Mantoux,BCG scar

1. Spotters
Dr Vichithra M
Senior resident
Department of Pediatrics

2. Spotter 1
Identify the spotter in the image?
Strain used in PPD?
How many TU of PPD used for TST?
Dose of PPD for TST?

3. Administration
Site of administration?
What gauge needle is used and how much length?
Angle at which needle has to be inserted?
After injection, wheal of _____ mm is seen
If no wheal what should be done?

4. Interpretation
When and how will you interpret?
Type of hypersensitivity reaction?
When it is considered positive?
What if child comes after 72 hours?
What doses positive TST indicate?

5. Interference in BCG vaccine
• After what age you can do TST?
• What happens to TST because of BCG vaccine?

6. Causes of False negativity
• Incorrect technique of administration
or Interpretation
• Improper storage of tuberculin
• Immunodeficiency/suppression
• – Primary
– Secondary like HIV infection, SAM,
• Immunosuppressive (e.g. steroids)
• Infections
– Viral (e.g. measles, varicella)
– Bacterial (e.g. Typhoid, leprosy,
pertussis)
• Vaccinated with live viral vaccine
(within 6 weeks)
• Neonatal patients
• Severe forms of TB

7. Causes of False positivity
• Incorrect technique of Interpretation
• BCG vaccination
• Infection with mycobacterium other than TB

8. Spotter 2
Identify?
Site?

9. Vaccine
Identify the person in image
Who and when discovered BCG vaccine?
What is the type of vaccine used?
Available form of vaccine?
Strain used in BCG vaccine?

10. More about vaccine
Diluent used in vaccine?
How do you store vaccine?
How long you can keep an open vial?
Dose and route of BCG vaccine?
Raise a wheal of ____ diameter

11. Schedule and efficacy
• When will you give vaccine?
• Is it given all over the world?
• Efficacy of the vaccine?

12. Vaccine reaction
Papule: 2 - 3 weeks
4 – 8 mm size: 4 -6 weeks
Ulcer and scar: 6 - 12 weeks

13. Adverse effects of vaccine
• Axillary lymphadenitis
• Disseminated BCGosis
• BCG IRIS with HIV

14. Vaccine – more info
• With which vaccine BCG cannot be given?
• Contraindication for BCG vaccine?
• BCG vaccine to child born to a mother who is HIV positive?

15. No BCG scar
• Should we revaccinate?
• Is it normal?