Diaskintest

Although this type of diagnosis is a development of Russian scientists, scientific interest in it is high abroad.In Denmark, China and Indonesia, Great Britain and New Zealand, scientists are studying the properties of the protein that is part of Diaskintest, looking for new ways to improve the diagnosis of tuberculosis.

The test is similar to any other allergy tests with allergens of animal or plant origin, which are used to diagnose pollinosis, bronchial asthma and other allergic diseases.

In everyday life, we are surrounded by many pathogens. We are able to deal with some of them easily and quickly on our own, vaccination has been developed against others, and others pose a real threat.

Despite numerous preventive measures, tuberculosis still poses a threat to human health both in the Russian Federation and abroad. And for people who have not been vaccinated against tuberculosis and patients with primary or acquired immunodeficiency, it can pose a deadly danger.

This disease is inextricably linked to various social problems: armed conflict, poverty, lack of access to medical care, drug addiction, alcoholism, as well as the disease caused by HIV. The active migration of the population increases the risk of infection spreading even to areas that are safe for this disease.

Despite the decrease in the incidence of tuberculosis in Russia in recent years, the situation is still difficult to call safe. The initial period of the disease is characterized by the absence of vivid clinical manifestations, or they are very weak. It can be weakness, fatigue, loss of appetite, irritability. In short, conditions that are easily underestimated and attributed to causes unrelated to such a formidable disease. Doctors call these manifestations nonspecific, and in the case of tuberculosis, symptoms of intoxication. At this point, it is especially important to start treatment on time, to prevent the pathogenic bacterium from gaining the upper hand.

Lyudmila Kolpakova, phthisiatrician:

"Indeed, it has long been noticed that the tuberculosis bacterium, when ingested, can actively multiply and cause no symptoms for a long time. The infectious period is hidden and unnoticeable. It is very important for the doctor to have a test result confirming the fact that tuberculosis bacteria have entered the patient's body. A positive skin test with Diaskintest looks like a mosquito bite or a nettle burn. For a patient, such a reaction is sometimes unexpected, and then he tries to explain to himself and the doctor that it's just an allergy. Yes, this is an allergic reaction to a specific tuberculosis allergen, as well as confirmation of an increased risk of tuberculosis. Infection with tuberculosis bacteria is not a disease. A healthy immune system, doctor's recommendations, and in some cases, drug prophylaxis will protect against the disease."

The Diaskintest sample is performed similarly to the Mantoux test as follows: 0.1 ml of the drug is injected intradermally, resulting in a papule or, as it is otherwise called, a "button" at the injection site. After 72 hours, the sample is evaluated by a pediatrician or a specially trained nurse. Up to this point, papules should not be irritated by applying various chemicals, such as shower gel, shampoo, cream, etc. The sample site should not be sealed or bandaged. The test result may be affected by a reaction to excessive sweating, for example, during exercise, or the friction of clothing.

In the EMC Children's Clinic, tuberculosis diagnosis using Diaskintest is carried out daily and does not require special training. It won't take long, but it will make sure that there is no dangerous disease.

The injection site of both the Mantoux test and the diaskintest can be soaked, but you can not rub, scratch, or use detergents such as soap, shower gel, etc.

The Mantoux reaction, like Diaskintest, is an intradermal diagnostic test to detect tuberculosis. The differences are in the composition of the drug. During the Mantoux reaction, tuberculin is used, which contains mycobacterium particles of human and bovine species. Diaskintest contains a recombinant protein with two related antigens, ESAT6 and CFP10, which are characteristic only of pathogenic strains of Mycobacterium tuberculosis and which are absent in vaccine strains.

Diaskintest contains a protein that includes two antigens specific to those types of Mycobacterium tuberculosis that can cause infection and disease. It is important that these antigens are not present in the BCG vaccine strain used for vaccination. Thus, the result of the reaction will be positive only if there is a multiplication of tuberculosis pathogens in the body, and there will be no false positive reaction associated with the vaccine strain of mycobacteria.

