The document provides information about intradermal tests. It defines intradermal tests as tests that involve injecting small amounts of diluted antigens into the skin. The document discusses the procedure for performing intradermal tests and interpreting the results. It also describes several specific intradermal tests used to diagnose infectious diseases like tuberculosis, leprosy, fungal infections, and parasitic infections as well as non-infectious conditions.
This document provides information on applying anti-embolic stockings, including their purpose to prevent deep vein thrombosis, contraindications for use, assessment steps, equipment needed, and application procedure and rationale. Key points are that stockings promote blood flow from the legs and prevent clots, should be properly fitted to avoid constriction or looseness, and removed twice daily to assess skin while encouraging leg exercises in between.
This document discusses medicated baths, which involve dispersing medication in water for therapeutic purposes to treat dermatological conditions. It describes different types of medicated baths like Epsom salt baths, oat meal baths, and sulfur baths. The document provides indications for various medicated baths to treat issues like psoriasis, eczema, itching, and arthritis pain. It outlines the preparatory, performance, and follow-up phases of administering a medicated bath and notes supplies needed. Potential complications are mentioned along with nursing responsibilities to monitor patients during and after medicated baths.
Skin allergy testing involves using small amounts of potential allergens on the skin to identify allergic reactions. There are different types of tests that detect immediate (within minutes) or delayed (over days) reactions. The skin prick test uses tiny needles to prick potential allergens into the top layer of the skin. Results are read within 15 minutes to see if any raised, red bumps form indicating an allergy. Patch testing applies allergens to patches worn on the skin for 48 hours to detect delayed reactions. Results show any irritated skin remaining after removal. Skin tests help identify allergies to substances like pollen, mold, foods or chemicals that cause skin irritation.
This document defines and classifies wounds and wound drainage. It discusses the process of wound healing, which involves inflammatory, proliferative and maturation phases. Factors that can influence wound healing include nutrition, tissue perfusion, infection and age. Wound management strategies involve moist wound healing, preventing infection, nutrition/fluids, positioning and preventing pressure ulcers. Complications of wound healing include hemorrhage, infection, dehiscence and evisceration.
Thoracentesis is a procedure to remove fluid or air from the pleural cavity through insertion of a needle into the chest wall. It is indicated for conditions such as pleural effusion, pneumonia, or trauma. The nurse prepares equipment like syringes, needles, and specimen containers and assists the physician by administering local anesthetic, observing for complications, and providing aftercare like monitoring for bleeding or infection. Precise technique and positioning are important to safely drain fluid and avoid injuries to lungs during the procedure.
Intradermal injection- Introduction, procedure,complications Ganga Tiwari
This document provides information about intradermal injections, including the purpose, common sites, required equipment, and procedure. An intradermal injection deposits medication into the dermis just below the epidermis, allowing for long absorption. Common sites are the inner forearm, upper arm, back, and chest. The procedure involves preparing the medication, cleaning the injection site, inserting the needle at a 5-15 degree angle just under the skin, injecting the medication to form a wheal, and properly disposing of supplies. Potential complications include redness, tenderness, abscess, and keloid scarring.
Scrubbing, gowning and gloving techniqueSudhir Jain
This document outlines proper scrubbing, gowning, and gloving technique for surgical procedures. It discusses removing transient and resident microorganisms from the skin through mechanical washing using scrubbing agents like soap, povidone iodine, or chlorhexidine for 5-10 minutes. Proper attire is also covered, including scrub suits, caps, masks, and protective clothing. The scrubbing procedure is described in steps from washing hands and nails to drying with towels. Gowning involves putting arms in a sterile gown without touching the outside and keeping hands in sight at all times. Gloves are put on using either an open or closed method.
This document provides information about rectal suppositories, including their purpose, equipment needed, and procedures for administration. Rectal suppositories are solid, cone-shaped masses that melt at body temperature to produce a bowel movement, soften feces, relieve pain, soothe the bowel, and stimulate secretion. The procedure involves explaining it to the patient, providing privacy, positioning the patient, inserting the tapered end of the suppository into the anal canal, and having the patient apply pressure over the anus to retain it.
This document provides information on applying anti-embolic stockings, including their purpose to prevent deep vein thrombosis, contraindications for use, assessment steps, equipment needed, and application procedure and rationale. Key points are that stockings promote blood flow from the legs and prevent clots, should be properly fitted to avoid constriction or looseness, and removed twice daily to assess skin while encouraging leg exercises in between.
This document discusses medicated baths, which involve dispersing medication in water for therapeutic purposes to treat dermatological conditions. It describes different types of medicated baths like Epsom salt baths, oat meal baths, and sulfur baths. The document provides indications for various medicated baths to treat issues like psoriasis, eczema, itching, and arthritis pain. It outlines the preparatory, performance, and follow-up phases of administering a medicated bath and notes supplies needed. Potential complications are mentioned along with nursing responsibilities to monitor patients during and after medicated baths.
Skin allergy testing involves using small amounts of potential allergens on the skin to identify allergic reactions. There are different types of tests that detect immediate (within minutes) or delayed (over days) reactions. The skin prick test uses tiny needles to prick potential allergens into the top layer of the skin. Results are read within 15 minutes to see if any raised, red bumps form indicating an allergy. Patch testing applies allergens to patches worn on the skin for 48 hours to detect delayed reactions. Results show any irritated skin remaining after removal. Skin tests help identify allergies to substances like pollen, mold, foods or chemicals that cause skin irritation.
This document defines and classifies wounds and wound drainage. It discusses the process of wound healing, which involves inflammatory, proliferative and maturation phases. Factors that can influence wound healing include nutrition, tissue perfusion, infection and age. Wound management strategies involve moist wound healing, preventing infection, nutrition/fluids, positioning and preventing pressure ulcers. Complications of wound healing include hemorrhage, infection, dehiscence and evisceration.
Thoracentesis is a procedure to remove fluid or air from the pleural cavity through insertion of a needle into the chest wall. It is indicated for conditions such as pleural effusion, pneumonia, or trauma. The nurse prepares equipment like syringes, needles, and specimen containers and assists the physician by administering local anesthetic, observing for complications, and providing aftercare like monitoring for bleeding or infection. Precise technique and positioning are important to safely drain fluid and avoid injuries to lungs during the procedure.
Intradermal injection- Introduction, procedure,complications Ganga Tiwari
This document provides information about intradermal injections, including the purpose, common sites, required equipment, and procedure. An intradermal injection deposits medication into the dermis just below the epidermis, allowing for long absorption. Common sites are the inner forearm, upper arm, back, and chest. The procedure involves preparing the medication, cleaning the injection site, inserting the needle at a 5-15 degree angle just under the skin, injecting the medication to form a wheal, and properly disposing of supplies. Potential complications include redness, tenderness, abscess, and keloid scarring.
Scrubbing, gowning and gloving techniqueSudhir Jain
This document outlines proper scrubbing, gowning, and gloving technique for surgical procedures. It discusses removing transient and resident microorganisms from the skin through mechanical washing using scrubbing agents like soap, povidone iodine, or chlorhexidine for 5-10 minutes. Proper attire is also covered, including scrub suits, caps, masks, and protective clothing. The scrubbing procedure is described in steps from washing hands and nails to drying with towels. Gowning involves putting arms in a sterile gown without touching the outside and keeping hands in sight at all times. Gloves are put on using either an open or closed method.
This document provides information about rectal suppositories, including their purpose, equipment needed, and procedures for administration. Rectal suppositories are solid, cone-shaped masses that melt at body temperature to produce a bowel movement, soften feces, relieve pain, soothe the bowel, and stimulate secretion. The procedure involves explaining it to the patient, providing privacy, positioning the patient, inserting the tapered end of the suppository into the anal canal, and having the patient apply pressure over the anus to retain it.
