and other chronically ill
patients.
4. A worker in the home care facility.
5. Malnutrition, postgastrectomy, steroid use, and Diabetes.
4. Induration >15 mm in diameter seen in:
1. Patient with active TB.
2. All patients who don’t fulfill the above criteria.
5. A booster reaction may be mistaken for conversion among hospital workers
or other people where repeated testing is needed.
6. In cases where the primary reaction is negative, or the result is in doubt, give
the second dose after one week.
7. If the size of the induration is increased by more than 6 mm next year, a new
tuberculous infection may be suggested.
What are the contraindications for the Tuberculin and Mantoux
skin tests (T T)?
1. A patient who has active TB will have a very severe reaction.
2. A patient who has a vaccination with Bacillus Calmette Guerin (BCG).
3. No use in a malnourished patient.
Where will you see the positive Tuberculin and Mantoux skin tests (TT)?
1. An active case of TB.
2. Other types of Mycobacterial infection.
Where will you see a negative Tuberculin or Mantoux skin test
(TT)?
1. Immune incompetent chronically ill patient.
2. The patient was not exposed to TB.
3. It is found that 20% of the HIV-negative and 40% of HIV-positive cases have
tuberculosis.
4. Viral infections, including measles and rubella, can suppress tuberculin reactivity.
However, this effect is transient.
Because the tuberculin skin test is limited in sensitivity and specificity, new methods,
such as a sandwich-capture enzyme-linked immune absorbent assay, are being developed
to diagnose Mycobacterium tuberculosis infection.