[Report 1967] / Medical Officer of Health, Cumberland County Council.

  • Cumberland (England). County Council.
Date:
1967
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1967] / Medical Officer of Health, Cumberland County Council. Source: Wellcome Collection.

    259/270 (page 253)
    Twenty years ago the Mantoux test and its interpretation xjippeared straightforward as a positive reaction meant previous •infection with the tubercle bacillus, and with a very few exceptions ao reaction meant the reverse. Within recent years, however, a rliifficulty has been recognised in that atypical myco-bacteria and G avian tubercle bacilli give rise to reactions usually of lower 3 intensity. This difficulty has been recognised abroad for some )fjtime but in England it was thought to be of little significance. /(fHowever, surveys in the last few years have changed this attitude, bland with growing awareness that reactions due to these atypical laorganisms can arise, the interpretation of the Mantoux test has olbecome more complex. A strong positive reaction, however, re- i^mains possibly the best index to the amount of tuberculosis in a the community, and can still be taken, 1 think, to indicate previous >]| infection or previous vaccination with B.C.G. The difficulty i/| usually arises in the weaker reactions. Mantoux testing after )) B.C.G. vaccination is no longer necessary in every case, and we ’^only do an occasional one. The question of chemoprophylaxis has also come to the fore I in recent years. Extensive trials have been conducted abroad, particularly in the U.S.A. but the methods have not been so i widely adopted in this country. The drug used in these trials s has usually been Isoniazid. I The United States of America National Tuberculosis Assoc- l iation has within recent months made recommendation that chem- I oprophylaxis should be mandatory for certain groups of patients. These groups include (1) previous patients who have had inadequate therapy; (2) patients with a positive Mantoux test and radiologically healed disease; (3) contacts with a markedly positive Mantoux test and reactors under 21; (4) known convertors in all age groups; (5) patients with a positive Mantoux test who are on steroid therapy, or those undergoing a gastrectomy, or those suffer- ing from instable diabetes. They also advise that pregnant women with inactive tubercle should be treated chemopraphylactically and that children developing measles and whooping cough should have Isoniazid for 8 weeks, if they have been treated for tuberculosis previously.