This document provides information on suture and wound care. It defines sutures as stitches used to close cuts and wounds, noting that absorbable sutures dissolve in the body while non-absorbable must be removed. It provides guidance on suture care including keeping the area covered, clean, and dry for 24-48 hours and not trimming sutures. It also describes the process for suture removal using sterile forceps and scissors. The document offers tips for cleaning wounds and helping them heal properly.
This document discusses different types of surgical drains used to remove fluid from wounds. It describes corrugated drains, rubber tubes, T-tubes, and gauze wicks that are used for specific types of surgeries and wounds. The document also categorizes different characteristics of wound drainage as serous, sanguineous, or purulent. It provides guidance on cleaning the drain site and surrounding skin from the cleanest to most contaminated area.
The document discusses different types of intestinal ostomies including colostomies. It describes the procedure for colostomy care including necessary supplies, assessment of the stoma, cleaning and changing the pouch and barrier. Guidelines are provided such as checking the stoma regularly, keeping the skin clean and dry, and recording intake and output. Drainable pouches are used when frequent emptying is needed and one-piece or two-piece pouches can be used.
STITCH OUT PROTOCOL
SUTURE REMOVAL
Sutures are used for wound stabilization All sutures, being foreign bodies, cause irritation to the tissues & hence have the potential to cause scarring.
PRINCIPLE OF SUTURE REMOVAL
Suture area is first clean with normal saline. The suture is then pulled towards the incision line to prevent dehiscence. If suture entrapped in a scab, application of Hydrogen peroxide/normal saline is necessary
If pieces of suture left are left out infection may occur. RECOMMENDED
DURATION
FAILURE OF WOUND CLOSURE
AFTER SUTURING
• Breakage
Extruded suture
Cuts out
Resorbs too rapidly
Knot slips
Removed too early
POSSIBLE COMPLICATIONS
HYPERTROPHIC SCAR
KELOID
INFECTION
THANK YOU
Topical medications are applied directly to body surfaces like the skin and mucous membranes. They come in many forms like creams, ointments, gels, and patches. The purpose is to deliver medication directly to irritated, inflamed, or infected areas of the skin or other tissues. Topical medications must be administered carefully according to safety protocols to avoid accidental exposure and ensure proper absorption of the drug. Common topical medications include antibiotics, steroids, and pain relievers.
Assisting with Cast application and removal.pptxAbdiWakjira2
The document discusses the application and removal of casts. It defines a cast as a rigid external device used to immobilize and support injured body parts. The objectives are to define casts, learn how to apply and remove them, and provide post-cast care. Key steps in application include preparing equipment, positioning the injured area, applying padding and casting material, and ensuring proper drying. Care involves monitoring for complications and ensuring the cast remains intact and dry. Removal requires checking for healing and using specialized tools to carefully cut and remove the cast.
Dermatitis is an inflammation of the skin that causes redness, swelling and itchiness. There are many types of dermatitis including atopic dermatitis, contact dermatitis and seborrheic dermatitis. Contact dermatitis occurs when the skin comes into contact with an irritant or allergen and can be either irritant or allergic in nature. Symptoms vary depending on the type but may include a rash, blisters, dry cracked skin and itchiness. Treatment involves identifying and avoiding triggers, using moisturizers and topical or oral medications like corticosteroids and antihistamines.
This document provides instructions for caring for various types of drainage tubes and recording output. It specifies that drains should be emptied regularly, the fluid measured and disposed of properly, and the output recorded. A special Stryker reinfusion drain is also described which collects and filters blood post-operatively to allow for reinfusion by a nurse, as long as certain volume and timing requirements are met.
Paracentesis is a procedure to remove fluid from the peritoneal cavity for diagnostic and therapeutic purposes. Large amounts of ascites fluid can cause respiratory compromise by exerting pressure on the diaphragm and abdominal organs. Paracentesis relieves this pressure and improves breathing. Key steps include ultrasound assessment, local anesthesia, inserting a needle into the abdomen, draining fluid, and analyzing laboratory samples of the fluid. Complications may include infection, bleeding, or organ damage.
An intradermal injection involves inserting medication into the dermis where absorption is slow. It is used for sensitivity tests, vaccinations like BCG, and diagnostic tests. The inner forearm and deltoid region are common sites. Materials needed include a tuberculin syringe, alcohol swab, gloves, and tray. Proper steps include preparing the site, inserting the needle at a 15 degree angle, injecting slowly, withdrawing, observing for reactions, and documenting.
The document provides information on basic life support (BLS) procedures. It outlines the steps of BLS which include ensuring safety, checking for response, activating emergency services, performing chest compressions, checking airway and ventilating, and defibrillating if needed. It describes how to check for a response using the COWS method (Can you hear me, Open your eyes, What is your name, Squeeze my hand). Instructions are given on performing chest compressions, opening the airway, performing rescue breathing with different devices, and using an automated external defibrillator (AED).
This document discusses surgical wound dressing. It defines a surgical wound and different types of dressings used including semi-permeable film, foam, hydrogel, hydrocolloid and alginate dressings. The purpose and principles of wound dressing are explained. The preparation needed for surgical wound dressing is described along with the articles and equipment required. The step-by-step procedure for surgical wound dressing is demonstrated along with safety considerations and documentation requirements.
The document discusses the insertion of a nasogastric tube. It begins by noting the risks of misplacement and discusses confirming proper placement through pH testing and aspiration rather than auscultation. It then defines NG tubes and describes their types, purposes, indications, contraindications and size selection. The procedure section outlines preparing supplies, positioning the patient, measuring and lubricating the tube, inserting it into the stomach, confirming placement, and post-care steps like securing and cleaning the tube.
This document provides information and guidelines for emergency medical responders (EMRs) on maintaining peripheral intravenous lines for stable patients during transport. It discusses the EMR's role in safely handling and transporting patients with existing IVs. It outlines personal safety concerns, required skills like adjusting drip rates and changing IV bags, and goals around keeping the IV patent and monitoring for complications. The document specifies considerations for IV transport, authorized and unauthorized IV solutions, complications, stabilization techniques, flow rate factors, drip rate calculations, troubleshooting problems, and required documentation.
This document provides guidelines for nurses on performing wound dressings using aseptic technique. It outlines the objectives, standards, purposes and types of dressings used. It then describes the step-by-step procedure for aseptic wound dressing, which involves preparing the necessary items, maintaining sterile technique, applying the appropriate dressing, and documenting wound findings. The overall aim is to promote wound healing through proper dressing while preventing infection.
This document outlines the process for wound dressing. The key aims are to keep the wound clean, lessen the spread of microorganisms, hasten tissue healing, and absorb or localize drainage. The procedure involves preparing sterile equipment and the patient, cleaning the wound with antiseptic solution, removing any dead tissue, applying a sterile dressing, and securing it with a bandage. Proper hand washing and sterile technique are emphasized to prevent infection.
Urinary catheterization involves inserting a latex, polyurethane, or silicone tube called a catheter into the bladder via the urethra to drain urine. It can be used to inject fluids for treatment or diagnosis. There are two main types: indwelling catheters that remain in place and intermittent catheters that are inserted and removed. The procedure involves preparing equipment, positioning the patient, cleaning the area, lubricating and inserting the catheter, inflating the balloon, and securing drainage. Complications can include infection, injury, and incontinence. Proper technique and aftercare are important to prevent issues.
