Tuberculin Mantoux testing and BCG vaccination

A tuberculin (Mantoux) test should be performed prior to BCG vaccination in all individuals over 6 months of age. (It is read at 48-72 hours.) If area of induration:

• < 5 mm—negative (Note: may be negative in presence of very active pulmonary infection)

• 5-10 mm: typical of past BCG vaccination

• > 5 mm—significant in immunocompromised, close contacts and HIV infection

• > 10 mm—positive = tuberculosis infection (active or inactive)

• > 15 mm—highly significant for 'normal' people

The BCG vaccination should be given if reaction < 5 mm induration. BCG recommended for:

• Aboriginal and Torres Strait Islander neonates in regions of high incidence

• neonates born to patients with leprosy

• children < 5 years travelling for long periods to countries of high TB prevalence

BCG considered for:

• neonates in household with immigrants or visitors recently arrived from countries of high prevalance e.g. South-East Asia (Note: tuberculin test not necessary for neonates < 14 days)

• children and adolescents < 16 years with continued exposure to active TB patient and where isonizid therapy contraindicated

• others at increased risk (and where value of BCG vaccine uncertain), e.g. health care workers, travellers > 5 years with significant exposure

BCG contraindicated for:

• tuberculin reactions > 5 mm

• immunocompromised or malignancies involving bone marrow lymphatics

• high-risk HIV infection

• significant fever or intercurrent illness

• generalised skin diseases including keloid tendency

• previous infection pr-irmai y pulmonary

-M ifliith hHaf lym^h nodes adu:t pulmonar/ TE (rcact:VíitiDn) other pulmonary prat-ems e.g. • collapse

• pneumonia adu:t pulmonar/ TE (rcact:VíitiDn) other pulmonary prat-ems e.g. • collapse

er/tnema nodosum

Fig. 26.1 Pulmonary and extrapulmonary distribution of tuberculosis: the primary infection starts in the lung and then spread can occur throughout the body, especially to lymph nodes meningitis dlGTO ulitis iridoeythhs lyimphadeniipHthy miliary pulmonary tb -—- constnctiví pen card: t:s li^f-JS vylQdrlS {Sfcul}

—_ sdnensi destrucaori (Addjran's disease) lenaiTB

peritoneum r ascites gastrointestinal iract tubal disease arthritis and osteomyelitis epididymitis er/tnema nodosum

Fig. 26.1 Pulmonary and extrapulmonary distribution of tuberculosis: the primary infection starts in the lung and then spread can occur throughout the body, especially to lymph nodes

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