Positive Mantoux Test

Author: Pediatric Oncall
A 2 years old boy presented with dry cough for 1 month. There is no fever or loss of appetite though he has not put on any weight in past 6 months. There is no contact with tuberculosis. On examination, he has insignificant cervical lymphadenopathy. Other examination findings are normal. A Mantoux test done in him was positive 15 x 10 mm.
Expert Opinion :
Dr Kehar,
Thanks for info on quantiferon test. However if the test is negative, it suggests that the postive mantoux could be due to BCG, atypical infections or past TB exposure. The positive test along with positive mantoux suggests recent TB exposure. It does not tell us active TB.

Regarding type of TB, most of you have replied as latent TB, however this child has cough as a symptom. Thus this child is symptomatic Mantoux positive. In such as scenario, dry cough could be due to primary complex, miliary TB or mediastinal adenopathy. Pleural effusion and pericaridal effusion could also cause dry cough, but there would findings on examination. A primary progressive tuberculosis would lead to features of consolidation and child would have clinical signs of pneumonia. A cavitatory TB would lead to cough with expectoration and fever. A pleural effusion would lead to cough with chest pain and breathlessness.

Thus in this child, it could be miliary TB, primary complex or mediastinal adenopathy. Miliary TB should have given to weight loss and wasting. Primary complex should have had fever or should have been asymptomatic. Thus most likely problem is mediastinal adenopathy though one should watch out for primary complex. Chest X-Ray of the child showed superior mediastinal widening suggestive of mediastinal adenopathy. CT chest showed necrotic caseous mediastinal adenopathy
Answer Discussion :
DrMohit Kehar
{ESAT-6 and, or CFP-10
responsiveness detected}
M. tuberculosis infection likely

{No ESAT-6 or CFP-10
responsiveness detected}
M. tuberculosis infection unlikely, but
cannot be excluded especially when
1. any illness is consistent with
tuberculosis disease
2. likelihood of progression to
disease {e.g., because of
immunosuppression} is increased

Test not interpretable

6 years ago
tarek kotbc
6 years ago

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