A chest tube is a catheter inserted through the chest wall to drain air, fluid, or pus from the pleural space and maintain negative pressure. It is indicated for conditions like pneumothorax, hemothorax, and pleural effusions. The chest tube is connected to a drainage system, usually a three bottle system, to continuously drain the pleural space and prevent a build up of air or fluid that could impair lung function. Nurses monitor the chest tube drainage closely and ensure the system remains intact and functioning properly to allow for full lung re-expansion and recovery following chest tube insertion.
The Mendel-Mantoux test, also known as the tuberculin sensitivity test, is used to screen for tuberculosis. It involves an intradermal injection of purified protein derivative (PPD) tuberculin, obtained from TB cultures. The test site is read 48-72 hours later to measure any induration, indicating an immune response. Induration sizes of 5-9mm, 10-14mm, and 15mm or more suggest different levels of TB infection risk or exposure. False positives can occur from BCG vaccines or atypical mycobacteria, while false negatives are possible due to various medical conditions that compromise immunity.
Cell-mediated immunity involves activation of phagocytes, cytotoxic T-lymphocytes, and cytokines in response to antigens, rather than antibodies. Effector cells include cytotoxic T cells, NK cells, and those performing ADCC. Cell-mediated immunity can be assessed using tests such as mixed lymphocyte reaction, cell-mediated lympholysis, and graft versus host. Delayed-type hypersensitivity is a type of hypersensitivity reaction mediated by T cells rather than antibodies, and can be assessed using skin tests such as Mantoux, patch, and intradermal tests. These tests measure induration resulting from local cytokine and chemokine production.
This document provides information on suture and wound care. It defines sutures as stitches used to close cuts and wounds, noting that absorbable sutures dissolve in the body while non-absorbable must be removed. It provides guidance on suture care including keeping the area covered, clean, and dry for 24-48 hours and not trimming sutures. It also describes the process for suture removal using sterile forceps and scissors. The document offers tips for cleaning wounds and helping them heal properly.
This document discusses different types of surgical drains used to remove fluid from wounds. It describes corrugated drains, rubber tubes, T-tubes, and gauze wicks that are used for specific types of surgeries and wounds. The document also categorizes different characteristics of wound drainage as serous, sanguineous, or purulent. It provides guidance on cleaning the drain site and surrounding skin from the cleanest to most contaminated area.
The document discusses different types of intestinal ostomies including colostomies. It describes the procedure for colostomy care including necessary supplies, assessment of the stoma, cleaning and changing the pouch and barrier. Guidelines are provided such as checking the stoma regularly, keeping the skin clean and dry, and recording intake and output. Drainable pouches are used when frequent emptying is needed and one-piece or two-piece pouches can be used.
STITCH OUT PROTOCOL
SUTURE REMOVAL
Sutures are used for wound stabilization All sutures, being foreign bodies, cause irritation to the tissues & hence have the potential to cause scarring.
PRINCIPLE OF SUTURE REMOVAL
Suture area is first clean with normal saline. The suture is then pulled towards the incision line to prevent dehiscence. If suture entrapped in a scab, application of Hydrogen peroxide/normal saline is necessary
If pieces of suture left are left out infection may occur. RECOMMENDED
DURATION
FAILURE OF WOUND CLOSURE
AFTER SUTURING
• Breakage
Extruded suture
Cuts out
Resorbs too rapidly
Knot slips
Removed too early
POSSIBLE COMPLICATIONS
HYPERTROPHIC SCAR
KELOID
INFECTION
THANK YOU
Topical medications are applied directly to body surfaces like the skin and mucous membranes. They come in many forms like creams, ointments, gels, and patches. The purpose is to deliver medication directly to irritated, inflamed, or infected areas of the skin or other tissues. Topical medications must be administered carefully according to safety protocols to avoid accidental exposure and ensure proper absorption of the drug. Common topical medications include antibiotics, steroids, and pain relievers.
Assisting with Cast application and removal.pptxAbdiWakjira2
The document discusses the application and removal of casts. It defines a cast as a rigid external device used to immobilize and support injured body parts. The objectives are to define casts, learn how to apply and remove them, and provide post-cast care. Key steps in application include preparing equipment, positioning the injured area, applying padding and casting material, and ensuring proper drying. Care involves monitoring for complications and ensuring the cast remains intact and dry. Removal requires checking for healing and using specialized tools to carefully cut and remove the cast.
Dermatitis is an inflammation of the skin that causes redness, swelling and itchiness. There are many types of dermatitis including atopic dermatitis, contact dermatitis and seborrheic dermatitis. Contact dermatitis occurs when the skin comes into contact with an irritant or allergen and can be either irritant or allergic in nature. Symptoms vary depending on the type but may include a rash, blisters, dry cracked skin and itchiness. Treatment involves identifying and avoiding triggers, using moisturizers and topical or oral medications like corticosteroids and antihistamines.
This document provides instructions for caring for various types of drainage tubes and recording output. It specifies that drains should be emptied regularly, the fluid measured and disposed of properly, and the output recorded. A special Stryker reinfusion drain is also described which collects and filters blood post-operatively to allow for reinfusion by a nurse, as long as certain volume and timing requirements are met.
Paracentesis is a procedure to remove fluid from the peritoneal cavity for diagnostic and therapeutic purposes. Large amounts of ascites fluid can cause respiratory compromise by exerting pressure on the diaphragm and abdominal organs. Paracentesis relieves this pressure and improves breathing. Key steps include ultrasound assessment, local anesthesia, inserting a needle into the abdomen, draining fluid, and analyzing laboratory samples of the fluid. Complications may include infection, bleeding, or organ damage.
An intradermal injection involves inserting medication into the dermis where absorption is slow. It is used for sensitivity tests, vaccinations like BCG, and diagnostic tests. The inner forearm and deltoid region are common sites. Materials needed include a tuberculin syringe, alcohol swab, gloves, and tray. Proper steps include preparing the site, inserting the needle at a 15 degree angle, injecting slowly, withdrawing, observing for reactions, and documenting.
The document provides information on basic life support (BLS) procedures. It outlines the steps of BLS which include ensuring safety, checking for response, activating emergency services, performing chest compressions, checking airway and ventilating, and defibrillating if needed. It describes how to check for a response using the COWS method (Can you hear me, Open your eyes, What is your name, Squeeze my hand). Instructions are given on performing chest compressions, opening the airway, performing rescue breathing with different devices, and using an automated external defibrillator (AED).
This document discusses surgical wound dressing. It defines a surgical wound and different types of dressings used including semi-permeable film, foam, hydrogel, hydrocolloid and alginate dressings. The purpose and principles of wound dressing are explained. The preparation needed for surgical wound dressing is described along with the articles and equipment required. The step-by-step procedure for surgical wound dressing is demonstrated along with safety considerations and documentation requirements.
The document discusses the insertion of a nasogastric tube. It begins by noting the risks of misplacement and discusses confirming proper placement through pH testing and aspiration rather than auscultation. It then defines NG tubes and describes their types, purposes, indications, contraindications and size selection. The procedure section outlines preparing supplies, positioning the patient, measuring and lubricating the tube, inserting it into the stomach, confirming placement, and post-care steps like securing and cleaning the tube.
This document provides information and guidelines for emergency medical responders (EMRs) on maintaining peripheral intravenous lines for stable patients during transport. It discusses the EMR's role in safely handling and transporting patients with existing IVs. It outlines personal safety concerns, required skills like adjusting drip rates and changing IV bags, and goals around keeping the IV patent and monitoring for complications. The document specifies considerations for IV transport, authorized and unauthorized IV solutions, complications, stabilization techniques, flow rate factors, drip rate calculations, troubleshooting problems, and required documentation.