According to the Order of the Ministry of Health of Russia No.124n dated March 21, 2017, the Diaskintest must be performed annually for all children from 8 to 17 years old inclusive. Children from high-risk groups, including those who have not been vaccinated against tuberculosis, need such an examination twice a year. The doctor may recommend a test if the child, for example, coughs for a long time for no apparent reason or complains of leg pain, feels weak, sweats a lot, has sleep disorders, appetite, attention, decreased academic performance at school. Diaskintest is required in case of prolonged increase in body temperature for no apparent reason, especially accompanied by weight loss. This modern diagnostic test is performed not only for children, but also for adults in order to quickly and timely identify the cause of prolonged malaise. In addition, Diaskintest is used as an additional diagnostic when it is necessary to clarify the results of the Mantoux test, and it can be performed simultaneously (on different hands) or sequentially with a tuberculin test.

Diaskintest is contraindicated during the period of exacerbation of any diseases, within a month after any vaccination, with epilepsy, severe skin diseases, during quarantine, as well as with hypersensitivity to any components of the drug.

To assess whether the test is positive or negative, the sample is checked 72 hours after diagnosis by measuring the papule with a transparent ruler.In case of a negative reaction on the skin, there will be no thickening (infiltration) or redness (hyperemia) at the injection site. An "injection" reaction of up to 2 mm is also counted as negative. People with a questionable or positive reaction need to undergo a more in-depth examination to rule out a disease caused by mycobacteria.

Rarely, short-term reactions occur after administration of the drug: fever, weakness, headache.

The cost of conducting a diaskintest at the EMC Children's Clinic is indicated in the price list below. A pediatrician's consultation is required before conducting a diaskintest.

The pediatrician's consultation is charged separately.

The manipulation is performed by experienced pediatricians who have all the necessary certificates, including for vaccination. Adults and children are also admitted to the EMC by a phthisiatrician who performs differential diagnosis of pulmonary diseases: tuberculosis, including "small" forms and latent tuberculosis infection, pneumonia, chronic nonspecific lung diseases, including "rare" pathologies: sarcoidosis, alveolitis, histiocytosis X, respiratory lesions with immunodeficiency states.

1. Order of the Ministry of Health of the Russian Federation No. 951 "On Approval of methodological recommendations for improving the diagnosis and treatment of tuberculosis of the respiratory system" dated 29 December 2014

2.             Order of the Ministry of Health of the Russian Federation dated 03/21/2017 N 124h

"On approval of the procedure and timing of preventive medical examinations of citizens in order to detect tuberculosis"

3.         Slogodskaya L. V., Senchihina O. Yu., Nikitina G. V., Bogorodskaya E. M. the Effectiveness of skin test with tuberculous recombinant allergen in the detection of tuberculosis in children and adolescents Moscow in 2013 // Pediatric pharmacology, 2015. – N 1. – P. 99-103

4.         Bai X., Liang Y., Yang Y., Zhang J., Wu X. A new method of screening for latent tuberculosis infection: Results from army recruits in Beijing in 2014. Immunol. Lett. 2017 Jun;186:28-32. doi: 10.1016/j.imlet.2017.03.014. Epub 2017 Mar 27.

5.         Aagaard C., Govaerts M., Meikle V., Vallecillo A.J., Gutierrez-Pabello J.A., Suarez-Güemes F., McNair J., Cataldi A., Espitia C., Andersen P., Pollock J.M. Optimizing antigen cocktails for detection of Mycobacterium bovis in herds with different prevalences of bovine tuberculosis: ESAT6-CFP10 mixture shows optimal sensitivity and specificity. J. Clin Microbiol. 2006 Dec;44(12):4326-35. Epub 2006 Sep 27.

6.         Slogotskaya L., Bogorodskaya E., Ivanova D., Sevostyanova T. Comparative sensitivity of the test with tuberculosis recombinant allergen, containing ESAT6-CFP10 protein, and Mantoux test with 2 TU PPD-L in newly diagnosed tuberculosis children and adolescents in Moscow. PLoS One. 2018 Dec 21;13(12):e0208705. doi: .1371/journal.pone.0208705. eCollection 2018