Pathology Laboratory (Medical)

Why Tuberculin Test (Mantoux Test) is Banned in India?

Last updated on January 13th, 2023 at 08:02 am

The tuberculin test, also known as the Mantoux test, is a diagnostic tool used to determine if an individual has been infected with tuberculosis (TB). The test involves injecting a small amount of protein, called tuberculin, into the skin and observing the reaction at the injection site. If the individual has been infected with TB, their immune system will have developed antibodies to the protein, causing a reaction at the injection site, typically in the form of redness and swelling.

Tuberculin Test (Mantoux Test) is Banned in India

Despite its effectiveness in diagnosing TB, the tuberculin test has been banned in India since 2017. There are several reasons for this ban, which we will explore in detail below.

  1. Lack of specificity: One major issue with the tuberculin test is that it lacks specificity. This means that the test may produce false positive results, leading to an incorrect diagnosis of TB infection. There are several factors that can contribute to false positive results, including prior vaccination with the Bacille Calmette-Guérin (BCG) vaccine, exposure to environmental mycobacteria, and previous TB infection that has since been resolved.
  2. Poor sensitivity: In addition to its lack of specificity, the tuberculin test also has poor sensitivity, particularly in individuals with HIV/AIDS or other immune compromising conditions. This means that the test may produce false negative results, failing to detect TB infection even when it is present.
  3. Limited usefulness in low TB prevalence areas: The tuberculin test is most accurate in populations with high rates of TB infection. In areas with low TB prevalence, the test may produce a high number of false negative results, leading to missed diagnoses. This is particularly problematic in India, where the TB incidence rate has been decreasing in recent years, making the test less useful in detecting infection.
  4. Alternative diagnostic methods available: There are several other diagnostic tests available for TB that are more accurate and reliable than the tuberculin test. These include the sputum microscopy test, which involves examining a sample of phlegm for the presence of TB bacteria, and the polymerase chain reaction (PCR) test, which uses genetic techniques to detect TB DNA. These tests are more sensitive and specific than the tuberculin test, and are therefore preferred for diagnosing TB in India.
  5. Limited effectiveness in preventing TB transmission: While the tuberculin test can be used to diagnose TB infection, it is not an effective method for preventing the transmission of the disease. This is because the test only detects the presence of TB antibodies, and does not provide information on the individual’s infectiousness. In contrast, the sputum microscopy and PCR tests can be used to determine if an individual is actively shedding TB bacteria and is therefore capable of transmitting the disease to others.
  6. Risk of unnecessary treatment: False positive results from the tuberculin test can lead to unnecessary treatment for TB, which can have serious consequences for the individual. TB treatment typically involves a long course of antibiotics, which can have side effects and may not be necessary if the individual does not actually have TB infection.

Which is the Advised Diagnostic Test for Tuberculosis (TB) in India?

Tuberculosis (TB) is a bacterial infection that primarily affects the lungs, but can also spread to other parts of the body. It is a leading cause of death worldwide, and is particularly prevalent in developing countries such as India. Accurate and timely diagnosis of TB is essential for ensuring that infected individuals receive proper treatment, which can help to reduce the spread of the disease and improve patient outcomes.

In India, the most commonly advised diagnostic test for TB is the sputum microscopy test. This test involves collecting a sample of phlegm produced by the respiratory tract and examining it under a microscope for the presence of TB bacteria. The test is simple, affordable, and widely available, making it an ideal option for diagnosing TB in India.

One major advantage of the sputum microscopy test is its high sensitivity, particularly in individuals with pulmonary TB. This means that the test is able to accurately detect TB infection in a large proportion of infected individuals. The test is also relatively specific, with a low rate of false positive results.

In addition to the sputum microscopy test, the polymerase chain reaction (PCR) test is also recommended for diagnosing TB in India. The PCR test uses genetic techniques to detect the DNA of TB bacteria in a sample of sputum or other body fluid. The test is highly sensitive and specific, making it an accurate and reliable method for diagnosing TB. However, the PCR test is more expensive and requires specialized equipment and trained personnel, which may limit its availability in some areas.

Other diagnostic tests that may be used for TB in India include the chest X-ray and the Tb gold test. The chest X-ray is a non-invasive imaging test that can help to identify abnormalities in the lungs that may be indicative of TB infection. However, the chest X-ray is not specific for TB and may not detect the disease in its early stages.

TB Gold Test is Gold Standard Test For Tuberculosis

The TB Gold test, also known as the QuantiFERON TB Gold test, is a diagnostic test used to detect tuberculosis (TB) infection. It is an in vitro test, which means it is performed in a laboratory using a sample of blood collected from the patient.

The TB Gold test works by measuring the patient’s immune response to TB antigens. When a person is infected with TB, their immune system produces antibodies to fight the infection. The TB Gold test uses a panel of TB antigens to stimulate the production of these antibodies, and measures the level of antibodies present in the blood sample. If the patient has been infected with TB, the level of antibodies in their blood sample will be higher than in a person who has not been infected.

One advantage of the TB Gold test is that it is highly specific, with a low rate of false positive results. This means that the test is unlikely to produce a positive result in someone who does not have TB infection. The test is also relatively sensitive, although it may not detect TB infection in its early stages or in individuals with HIV/AIDS or other immune compromising conditions.

The TB Gold test is typically used as a supplement to other diagnostic tests for TB, such as the sputum microscopy test or the polymerase chain reaction (PCR) test. It is not recommended as a standalone diagnostic test due to its limited sensitivity.

In conclusion, the TB Gold test is a diagnostic tool used to detect TB infection by measuring the patient’s immune response to TB antigens. It is highly specific but has limited sensitivity, and is typically used in combination with other diagnostic tests for TB.

Conclusion

In conclusion, the tuberculin test has been banned in India due to its lack of specificity and sensitivity, limited usefulness in low TB prevalence areas, the availability of more accurate diagnostic methods, and the risk of unnecessary treatment. While the test may still be used in some countries, it is not considered a reliable method for diagnosing TB in India.

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