This document provides guidelines for nurses on performing wound dressings using aseptic technique. It outlines the objectives, standards, purposes and types of dressings used. It then describes the step-by-step procedure for aseptic wound dressing, which involves preparing the necessary items, maintaining sterile technique, applying the appropriate dressing, and documenting wound findings. The overall aim is to promote wound healing through proper dressing while preventing infection.
This document outlines the process for wound dressing. The key aims are to keep the wound clean, lessen the spread of microorganisms, hasten tissue healing, and absorb or localize drainage. The procedure involves preparing sterile equipment and the patient, cleaning the wound with antiseptic solution, removing any dead tissue, applying a sterile dressing, and securing it with a bandage. Proper hand washing and sterile technique are emphasized to prevent infection.
Urinary catheterization involves inserting a latex, polyurethane, or silicone tube called a catheter into the bladder via the urethra to drain urine. It can be used to inject fluids for treatment or diagnosis. There are two main types: indwelling catheters that remain in place and intermittent catheters that are inserted and removed. The procedure involves preparing equipment, positioning the patient, cleaning the area, lubricating and inserting the catheter, inflating the balloon, and securing drainage. Complications can include infection, injury, and incontinence. Proper technique and aftercare are important to prevent issues.
A chest tube is a catheter inserted through the chest wall to drain air, fluid, or pus from the pleural space and maintain negative pressure. It is indicated for conditions like pneumothorax, hemothorax, and pleural effusions. The chest tube is connected to a drainage system, usually a three bottle system, to continuously drain the pleural space and prevent a build up of air or fluid that could impair lung function. Nurses monitor the chest tube drainage closely and ensure the system remains intact and functioning properly to allow for full lung re-expansion and recovery following chest tube insertion.
The Mendel-Mantoux test, also known as the tuberculin sensitivity test, is used to screen for tuberculosis. It involves an intradermal injection of purified protein derivative (PPD) tuberculin, obtained from TB cultures. The test site is read 48-72 hours later to measure any induration, indicating an immune response. Induration sizes of 5-9mm, 10-14mm, and 15mm or more suggest different levels of TB infection risk or exposure. False positives can occur from BCG vaccines or atypical mycobacteria, while false negatives are possible due to various medical conditions that compromise immunity.
Cell-mediated immunity involves activation of phagocytes, cytotoxic T-lymphocytes, and cytokines in response to antigens, rather than antibodies. Effector cells include cytotoxic T cells, NK cells, and those performing ADCC. Cell-mediated immunity can be assessed using tests such as mixed lymphocyte reaction, cell-mediated lympholysis, and graft versus host. Delayed-type hypersensitivity is a type of hypersensitivity reaction mediated by T cells rather than antibodies, and can be assessed using skin tests such as Mantoux, patch, and intradermal tests. These tests measure induration resulting from local cytokine and chemokine production.
This document discusses the treatment of tuberculosis (TB). It outlines the main aims of TB treatment as curing TB to prevent morbidity/mortality while also interrupting transmission. Standard regimens involve an intensive bactericidal phase and continuation sterilizing phase. Directly observed treatment, short course (DOTS) involves administering drugs under direct supervision. First-line drugs include isoniazid, rifampicin, pyrazinamide, and ethambutol. Second-line drugs are used to treat drug-resistant TB. Treatment is monitored through smear microscopy and managing drug toxicity. Latent TB, drug-resistant TB, TB/HIV co-infection, and vaccination strategies are also summarized.
The Mantoux test, also known as the tuberculin skin test, is used to determine if a person has been infected with tuberculosis. It involves injecting a small amount of purified protein derivative into the skin on the lower arm. After 48 to 72 hours, a health care worker measures any induration, or hard, raised area that develops on the arm, which can indicate infection. A positive result is based on the size of the induration and the person's risk factors. While very accurate, the test can sometimes produce false positives or negatives, requiring further evaluation and testing to diagnose active TB disease.
This document discusses a case study of hand infections in diabetic patients. 49 diabetic patients with hand infections were examined. The majority had deep infections involving bone or joints. Many required multiple surgeries and amputations. Poor glucose control and insulin dependence were associated with worse outcomes. Aggressive surgical debridement and antibiotic treatment are needed to manage these infections, which often have severe consequences if not properly treated.
- Tuberculosis is caused by Mycobacterium tuberculosis and primarily affects the lungs. It spreads through airborne droplets from the lungs of infected individuals.
- Case finding through sputum smear microscopy is the main method for tuberculosis control. Patients with at least 10 bacilli per 100 oil immersion fields in their sputum are considered positive and most infectious.
- The standard WHO recommended treatment regimen for new sputum-positive pulmonary TB cases is 2 months of isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by 4 months of isoniazid and rifampicin. Effective treatment reduces infectivity by 90% within 48 hours.
This document discusses the use of antibiotics in oral and maxillofacial surgery. It begins with an introduction and overview of antibiotic classification, mechanisms of action, principles of use, and indications. It then covers specific topics like empirical therapy, combination therapy, special patient populations, surgical wound classification, antibiotic resistance, and newer antibiotics. The key points are that antibiotics are generally used to treat established infections, as prophylaxis for high-risk procedures, and that principles of prudent use include narrow-spectrum therapy based on culture and sensitivity testing when possible.
This document discusses antibiotic sensitivity testing (AST), including the Kirby-Bauer disk diffusion method and minimum inhibitory concentration (MIC) method. It provides details on selecting media, control strains, preparing antibiotic discs and inoculum, and interpreting zone sizes. AST is useful but has limitations as it only measures in vitro drug activity, not in vivo effects. Proper technique and quality controls are important for accurate results. New automated methods can generate reports faster than traditional AST.
This document discusses guidelines for antibiotic treatment and management. It covers factors like selecting initial empiric therapy based on the infection type (mono vs polymicrobial), choosing agents based on likely pathogens, and tailoring therapy based on host factors. It recommends narrowing coverage once cultures identify pathogens. The optimal duration depends on the infection site but is typically 3-5 days for most infections. It advises converting IV therapy to oral when possible for safety and earlier discharge. Prolonged or excessive antibiotic use should be avoided to prevent resistance.
This document discusses the use of antibiotics in surgery. It begins by classifying antibiotics based on their mechanisms and targets, such as cell wall synthesis inhibitors and protein synthesis inhibitors. It then covers the principles of using antibiotics for prophylaxis and therapy in surgery. Antibiotic prophylaxis involves administering antibiotics before surgery to prevent infection, typically using a single pre-operative dose. Therapeutic antibiotics treat existing infections and require determining the causative organism and administering effective antibiotics, usually for a short course. The document stresses the importance of appropriate antibiotic use to minimize resistance.
This document provides an overview of antigen-antibody interactions and their applications in infectious disease diagnosis. It discusses how immunochemical methods can detect microorganisms in patient specimens using antigens and antibodies. Various serological tests that utilize antigen-antibody reactions are described, including precipitation reactions, agglutination reactions, complement fixation tests, neutralization tests, and immunoassays. Specific techniques like immunodiffusion, immunoelectrophoresis, and slide and tube agglutination are also summarized. The document aims to explain the basic principles of antigen-antibody reactions and their uses in clinical diagnosis and epidemiology.
•Describe the role of antibiotic use in the development of resistance
•Review toxicity of commonly used antibiotics
•Understand the prevalence and clinical impact of carbapenem resistant enterobacteriaceae
•State the prognosis antimicrobial resistant Staph aureus infections
• Describe the role of antibiotic use in the
development of resistance
• Review toxicity of commonly used antibiotics
• Understand the prevalence and clinical impact
of carbapenem resistant enterobacteriaceae
• State the prognosis antimicrobial resistant
Staph aureus infections
1) Determining if a clinically unstable infant truly has an infection remains challenging in neonatal sepsis evaluation and management.
