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As the global focus on tuberculosis (TB) continues to increase, Mantoux testing, as an important screening tool, has become the cornerstone of the diagnosis and response to tuberculosis.This test is not just a simple skin injection, but it also covers the complex science of how the human body fights tuberculosis bacteria.
The core purpose of the Mantoux test is to detect the body's immune response to tuberculosis bacterial protein.
History of tests
The Mantoux test was originally developed by German doctor Felix Mendel in 1908 and was named after French doctor Charles Mantoux.Its predecessor was the vaccine reaction described by Robert Koch in 1890.With in-depth research on tuberculosis bacterial proteins, Koch's work laid the foundation for later detection technology.
In the 1930s, Florence B. Seibert successfully extracted purified protein derivatives (PPDs), which supported the reliability of the Mantoux test.
Testing process
The standard procedure for the Mantoux test is to inject 5 TU of tuberculin under the skin of the forearm, approximately between the elbow and wrist.The correct injection should create a light-colored expansion area on the skin surface, with a diameter of 6 to 10 mm.
The results of this test need to be interpreted after 48 to 96 hours, and are usually recommended to perform within 72 hours.This reaction is a typical example of the delayed allergic reaction (DTH) of the human immune system to tuberculosis.
How to interpret the test results
The interpretation of Mantoux test results is very important and must be carried out based on the individual's medical risk factors.For example, in some high-risk groups, such as HIV-positive patients or patients with recent exposure to tuberculosis, 5 mm and above skin sclerosis is considered a positive reaction.For low-risk groups, a larger range of sclerosis may be required to confirm positive results.
The positive results of the tuberculosis test should be interpreted with caution, as false positives and false negative reactions are possible.
False positive and false negative results
False positive results can be caused by a variety of reasons, including past vaccination with BCG or other non-tuberculous mycobacterium infections.When the injection site is touched, it can also cause swelling, causing incorrect readings.
False negative results appear due to suppression of the immune system, such as in the event of recent TB infection, or due to steroid therapy.
For certain populations, such as AIDS patients, Mantoux tests may not effectively display infection.
BCG vaccine and Mantoux test
The interpretation of the results of people vaccinated with BCG vaccine when conducting Mantoux tests is controversial.The U.S. Centers for Disease Control and Prevention (CDC) recommends that BCG vaccination should not affect the interpretation of the results of the Mantoux test, while the United Kingdom recommends the use of interferon-γ release tests (IGRAs) to assist in explaining positive results above 59 mm.
Latest developments and alternatives
With the advancement of technology, interferon-γ release tests (IGRAs) have begun to be widely used clinically.In some cases, IGRAs can replace traditional Mantoux tests, especially in patients with an impact on the immune system, which provide more targeted results.
In 2005, the CDC updated guidelines also reclassified the results of the Mantoux test, with a more detailed interpretation based on previous or baseline results.
Conclusion
With the popularity and development of Mantoux testing, how to more effectively deal with the challenges of tuberculosis on a global scale has become an important topic in the medical community.This test is not only a tool for doctors to diagnose, but also a window to study the body's response to tuberculosis bacteria.How will future developments change our understanding and response to tuberculosis?
