1. TUBERKULIN SKIN TESTING (MANTOUX TEST) OR PROTEIN PURIFIED DERIVATIVES SKILLS LAB RESPIRATORY SYSTEM

2. DEFINITION
Tuberculin skin test
- Used to determine whether a person has tuberculosis (TB)
infection. It is not a vaccine
- Tuberculin testing is useful for :
a. Examining a person who isn’t sick but may have TB
infection
b. Screening groups of people at risk of TB disease
once infected
c. Examining a person who has symptoms of TB disease

3. Mantoux Test/PPD Test
- The both terms are used interchangeably
- Intradermal injection of Purified Protein Derivative
(PPD)
- PPD  highly purified protein fraction  culture
filtrates of human type strains of M. Tuberculosis
- Standar dose  2 tuberculin units ( 2 TU )

4. Types of Skin tests
Mantoux skin test (purified protein derivative or PPD)
1. Only standarized method available for identifying persons
infected with M. tuberculosis
2. Administration
- 0,1 ml of PPD tuberculin containing two tuberculin units
injected intradermally on the volar surface of the forearm
- gloves are not necessary for proper intradermal injections.
However, individual institution or agency policies may
vary

5. 3. Reading
- patient’s arm is inspected 48 to 72 hours after tuberculin
is injected
- the reaction is the area of induration, or swelling, around
the injection site. Erythema or redness should be ignored
when assessing induration
* diameter of the indurated area is measured across the
forearm and recorded in millimeters
* erythema, or redness, is not measured. The presence of
erythema does not indicate that a person has TB infection
- a clearly positive reaction may read up to one week (day 7)
after testing

6. B. Multiple –puncture test
1. Easy to give and convenient, but not as accurate as
Mantoux skin test
Amount of tuberculin entering the skin cannot be measured
2. Positive reactions to multiple-puncture tests should be
confirmed with a Mantoux skin test

7. DOSAGE & ADMINISTRATION
Mantoux
PPD solution  plastic walls of syringes
Injection intradermally  flexor surface forearm
The site cleansed with alcohol dried with cotton
ball
Inject 0,1 ml PPD solution  ½ inch 26-or 27-
gauge needle
If placed correctly  6-10 mm wheal formed
Avoid injecting subcutaneously  no local
reaction develop

8. Positioning The Needle
Stretch skin taut between your thumb and
index finger
Face the bevel of the needle upward and hold the needle
& syringe almost parallel to the skin
Insert properly
Insert the needle just beneath the skin surface.
When placed properly, the needle is under the epidermis. A 6-10 mm
wheal should appear

9. Penyuntikan yang benar
Wheal mm

10. The Needle is Too Deep (incorrect)
Needle placed too deeply under epidermis
 shallow, diffuse bulge instead of a tense
white wheal  difficult to measure

11. Penyuntikan terlalu dalam

12. The Needle is Too Shallow (incorrect)
The bevel will barely penetrate the epidermis
Tuberculin → leaking from the injection
→ repeat the test in other arm

13. Penyuntikan terlalu ke permukaan

14. Method for Reading
Read the site of the TST in good light with the forearm
supported o a firm surface
Look for the presence or absence of induration (swelling)
Using a ballpoint pen, draw a line from the outer edge of
the arm inward toward the induration, and stop when the pen
comes against the border of the induration. Repeat the process
on the other side ( Ballpoint-pen Sokal Method).
Using a flexible millimeter (mm) ruler , measure across
the induration between the two lines.
- Other method is palpation method

15. MANTOUX RESULTS Readings: TB skin test are measured 48-72 hours
after injection
A reaction usually consist of both induration and
erythema. Measure only the induration.
2. Find → margin of induration
3. Diameter of induration → measured transversely
4. Using a millimeter ruler
B. Recording Results
All measurements in mm of induration
No induration mm

16. C. Interpretation of Results
Positive Reactions
a. 5 mm
b. 10 mm
2. Negative Reactions
Any mm reaction < cut-points
3. False Negative and Positive Reactions

17. D. Counseling Inmates
Explain the significance of the (+) or (-)
reactions

18. 3. Contraindications
Those already diagnosed with culture (+) active TB
Those with a documented previous (+) skin test a mm result

20. Pembacaan PPD secara palpasi

22. Pembacaan Ballpoint Pen Sokal
PPD: 15 mm

24. THANK YOU