2) Advances like heart rate characteristics monitoring and new sepsis biomarkers show promise for earlier infection detection, while molecular techniques may reduce pathogen identification time.
3) Antibiotic-resistant infections require less common drugs like linezolid, daptomycin, ciprofloxacin, and colistin, though safety data in neonates is limited; prevention focuses on hand hygiene and early catheter removal.
Pelvic inflammatory disease (PID) is a major health issue caused by sexually transmitted pathogens ascending from the lower to upper genital tract. It can lead to long-term complications like chronic pelvic pain and infertility. Broad-spectrum antibiotics are used to treat PID, while prevention relies on sex education, barrier methods, screening and contact tracing to curb rising prevalence worldwide. More efforts are needed nationally and locally to improve awareness and access to reproductive healthcare services, especially for adolescents.
Pelvic inflammatory disease (PID) is a major health issue that results from sexually transmitted infections ascending into the female reproductive tract. It can cause long-term complications like infertility and chronic pelvic pain. While antibiotics can treat PID, prevention through education and screening programs may help reduce its prevalence and impact. More comprehensive sex education programs in schools as well as screening and partner treatment initiatives could potentially further curb PID cases.
The document discusses various topics related to immunization including:
- The goals of immunization are disease prevention in individuals and eventually worldwide disease eradication.
- Immunization involves administering vaccines to stimulate immunity against infectious diseases. There are active, passive, and herd types of immunization.
- Pakistan's Expanded Program on Immunization (EPI) recommends vaccines for BCG, polio, diphtheria, pertussis, tetanus, hepatitis B, Hib, and measles to be given from birth through age 15 months. Some non-EPI recommended vaccines include rotavirus, influenza, varicella, meningococcal, and pneumococcal vaccines.
The document discusses various topics related to immunization including:
- The goals of immunization are disease prevention in individuals and eventually worldwide disease eradication.
- Immunization involves administering vaccines to stimulate immunity against infectious diseases. There are active, passive, and herd types of immunization.
- Pakistan's Expanded Program on Immunization (EPI) recommends vaccines for BCG, polio, DPT, hepatitis B, Hib, pneumococcal, and measles at various ages from birth to adolescence. The program aims to provide pediatric and adult immunization against major diseases.
This document discusses antitubercular drugs and drug susceptibility testing. It provides details on several first and second line antitubercular drugs including isoniazid, rifampicin, streptomycin, pyrazinamide, ethambutol, thioacetazone, fluoroquinolones, macrolides, and newer drugs. It describes the DOTS regimen and criteria for drug susceptibility testing. Both phenotypic and genotypic methods for drug susceptibility testing are outlined, including the proportion method, BACTEC, MGIT, and molecular techniques like Xpert MTB/Rif.
INVESTIGATIONS AND TREATMENT OF TUBERCULOSIS.pptxvanshikauppal1
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intradermal tests.pptx
1. INTRADERMAL TESTS
PRESENTER: Dr Vinayak Akki PGY1
MODERATOR: Dr. A. Venkata Krishna Sir (Professor & HOD)
PAPER INCHARGE : Dr. A. Venkata Krishna Sir (Professor & HOD)
GUIDE:Dr. A. Venkata Krishna Sir (Professor & HOD)
2. OVERVIEW
• Definition
• Procedure
• Interpretation
• IDT for infectious diseases
Bacterial diseases
Fungal diseases
Parasitic diseases
• IDT for non infectious diseases
3. DEFINITION
• A test for immunity or hypersensitivity made by injecting a
minute amount of diluted antigen into the skin
• Also called as Intracutaneous test
• For the first time used in 1916
4. • Intradermal tests are widely used to support the diagnosis of
dermatological and nondermatological diseases.
• They are mainly indicated for the detection of immediate (Type I
hypersensitivity) and delayed type hypersensitivity (DTH, Type
IV hypersensitivity) towards exogenous or endogenous
antigens.
5. Prerequisites
• Before undertaking intradermal test, it is advisable to stop or
avoid systemic steroids or immunosuppressive agents at least
three days before the procedure as moderate to large doses of
corticosteroids may inhibit a DTH reaction.
6. • Intradermal testing is in general safe with few reactions and
does not appear to result in sensitization, resuscitative
measures should be kept ready as there remains possibility of
anaphylaxis.
• In case of anaphylaxis supplies needed:
• Epinephrine 1:1000
• Systemic corticosteroid
• Systemic antihistamine
• Oxygen
7. Contraindications
• Severe eczema,dermographism
• Severe asthma.
• Drug intake such as antihistamines, ACE inhibitors,beta
blockers,antidepressants,calcineurin inhibitors as they affect
result interpretation.
• Acute or chronic UV B radiation exposure in the skin test area.
• Pregnancy
9. PROCEDURE
• The uniform feature of all intradermal tests is the injection of the
antigen into the superficial layer of the dermis through a fine-bore
(26 or 27-G) needle with its bevel pointing upwards.
10. • The quantity injected may vary from 0.01 to 0.1 ml but conventionally
0.1 ml is universally used.
• Although the tests could be done at any site, the proximal part of the
flexor aspect of the forearm is conventionally used.
• This site can be conveniently exposed and the skin of the proximal
area is more sensitive.
11. INTERPRETATION OF INTRADERMAL
TESTS
• The optimal time for reading the reaction depends upon the
pharmacological agent used for the test and the type of
immunological reaction to be observed.
• IDT for drug sensitivity are read at 15 minutes.
• IDT for the detection of DTH are read at 48h, although they can be
read as early as 12h and as late as 4 days.
• The size of the induration is more important than erythema while
interpreting Type IV hypersensitivity.
12. • The measurement of a wheal is made by diameter, more
sophisticated methods like volume measurements and Doppler flow
have been used.
• If the wheal is not circular, an approximation may be made by
averaging maximum/minimum diameters, or more accurately the
area may be calculated by the formula D1*D2*π/4, where D1 and D2
are the maximum and minimum diameters .
• For irregular wheal's, a tracing may be made on squared paper.
Pseudopodia should be noted, but for measurement of diameter they
are ignored.
• Attempts to assess the volume of a wheal are less satisfactory for
routine use
13. • The size of the wheal is not directly proportional to the dose of the
active agent, but may vary with the total volume of fluid injected.
• For accurate quantitative observations, wheal diameters below 4 mm
or above 15 mm cannot be relied upon.
14. INTRADERMAL TESTS ARE BROADLY
DIVIDED INTO TWO CATEGORIES
A. INTRADERMAL TESTS USED FOR INFECTIOUS DISEASES.
B. INTRADERMAL TESTS USED FOR NON-INFECTIOUS
DISEASES.
15. INTRADERMAL TESTS USED FOR INFECTIOUS DISEASES
IDT USED FOR BACTERIAL
INFECTIONS
• Tuberculin test
• Lepromin test
• Frei's test
• Ito Reenstierna test
• Anthraxin test
• Foshay test
• Dick's test
IDT FOR FUNGAL INFECTIONS
• Trichophytin test
• Candidin test
• Coccidioidin test
• Histoplasmin test
IDT FOR PARASITIC INFECTIONS
• Leishmanin test
• Casoni test
• Onchocerca skin test
16. INTRADERMAL TESTS USED FOR NON INFECTIOUS
DISEASES
• Intradermal sensitivity test for common allergens
• Predictive sensitization tests
• Autologous serum skin testing (ASST)
• Kveim-Siltzbach test
• Pathergy test
• Auto erythrocyte sensitization test
• Histamine test
• Pilocarpine test
18. IDT USED FOR BACTERIAL INFECTIONS
Tuberculin test
• Also known as Pirquet's test/reaction or scarification test.
