Mantoux test

TB skin testing with the 5-TU strength of brand purified protein derivative (PPD), also known as the Mantoux test, is the preferred method for skin testing.2,16,20 The product is injected into the skin (not subcutaneously) with a fine (27-gauge) needle and produces a small, raised, blanched wheal to be read by an experienced professional in 48 to 72 hours. Criteria for interpretation are listed in Table 72-1.1,2,6,16,20 The Centers for Disease Control and Prevention (CDC) does not recommend the routine use of... 

Reactivation of latent tuberculosis is a major concern with infliximab (SEDA-26, 402), and accounts for about one-third of infections in these patients. According to data from the manufacturers, 130 cases of active tuberculosis were notified up to October 2001. Many of the cases were disseminated or extrapulmonary tuberculosis, and several patients died. Several case reports have provided detailed information in at least seven other patients, including three who developed miliary tuberculosis and one who developed Mycobacterium tuberculosis enteritis (44-48). A detailed analysis of 70 cases of tuberculosis reported to the FDA has been published (49). Two-thirds of the cases were noted after three or fewer infusions and 57% of the patients had extrapulmonary disease. There were 64 cases from countries with a low incidence of tuberculosis. From these reports and the number of patients treated with infliximab, the estimated rate of tuberculosis in patients with rheumatoid arthritis treated with infliximab was four times higher than the background rate. Patients with evidence of active infection should not receive infliximab until the infection is under control all should be screened for tuberculosis before starting infliximab (50). From these and other data it has been estimated that the risk of tuberculosis in the first year of infliximab treatment is 0.035 in US citizens and 0.2% in non-US citizens. Further investigations, such as a chest X-ray and a Mantoux test, and prophylactic treatment with isoniazid, will show whether the incidence can be reduced in patients taking anti-TNF treatment (51). 

The Mantoux test is the preferred TB skin test. It uses tubercuUn purified protein derivative (PPD), and unlike the Heaf or tine test, the Mantoux test is quantitative. The standard 5 tubercuUn unit PPD dose is placed intracutaneously on the volar aspect of the forearm with a 26- or 27-gauge needle. This injection should produce a small, raised, blanched wheal. An experienced professional should... 

Vukmanovic-Stejic M, Reed JR, Lacy KE, Rustin MHA, Akbar AN. Mantoux test as a model for a secondary immune response in humans. Immunol Lett 2006 107 93-101. 

Because of the risks of adverse reaction to the vaccine by persons who had already been exposed to the disease a sensitivity test must be carried out prior to immunization with BCG. A Mantoux skin test assesses an individual s sensitivity to a purified protein derivative (PPD) prepared fi om heat-treated antigens (tuberculin) extracted fiom M tuberculosis. A positive test imphes past infection or past, successful immunization Those with strongly positive tests may have active disease and should be referred to a chest clinic. Many people with active TB, especially disseminated TB, however, sero-convert fiom skin test positive to skin test negative. Results of the skin test must therefore be interpreted with care. 

Tuberculin skin testing is an important part of the care of all HIV-1-infected patients or persons at risk for HIV-1 infection. Tuberculin skin testing should be done using the Mantoux method. A tuberculin reaction of >5 mm of induration is classified as positive in persons known to have or suspected of having HIV-1 infection. Unfortunately, as the CD4 lymphocyte count declines with progression of HIV-1 disease, many patients no longer react to delayed-type hypersensitivity testing. More than 60% of persons with CD4 lymphocyte counts of <200 cells/pl may have skin test reactions of <5 mm. Thus, it is impossible to detect the presence of tuberculous infection in many HIV-l-infected individuals. 

Mantoux tuberculin skin test (Charles Mantoux) French physician Mantoux develops a skin-reaction test to diagnose tuberculosis. He builds on the work of Robert Koch and Clemens von Pirquet. 

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