Tuberculosis is a tricky disease. Its pathogen adapts very quickly to antibiotics. Treatment in this case is expensive and not always helps. Therefore, it is important to identify infected people. With this task more than 100 years did the Mantoux test. She was replaced by Diaskintest. Scientists argue: equivalent replacement and if not will it be a source of new tuberculosis epidemic among children?
That may mean changing the color of the skin at the injection site of the Mantoux test?
100 years in the afternoon
Tuberculosis is declared a social disease. If a person eats well, lives in favorable conditions, it should not hurt the tubercule Bacillus (as is traditionally called Mycobacterium tuberculosis) do not take root in a strong body. However, problems with immunity and close contact with man-bacteriolytical can play a fatal role. For example, in 2013 the Bataysk railway technical school in Rostov region were closed due to the epidemic of tuberculosis among the students. The source of infection appeared to be a student with an active form of the disease. He fell ill and was coughing, until he infected more than two dozen of his classmates. A similar case occurred just a few months ago in the Yaroslavl railway technical school. The situation discussed in the blogs, mothers of ill children are outraged, but the case was hushed up.
For the detection of tuberculosis infected people for more than 100 years use Mantoux test. In the USSR it is in the course of 1952. Intradermally injected tuberculin is a mixture of killed cultures filtrates of Mycobacterium tuberculosis “human” and “bovine” types. The drug identifies people infected with all the eight known types of tubercle bacilli. Allergic tuberculin reaction is most pronounced in the initial period of tuberculosis. At this time lesions in the organs are not yet formed or are so small that radiologically it is impossible to identify them. Who believes it is PPD is the most effective means for TB detection.
The main phthisiopediatric of the Ministry of health: “Tuberculosis in children has become less”
The years went by, and the Mantoux test have accumulated claims. Parents did not like that the child can thetemperature after setting the sample, and the “button” you cannot soak. Moreover, fear of the vaccine BCG “advanced” mom and dad moved to the diagnostic test, considering it grafting. Scientists searched for new methods of diagnosis. In 2008, Russia entered the market Diaskintest – intradermal test with artificial allergen. It is a proteins of Mycobacterium tuberculosis human species, grown in a E. coli genetic engineering method. It is clear that the test is positive in infected human, that is only one of the eight types of the tubercle Bacillus. All other agents remain “overboard”.
For eight years, do not stop a heated debate, which of diagnosis of tuberculosis more effective and safer. The main wells of the Yaroslavl region Lyudmila Vasilyeva believes that the Mantoux test today largely lost its meaning because “literally an avalanche-like increase of allergic reactions in children.” However, the smoke without fire does not happen. Russian medical school Abrikosov – Strukov – Serov has adequately proven that the “bullish” view mycobacteria can cause extrapulmonary tuberculosis with lesions in the kidneys, bones, brain and other organs. Extrapulmonary TB-TB and are diagnosed at very late stages. Epidemiology “bovine” tuberculosis is practically not studied due to the lack of available methods for its determination. But it is possible with high probability to assume that if 40-90% of people with a positive Mantoux test and Diaskintest at the same time negative, people infected by tubercular mycobacteria is not “human”, and another: in Russia most often bullish. These carriers should be identified and treated.
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Who came in second
Diaskintest have a lot of fans both among healthcare professionals and among practitioners. They call a lot of advantages. For example, the head of Department of Phthisiopulmonology of fgbu “Spbniifp” Ministry of health of Russia Anna Starshinova argues that the test Diaskintest with high sensitivity and specificity, allows high accuracy to identify individuals at early stages of the disease, and those with a high risk of developing TB. It allows to use the test with the drug Diaskintest for screening children and adolescents for tuberculosis is the Mantoux test.
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However, there are opposing opinions, and very reasoned. According to the Professor, head of laboratory of immunoprophylaxis, Central research Institute of epidemiology of Rospotrebnadzor Irina Mikheyeva, the sensitivity of the Mantoux test in identifying active TB in children was significantly higher than Diaskintest. Therefore, the transition to screening using DST the number of missed cases of active TB in children in the Russian Federation may be more than 300 cases per year. And this is the beginning of the epidemic.
Not instead, but together
Maybe in Russia wound up opponents of scientific progress, which put a spoke in the wheel of implementation of innovative diagnostic method? Not at all. The problem of diagnostics of tuberculosis has not been resolved at the global level. Head of the laboratory of immunological and molecular methods for diagnostics of tuberculosis, research Institute of Phthisiopulmonology, MD, Professor Mikhail Vladimir conducted a comparative analysis of foreign publications. The conclusion is clear: methods that use specific peptides from Mycobacterium tuberculosis, when high specificity is not sensitive enough. Last year’s study, conducted in Denmark with a full analogue of the Russian Diaskintest clearly showed it. So Russian opponents full transition to DST to accuse of bias is impossible. And the Ministry of health hurried to put an end to the debate, at least hastened.
Now on the official portal of legal information hanging the Order on the order of carrying out screening tests for TB detection. In accordance with him samples from Diaskintest will replace the Mantoux test in all groups, except for children up to 7 years this fall. This contradicts the current Regulations which is in the form of the law.
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It is quite obvious that the discussion is about a complete transition to DST too early. “It should be noted that officially intradermal DST was approved only 5 years ago and is only in Russia – we read in No. 2 of the journal “Epidemiology and vaccinal prevention” from 2013. – From our point of view, currently there is confident the scientific evidence that latent TB due to the cancellation of the Mantoux test, missed in children of older age groups and teenagers in a few years will not respond “epidemic rebound” in the form of a sharp increase in the number of active forms of tuberculosis”, – said the author of the article, chair of the Department of Microbiology, Virology and immunology Spbpgmu, laureate of state prize of the USSR Alexander Korolyuk.
His assumptions are justified: according to official statistics, the decline in 2015 compared to 2014, total incidence of tuberculosis 3.0% was noted in increased incidence in adolescents in 48 of the 85 subjects of the Federation (56.5 percent), and among children – 35 (41,2%) regions. In 2015, the increase in the incidence of children and adolescents occurred in 64 of the 85 subjects of the Federation that is 75.3%. This growth occurred on the background of the application of DST.
But this does not mean that the creators of DST have done a great job in vain. “Diaskintest and tuberculin have their niches in the diagnosis of tuberculosis and must, in some cases, to Supplement (but not replace) each other, – says head of the Department of immunobiotechnology, Deputy Director Spbniivs Professor Igor Krasilnikov. – Mass for the primary diagnosis of tuberculosis should be used in Mantoux test the standard formulation with modern drug tuberculin. And Diaskintest is a convenient and effective test to confirm the specificity of tuberculosis”.
Security – under the question
One of the arguments supporters of DST was its improved tolerability. However, DST can cause serious allergic reactions. In December 2015, the company “Generium” was forced to suspend the production and sale of one series of the drug. It happened after the death of six-year-old daughter during the injection of DST in TB dispensary in Smolensk. Roszdravnadzor has started the test, but on 2 June 2016 selling this series of the drug was resumed.