• Antigen used - Tuberculin, a purified protein extract of bacilli grown on 5%
glycerol broth (ultra filtrate of tubercle bacilli containing over 200 ag shared
with bovine BCG and many NTM)
• Routinely used is PPD equivalent to 1 TU of RT23 strain with tween 80.
• PROCEDURE: 0.1ml is injected intradermally on the flexor aspect of the
forearm and a reading taken after 48h-72h (Mantoux method).
• RESULT: Induration measuring more than 10 mm in diameter is considered
to be a positive response while that measuring less than 5 mm is
considered as negative.
19. • A positive test indicates past or present infection with M. tuberculosis
(latent or clinical) or vaccination with bacillus Calmette-Guerin (BCG) or
other mycobacteria.
• A tuberculin test represents DTH but this response is not associated
with protective immunity against M.tuberculosis.
• A positive test does not indicate active infection except in children
younger than two years and is directly proportional to the strength of the
reaction.
• An induration of more than 15 mm is usually not due to BCG
vaccination.
• Readings between 6 mm and 9 mm are doubtful and could be because
of an atypical mycobacterial infection.
20. 5 mm considered + for high risk group
which includes – close contacts,
radiographic abnormalities, HIV, on
corticosteroids, on
immunosuppressive drugs.
10 mm considered + for migrants in
endemic areas, health care
workers, homeless, silicosis, DM,
CKD
15 mm considered + for no risk persons
21. • A negative tuberculin test can also occur due to technical errors.
• A negative tuberculin test indicates non-exposure or decreased or
absent delayed hypersensitivity to M. tuberculosis as in HIV
infection/AIDS, disseminated tuberculosis, primary
immunodeficiency disorders of CMI, lymphoreticular malignancies,
sarcoidosis, etc.
• A repeat test is not advocated before one week as the tuberculin
injected for the first test has a booster effect on the subsequent
dose.
22. • Small non necrotising response is consistent with protection.
• Strong reaction to tuberculin directly correlates with prevalence of
active Tb.
• Weaker reaction does not correlate with the active Tb and may be
due to other infection or waning of reactivity due to ageing
(reversion).
23. • TST can act as a triggering factor for granuloma annulare
• TST is recommended in the work up of patients with sarcoidosis
• TST is routinely recommended before starting steroids,
immunosuppressive, immunomodulator drugs and biologicals
24. • Tuberculin's from atypical mycobacteria or environmental bacteria
have also been prepared.
• They include PPD-B for Battey mycobacteria, PPD-Y for M. kansasii
, SCROFULIN for M scrofulaceum and BURULI for M. ulcerans .
• Lack of specificity is the major drawback in population vaccinated
with BCG
• Now TST is being replaced by IGRA (interferon gamma release
assay) & NAAC ( nucleic acid amplification)
25. Disease Reactivity
Primary inoculation Tb - At beginning, + later
Scrofuloderma +
Orificial tb Usually +
Ac cutaneous tb -
Metastatic tuberculous abscess Usually + but can be – due to poor GC
Lupus vulgaris Strongly +
Tuberculids Strongly + but bx & culture -
Lichen scrofulosum Strongly + and can even ulcerate
Papulonecrotic tuberculid + and necrotic r/n
Erythema induration of bazin +
Lupus miliaris disseminated faciei +
Tuberculous mastitis +
26.
27. Lepromin test
• It is a prognostic test which helps in classifying leprosy.
• It cannot be used for diagnostic purpose since it is positive in a
significant number of normal people and is negative towards the
lepromatous pole of the disease.
• Antigens used – 1. Mitsuda lepromin, an autoclaved suspension of
tissue (whole bacilli) obtained from experimentally infected
armadillos (Lepromin A)
2. Dharmendra lepromin, a purified chloroform-ether extracted
suspension of M. leprae (fractionated bacilli with soluble protein
component). More specific.
In India, lepromin antigen is prepared by the Central Leprosy
Teaching and Research Institute, Chengalpattu,Tamil Nadu.
28. • Result: The response after intradermal injection is biphasic, with an
early Fernandez reaction (48-72 hours – erythema with induration)
and a late Mitsuda reaction( 4 weeks – nodule/ulceration).
• Both responses are manifestations of CMI towards the antigen.
29. Response Time Reading Inference Remarks
Fernandez
reaction
48-
72h
Erythema or induration <5 mm
Erythema or induration 5-
10mm
Erythema or induration 11-
15mm
Erythema or induration >16mm
Negative
Weakly positive(+)
Moderately
positive(++)
Strongly positive
(+++)
More prominent with
Dharmendra
Lepromin
Measure of existing DTH
Mitsuda
reaction
3-4
weeks
Nothing to see/feel
Papule<3mm
Erythematous papule 4-7 mm
Erythematous papule 7-10 mm
Erythematous papule >10 mm
or
One of any size with ulceration.
Negative
Doubtful
Positive (+)
Positive (++)
Positive (+++)
More prominent with mistuda
Lepromin indicates the ability to
generate a cell mediated
immune response
30. • In immune competent person early lepromin reaction indicates a
state of sensitisation against M leprae & was regarded as evidence
for prior infection
• Late reaction represents CMI in patients & normal persons
• Incidence of LL is higher in sub clinically infected & Mitsuda negative
persons
• Test is positive in TT & BT with increase in sensitivity in T1R &
negative in other types.
31. Provides immunological aid in classification
Spectrum TT BT BB BL LL
Reactivity +++ +/++ -/+WEAKLY - VE -VE
• NEGATIVE in histoid leprosy
• Strongly POSITIVE in HIV + leprosy
32. Limitations :
• Low specificity
• Paucity of human leproma
• Reduced availability of test subjects
33. MEDINA TEST:
• Similar to lepromin test but antigen is prepared from lesions of lucio
leprosy
• Second generation based tests – soluble antigen lipoarabinomannan
(MLSA-LAM)
• MLCW antigen to test cell proliferation & CMI
34. Frei's test
• Frei's test was developed in 1925 for lymphogranuloma venereum
(LGV)
• Antigen used - Frei's antigen.
• It indicates delayed hypersensitivity to an intradermal standardized
antigen prepared from chlamydia grown in the yolk sac of a chick
embryo.
• Result: The test is read after 48h and again on the fourth day.
A nodule more than 5mm at fourth day is considered a positive
response.
35. • A positive test indicates past or present chlamydial infection.
• Frei's test becomes positive two to eight weeks after infection.
• Frei's antigen is common to all chlamydial species and is not
specific to LGV.
• Due to its non specific nature, the test is no longer used.
36. Ito Reenstierna test
• Also known as Ducrey's test.
• This test was detects hypersensitivity against Hemophilus ducreyi
(chancroid).
• A response indicates cell-mediated hypersensitivity against H.
ducreyi and is due to past or current infection with the organism. The
antigen is not commercially available.
37. Anthraxin test
• The anthraxin skin test measures DTH to anthrax antigens is used
as a diagnostic tool.
• It has also been recommended by the WHO for evaluation of
immunological memory against anthrax.
• Antigen used - Anthraxin, a cell wall extract from the vegetative, non
capsulated strain of B. anthracis (Sterne strain), consists mainly of a
complex of peptidoglycans and polysaccharides.
38. • Anthraxin is prepared by using a cell wall extract in place of the
vaccine antigen.
• The anthraxin skin test can differentiate between exposed and
unexposed individuals, even if they have been immunized.
• Result: The anthraxin skin test becomes positive in most of the
cases (80%) in the first three days of the disease, and stays positive
for a long time after recovery from the disease.
• Anthraxin skin test is a valuable method for early diagnosis of acute
anthrax and is the only method for the retrospective diagnosis of
human anthrax.
