Case studies to assess the efficiency of mantoux test

Role of Mantoux test in the diagnosis, though limited, cannot be underestimated in immune competent patients with an average nutritional status. Most persons likely to have the positive reaction develop mild erythema, induration, and itching by 24-28 hours. The positive reaction peaks at 48-70 hours with an area of erythematous induration that resolves within a week. We describe below a patient who developed a very large lesion after Mantoux testing (Anibarro et al., 2011).
CASE STUDY
A 46-year-old woman presented with intermittent, low-grade fever associated with headache since three months. There was no history of vomiting, cough, hemoptysis, weight loss, seizure, altered sensorium, or any specific anesthetic skin lesion. The patient denied any family history of the tuberculosis or leprosy. General physical and systemic examinations and observations were normal, except a single tender lymph node approximately 1 x 1 cm in the left axilla.

1. Case Studies To Assess The Efficiency Of Mantoux Test BY Dr. S.SREEREMYA FACULTY OF BIOLOGY

2. INTRODUCTION Role of Mantoux test in the diagnosis, though limited, cannot be underestimated in immune competent patients with an average nutritional status. Most persons likely to have the positive reaction develop mild erythema, induration, and itching by 24-28 hours. The positive reaction peaks at 48-70 hours with an area of erythematous induration that resolves within a week. We describe below a patient who developed a very large lesion after Mantoux testing ( Anibarro et al., 2011). CASE STUDY A 46-year-old woman presented with intermittent, low-grade fever associated with headache since three months. There was no history of vomiting, cough, hemoptysis , weight loss, seizure, altered sensorium, or any specific anesthetic skin lesion. The patient denied any family history of the tuberculosis or leprosy. General physical and systemic examinations and observations were normal, except a single tender lymph node approximately 1 x 1 cm in the left axilla.

3. Venereal Disease Research Laboratory (VDRL) and enzyme linked immune sorbent assay (ELISA) for the human immune deficiency virus (HIV) were nonreactive ( Chaturvedi et al., 1992). Chest radiograph did not show infiltration/ adenopathy and abdominal ultrasound was normal. Erythrocyte sedimentation rate was 76-77 mm in the 1st hour. Fundoscopy did not show any papilloedema . A Mantoux test was done by intradermal injection of 0.2 ml purified protein derivative (PPD) containing 5 tuberculin unit (0.1 μg standard PPD) on the anterior aspect of forearm. Patient started developing marked erythema and in duration within 6 hours. By 48 hours she developed a red lesion with marked in duration measuring 50 x 72 mm along with a prominent bullous lesion without ulceration or discharge. This massive lesion persisted for nearly two weeks. After the needle aspiration cytology of the left axillary lymph node specifically showed evidence of granuloma and necrosis along with acid fast bacilli (AFB).

4. She was diagnosed as tubercular lymphadenitis and started on category III ant tubercular regimen comprising of rifampicin 420 mg, isoniazid 300 mg, ethambutol 800 mg, and pyrazinamide 1000 mg daily for initial two months during intensive phase followed by rifampicin 420 mg and ionized 300 mg daily for four months during continuation phase. Patient showed quiet remarkable improvement of symptoms within a month of treatment with regression of lymph node size and is completely asymptomatic at present on completion of antitubercular therapy (Starke, 1996). Who needs a Mantoux test ( Anibarro et al., 2011?)  Recent contacts of someone who has active TB disease. This could be the family members, friends, or co-workers.  Those that have the chest X-ray with findings suggesting they have had untreated TB disease in the past. Plethysmography is another advanced technique by which lung related disorder can be observed ( Sreeremya (a) et al.,2018).Persons having bullous lung disease symptoms can also be examined for the mantoux test ( Sreeremya (b) et al.,2018).  People who have lowered immunity such as with HIV infection or medical conditions e.g. renal failure

5. Patients before they consume or start consuming steroids or other immunosuppressive drugs.  People who are required to be tested for the employment reasons or as part of a school screening program (provided they have not had a previous positive Mantoux test or active TB).  People about to undergo organ donation.  People donating an organ.  People travelling to a high risk TB country.  Infants and children greater than 6 months old being considered for BGC vaccine. THE MANTOUX TEST A Mantoux test is a simple and quiet safe test. A small amount of tuberculin purified protein derivative ( Tubersol ®) is injected just under the top layer of skin on a person’s arm availing a small sterile needle and syringe. The skin reaction (lump) is measured 2 to 3 days later and the result recorded

6. TB skin test is negative The test is “negative” if there is no bump (or only a very small bump) at the spot, site where the fluid was injected. A negative TB skin test usually means that you don’t have TB (Fig: 2). In some situations, you may need to have another TB skin test later (Al Zahrani et al., 2000). TB skin test is positive The test is “positive” if there is a bump of a certain size where the fluid was injected. This means one probably have TB germs in your body. Most people with a positive TB skin test have latent TB infection. To be sure, your doctor will examine you and give you a chest x-ray. One may need other tests to see if you have active TB disease

7.   Journal of General Nursing and Community Health, Case Studies To Assess The Efficiency Of Mantoux Test, Dr.S.Sreeremya , 2019.Vol 1(1):1-6.