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I wanted to talk about the Mantoux test.and this is spelled ma n tou X kind of.an interesting spelling after a French.doctor who popularized it and another.way you might hear this referred to as a.PPD.or a TST and what these things stand for.is the PPD stands for purified protein.derivative and actually gives us a clue.as to what we're using in this test.which is that we're using specifically.TB protein OPA that in parentheses and.the the location of the test is actually.also going to be kind of a clue here.with TST this is a tuberculous again.referring to tuberculosis tuberculous.skin test this tells you where we're.gonna put all that protein right we're.gonna put it in the skin and you may.have seen this and this is kind of a.picture right here of someone doing the.test sometimes this refers to as kind of.that bubble test a lot of people say oh.yeah you know my doctor you know.injected some liquid in my forearm and.it kind of bubbled up and this is how.people usually think about this test.they remember that because a very.obvious visual and so what I wanted to.do is kind of give you an example or a.diagram of what's actually happening.when you get this test done so let's.imagine this is your skin layer this is.also referred to as the dermis and below.the dermis is some subcutaneous so below.the skin subcutaneous layer and usually.not layer one of the most common things.is fat so I'm just gonna draw that in.here this is the subcutaneous fat so the.idea here is that you're basically.putting a little needle in here which is.what you're seeing in that picture on.the on the right there and that needle.is full of some TB protein so this.purified protein derivative is in that.needle it's actually gonna be injected.in so you've got all these little TB.proteins in here and the volume you're.putting in is a small volume it's about.1/10 of a milliliter so 0.1 milliliters.and you're putting it intradermally.intradermally this is actually an.important point it's going into that.dermis layer so it's intradermal.injection and what happens is that if.you then let's say moments later you.remove the needle you throw it away and.now what you're going.notice that because you put a little.volume in there a little 0.1 MLS that is.gonna bubble up right because that.volume is gonna make the skin puff out a.little bit but if I came back over some.time this protein is kind of diffused.over this liquid has been absorbed into.the skin and that bubble will disappear.so if you come back you might see a.little bit of redness because of course.poking the skin causes a little bit of.redness and irritation but the bubble.will disappear over time so what are we.hoping to accomplish with this test.exactly let me bring up a couple of more.pictures for us well this test is gonna.help us answer the question of has the.person had prior TV exposure just.remember that that's the question we're.trying to answer have they had prior TB.exposure yes or no and let's think about.what would happen in either scenario so.this would be that they have not had.prior TB exposure and on this side let's.talk about whether they what would.happen if they have had prior TB.exposure so two scenarios let's start on.the nose side so let's draw our skin.again so this is just as before let's.draw some TB protein in here and what's.gonna happen is you're gonna have some.macrophages these macrophages are gonna.come around.and they're always kind of patrolling.the area they're making sure that almost.like police officers making sure that.there's no problem and they're gonna.come and they're gonna pick up some of.this TB protein so they're gonna take it.in side of themselves and they're gonna.present that TB protein to another cell.this is our t cell so they're gonna.present this T V protein to the T cell.and the T cell is gonna say you know I.have had no prior TB exposure I don't.recognize this TB protein and it's gonna.kind of go on its merry way it's not.gonna make a big deal about what's going.on so the T cell kind of meanders away.it leaves the area.these proteins over time start to get.kind of chewed up and digested by.macrophages and eventually all of it is.gone and if you look on the outside you.see flatness the skin looks nice and.flat and this might seem very obvious.from this picture that of course it.looks flat but that's essentially what.we're looking at here is flatness and.looking at this picture you can see a.little bit of redness here but if you.were to feel it.with your finger it would be flat so.it's red but it's flat and that's the.key and so this person we would say if.if there is no bulge or bump we would.say this person has a negative PPD this.person right here has a negative PPD so.that's basically how we would read this.flat PPD now what happens on the yes.side let's say the person has had prior.TB exposure so same setup as before.let's draw the skin and we've got some.TV protein let me draw that in here and.this TV protein is gonna get picked up.as before by the macrophage so the.macrophage is gonna come by pick up some.of this TB protein and it's gonna just.as before it's gonna find a t-cell and.these t-cells are also kind of moving.around and this t-cell this time is.gonna say you know what I have seen this.TB protein before and this t-cell is.gonna start getting very excited and.this is the key difference right it's.gonna get excited before it didn't get.excited just kind of left the area.unexcited but now it gets excited and it.starts releasing chemokines little.chemical messages you know what that.does that attracts lots and lots of.other cells to the area lots of.macrophages start coming to the area.they say aha interesting that the t-cell.tells us that we've seen this stuff.before and this layer this intradermal.layer starts to swell up with cells so.it's getting full of cells because of.all these new macrophages that are being.attracted to the area so this is.actually gonna start looking like this.full of cells right on both sides it.becomes a nice big bulge and this is.loaded with cells macrophages in here.maybe a few more t-cells in here as well.but you get the idea.lots and lots of cells and we call this.a hypersensitivity reaction so when you.see all these cells coming into this.area this is a classic hypersensitivity.reaction in fact there are different.types of hypersensitivity reactions we.would call this a class 4 type 4 and the.reason that they're there typed out.differently is that.type four in particular involves lots of.cells so this is a very cellular.reaction meaning lots of your immune.cells are involved and you can see that.in the drawing you can see lots of.macrophages and T cells in that area so.this is a type 4 hypersensitivity.reaction happening here and if you were.to feel with your finger from here to.here it would not feel flat right this.is not flat at all this is actually.bulging out and we call this indurated.indurated meaning it feels very firm and.it does not feel flat so this is what.you're seeing in the picture here is.that you actually can see from here to.here there's induration so that's the.induration they're actually measuring it.with a ruler so this is the induration.and you can also see that they're doing.it perpendicular to the long axis so in.other words if this is the long axis.this way they're kind of choosing a.90-degree angle to that something like.that to measure the induration so that's.how you would measure in duration of a.PPD so this looks like a positive PPD on.this second picture over here and we'll.get into in just a moment how we.actually decide if it's negative or.positive now one thing I forgot to.mention is that you're going to be.reading these PPD's 48 to 72 hours after.you initially injected the protein so 42.to 72 hours later this is when you.actually read the PPD and that's very.important because that gives enough time.to either go flat like this or to.actually get indurated like that and one.key point I want to make is that let's.say you've got redness all the way.around here do you actually want to.measure the redness no you want to.measure the in duration so just keep.that in mind.in duration not redness not redness.because they're very very easily.confused for one another but it makes a.big difference.not redness.

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Blank Tb Test Form Printable FAQs

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Which type of document do we need to fill out the KVPY application form or entrance form?

The students applying for KVPY Application Form need to upload the following documents: Scanned Image of Photograph and Signature Caste Certificate for SC/ST Students Medical Certificate in case of PWD candidates

How do you administer a TB test?

Annual testing is a requirement for many education programs in healthcare and is an annual requirement for me, as a nurse. I’ve undergone annual testing for a long time. No, it’s not dangerous. If you’re thinking that testing exposes you to Mycobacterium tuberculosis (the specific bacteria that caus Continue Reading

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