39. Foshay test
• The test involves intradermal injection of a suspension of killed
Bartonella henselae , the causative agent of cat-scratch disease.
• Antigen used - The antigen is prepared from the sterile lymph node
material obtained from a patient of cat-scratch disease.
• Result: The appearance of an area of erythema more than 5 mm
diameter after 48h at the injection site is considered a positive
reaction.
• A positive test is a sign of past or present infection.
• The test is of historical importance only, no longer used for diagnosis
because of concerns about the transmission of the organism.
40. Dick's test
• This test was used to identify children susceptible to scarlet fever,
but is of historical value as scarlet fever is no longer a common or
serious disease.
• The antigen used is pyrogenic exotoxin or Dick's or scarlatinal toxin
of Streptococcus pyogenes . It is also known as erythrogenic toxin
because intradermal injection causes an erythematous reaction in a
susceptible person.
• Procedure: About 0.1 cc of the toxin in the dilution of 1:1000 is
injected intradermally on the forearm.
41. • Result: the response is read after 24h.
• The reaction is considered positive when there is an erythema more
than 5 mm in diameter and strongly positive if induration also develops.
• A positive reaction develops after 8-12h and reaches its maximum after
24h.
• It is negative in convalescent patients and in insusceptible individuals.
42. IDT FOR FUNGAL INFECTIONS
Trichophytin test
• This test is performed to detect allergic hypersensitivity towards
dermatophytes.
• Antigen used - Trichophytin antigen is a glycopeptide extracted
(using acetone-ethylene glycol extraction method) from the spores
and mycelia of dermatophytes, mostly Trichophyton
mentagrophytes.
• Procedure: Trichophytin in the concentration of either 10 μg, 1 μg or
0.1 μg in 0.1 ml of normal saline is injected intradermally into the
flexor forearm.
43. • Result: The test is read after 20 min for an immediate reaction and
after 24 or 72h for a delayed response.
• Erythema, edema or induration may be seen and a papulovesicular
or ulcerative lesion can also occur.
• A wheal larger than 10 mm in diameter at 20 min and induration
more than 5 mm at 72h is considered a positive response.
44. Candidin test
• Hypersensitivity towards Candida albicans is universal.
• Hence, a test cannot be used to diagnose the infection.
• The candidin test serves as an aid to evaluate the cellular immune response
in patients suspected of having reduced CMI.
• Antigen used - Candidin is used as a recall antigen for detecting DTH by
intradermal testing.
• Candidin is made from the culture filtrate and cells of two strains of Candida
albicans .
• Compared with healthy controls, reactivity to candidin is significantly
reduced in patients with AIDS, Hodgkin's disease and sarcoidosis(tuberculin
sensitivity is more reliable in the latter case).
45. • Procedure: The test dose of 0.1 mL is injected intradermally on the
forearm
• Result: an induration response in excess of 5 mm at 48h after
injection in immunocompetent persons with cellular hypersensitivity
to the antigen.
46. Coccidioidin test
• Antigens used - two antigens available: coccidioidin and spherulin.
• Coccidioidin is prepared from autolysates of the mycelial phase (saprophytic
phase) of Coccidioides immitis , and spherulin, a more sensitive reagent,
from the spherule phase (parasitic phase).
• A positive test is helpful in detecting exposure to the fungus Coccidioides
immitis .
• It can help in differentiating the chronic pulmonary disease caused by this
fungus from other chronic cavitary, nodular and fibrotic diseases like
tuberculosis and malignancies.
• The test is negative in patients with disseminated disease or in patients with
thin-walled cavities.
47. Histoplasmin test
• Histoplasmin skin testing is useful in epidemiological studies, such
as investigations of case cluster or the definition of endemic areas
but is not predictive of histoplasmosis.
• An antigen containing the M and H precipitins of Histoplasma
capsulatum tends to elicit both immediate and delayed
hypersensitivity, and hence more false-positive reactions.
• An antigen that is deficient in the M component can reduce this
problem.
48. IDT FOR PARASITIC INFECTIONS
Leishmanin test (Montenegro test)
Antigen used - Leishmanin, which contains killed Leishmania.
• A positive reaction consists of a palpable nodule more than 5 mm in
diameter developing in 48 to 72h and indicates DTH, but not
necessarily immunity, to leishmania organisms.
• The test is not species-specific.
• It becomes positive early in the course of cutaneous or
mucocutaneous leishmaniasis (except in diffuse cutaneous
leishmaniasis) and only after recovery from visceral leishmaniasis.
• It is highly sensitive for cutaneous leishmaniasis.
49. • It is a useful and important tool for epidemiological, immunological,
and diagnostic studies and is an essential component of vaccine
trials.
• However, it cannot distinguish between present and past infection.
50. Casoni test:
• Done for Hadatid disease or Echinococcosis.
• Intradermal injection of 0.2 mL of fresh sterile hydatid fluid or
hydatid antigen produces in half an hour a 5 cm wheal with
multiple pseudopodia fading in an hour in positive cases.
• Normal saline is used as a control. A rapid slide test has been
proposed for resource poor settings.
51. Onchocerca skin test
• The intradermal test with products from Onchocerca volvulus is highly
sensitive in the detection of active onchocerciasis.
• However, a few reports indicate decreased CMI to parasite-derived
antigens, delayed skin-test reactivity, and response to unrelated
antigens during Onchocerca volvulus infection.
• Intradermal tests in various skin or systemic infections thus serve an
important role in reaching a diagnosis and predicting the prognosis of
these conditions.
53. Intradermal sensitivity test for drug
• Intradermal testing is a rapid, convenient and reproducible method of
detecting drug hypersensitivity (drug-specific IgE antibodies).
• It is commonly performed for penicillin, general and local anaesthetic
agents, tetanus toxoid, iodinated radiocontrast media, insulin,
heterologous sera, collagen chymopapain etc.
• Intradermal testing is in general safe with few reactions and does not
appear to result in sensitization.
• However, resuscitative measures should be kept ready as there
remains possibility of anaphylaxis.
54. • Penicillin intradermal skin tests should be carried out using major
determinant (benzyl penicilloyl polylysine, PPL)and minor
determinant mixture (benzyl penicillin, benzyl penicilloate and benzyl
penilloate) antigens.
• The test can also be performed using 2-10 units of freshly prepared
penicillin.
• Skin test is read at 20 minutes.
55. Result:
Negative response no increase in size of original bleb
and no greater reaction than the
control site
Ambiguous response wheal only slightly larger than initial
injection bleb, with or without
accompanying erythematous flare
and slightly larger than the control
site; OR discordance between
duplicates
Positive response itching and significant increase in
size of original blebs to at least 5mm.
Wheal may exceed 20 mm in
diameter and exhibit pseudopods
56. • Negative intradermal test does not rule out penicillin sensitivity.
• Other agents are tested similarly for detection of immediate and
delayed type of hypersensitivity.
• Intradermal skin tests have no predictive value in non IgE-mediated
reactions such as serum sickness, haemolytic anaemia, drug fever,
interstitial nephritis, contact dermatitis, maculopapular exanthemata or
exfoliative dermatitis.
• Skin testing is contraindicated where there is a history of exfoliative
dermatitis, Stevens-Johnson syndrome or TEN.
57. Predictive sensitization tests
• Sensitization index is the relative capacity of a given agent to induce
sensitization in a group of humans or animals.
• Predictive sensitization tests are used to compare the sensitizing
properties of new products or chemicals with those of known
substances.
• Both in guinea-pigs and humans, an estimate of the sensitizing
potential can be performed using intradermal route.
• Draize test and Freund's complete adjuvant test are intradermal
methods of testing sensitization potential.
58. Autologus serum skin testing (ASST)
• Autologous serum skin test is a simple in-vivo clinical test for the detection
of basophil histamine releasing activity and to diagnose chronic autoimmune
urticaria among chronic spontaneous urticaria patients.
• About 25-45% of patients of chronic idiopathic urticaria have autoantibodies
against the high affinity IgE receptor FceRI or IgE that are capable of
histamine release.
• These antibodies, if present in serum, can cause wheal and erythema
following intradermal serum injection. This reaction forms the basis of the
ASST.
• Procedure: The test is performed by injecting 0.05 ml of the patient's own
serum intradermally into the left flexor forearm two inches below the
antecubital crease and a saline control into the right forearm.
59. • Serum is obtained after withdrawing 5 ml of venous blood and
standing for about 45 min for separation.
• The process can be hastened up by centrifugation of the blood.
• About 5 ml of venous blood was collected in a sterile vacutainer and
allowed to clot at room temperature for 30 min. Serum was
centrifuged at 2000 rpm for 15 min and 0.05 ml of autologous serum
was injected intradermally, in uninvolved skin, using a 1 ml insulin
syringe (30 gauge needle) into the right forearm 2 cm below the
cubital fossa.
• Similarly, 0.05 ml of 0.9% sterile normal saline (negative control) was
injected intradermally proximally into the left forearm, and at a
distance of at least 5 cm, 0.05 ml of histamine (10 μg/ml) was
injected distally into the left forearm as a positive control.
60. • A serum induced erythematous wheal with a diameter of 1.5 mm
more than the saline induced response within 30 min was taken as
positive
61. • ASST positivity has been found to correlate well with the severity
and duration of attack of urticaria.
• The cases of idiopathic urticaria which are ASST positive are
designated as autoimmune urticaria.
• Western blot, ELISA, flow cytometry may be useful for screening in
the future
62. Intradermal allergy testing
• A small amount of diluted allergen is injected into the dermis.
• It is carried out with allergen concentrations 100 to 1000 times less
than that used for skin prick tests. It increases the sensitivity but
decreases the specificity of the test.
• It is most commonly used in testing for drug and venom allergy.
• IDSTs have a very high non-specific reaction rate and are not
recommended for testing with inhalants or foods and food allergens.
• Moreover, intradermal tests carry a higher risk of adverse reactions
than SPTs.
63. Kveim-Siltzbach test
• It is a valuable intradermal test for the diagnosis of sarcoidosis.
• The test can be utilized to differentiate from other causes of diffuse
pulmonary mottling, uveitis and erythema nodosum.
• The antigen is prepared from the splenic tissue obtained from a
proven case of sarcoidosis either after splenectomy or during
autopsy.
• About 0.1-0.15 ml of this antigen is injected intradermally, a nodule
develops after four to six weeks, which can be biopsied for
histopathological confirmation of the diagnosis.
64. • False positive reactions were found in an appreciable proportion of
patients with Crohn's disease, ulcerative colitis and tuberculous
lymphadenitis, but only with few batches of commercially available
antigens.
65. Pathergy test
• Pathergy is the development of a papulopustular lesion around a
puncture site on the skin, 24-48h after the injection of a sterile
substance like normal saline intradermally. This phenomenon forms
the basis of the pathergy test.
• The test is used as a diagnostic criterion for Behcet’s disease.
• Results of the test depend upon the type of needle used; reactivity
varies with the diameter and sharpness of needle.
• The sensitivity and intensity of the reaction is considerably less with
sharp needles and needles with smaller diameter.
66. • Pathergy is also a reported phenomenon in pyoderma gangrenosum,
in hairy cell leukaemia, Hodgkin's lymphoma and in chronic myeloid
leukaemia treated with interferon alpha.
• Histopathological evaluation of the test is not found to be more
sensitive than the clinical evaluation.
67. Auto erythrocyte sensitization test
• The intradermal test for the diagnosis of auto erythrocyte
sensitization syndrome is done with washed RBCs of the patient in
the intrascapular region with a saline control on the opposite side.
• Patient develops a painful ecchymotic reaction within two hours at
the site of the injection indicating positive test.
• The control site does not show reaction.
68. Histamine test
• When histamine is injected intradermally, it causes bright red
histamine flare due to capillary vasodilatation.
• However, this effect is due to axon reflex within dermal nerves.
• The histamine test can be used to test integrity of dermal nerves in
cases of tuberculoid leprosy.
• One drop of histamine acid diphosphate 1 in 1000 (1mg/ml) is
placed on the skin surface, one each on the normal skin and the
other on the suspected patch. Superficial prick is made through the
drop. The histamine solution is wiped off and the area is watched for
5 minutes.
• Response takes little longer on the extremities.
69. • In the normal skin, a wheal at the site of prick and a flare of 2 cm
diameter surrounding the wheal would be seen (test labeled as
positive).
• The flare disappears in 10 minutes.
• In the patch of leprosy the flare is impaired or absent and only a
wheal is seen (test negative). The flare is feeble and delayed in
indeterminate and borderline leprosy, and absent in a tuberculoid
lesion.
70. • The response in the skin to histamine depends on the integrity of
nerves of the autonomic nervous system.
• Autonomic nerves are nonmyelinated nerve fibers sheathed only by
Schwann cells and are distributed along with the small dermal blood
vessels.
• In early leprosy, which manifests as localized skin patches, the
Schwann cells are parasitized by M. leprae.
• There is perivascular and perineural inflammation and the functions
of sympathetic nerves of the skin supplying the blood vessels are
impaired, even before the sensory nerves are affected.
71. • The test is useful only to differentiate hypopigmented macules of
leprosy from those of other skin diseases.
• There will be a normal flare (positive test) in other hypopigmented
macules due to non leprosy conditions like vitiligo, pityriasis alba,
fungal infections, etc.
• The histamine test will also be negative in patients without any skin
changes but only with areas of nerve deficit due to other peripheral
neuropathies.
• In patients with dark skin this test may not be useful because the
flare is not easily visible.
72. Pilocarpine test
• Pilocarpine intradermal test is used to detect the integrity of dermal
nerves in suspected cases of tuberculoid leprosy.
• About 0.2 ml of 1 in 1000 solution of pilocarpine nitrate is injected
intradermally into the lesion, the injection site is then painted with
tincture of iodine and then dusted with starch powder.
• Sweating, if present, causes blue discoloration of the powder.
• Alternatively, quinizarin powder can be used in place of starch
powder with the advantage that there is no need for painting the test
site with tincture of iodine.
73. Prausnitz - Kustner (PK) Test
• Used to test people for life threatening allergens such as bee venom
• Test involves transferring serum from the test subject to another
healthy person.
• Serum from allergic patient is injected into healthy person and 24
hrs later suspected antigen is injected intradermally into healthy
person.
• If allergic patient had developed antibodies, this will cause local
reaction in the healthy person when the antibodies mix with
antigen
• A positive PK test appears as wheal and flare demonstrating type 1
hypersensitivity reaction reaction.
• No longer recommended now.
74. Therapeutic uses of IDT:
Autoinoculation :
• Done in viral warts, by excising ,mincing and implanting
homogeneous tissue in a small dermal pocket in forearm.
• Antibodies thus produced help in clearing the warts
• It’s an effective treatment modality for multiple and recurrent
warts.
75. Autologous serum therapy:
• Used in Chronic urticaria.
• Repeated injections of autologous whole blood or serum can induce
desensitisation or tolerisation of auto reactive chronic urticaria
patients to pro inflammatory signals expressed in their circulation.
76. REFERENCES
• Rook’s textbook of dermatology
• IAL textbook of leprosy
• IADVL textbook of dermatology
• IJDVL
• Internet