PPD question

[PACmatthew]

This is to any nurse who deals with PPD readings and really knows their stuff. Do you know if having a PPD done within a month of your last one can lead to a false positive, or simply a larger reaction? I had a patient who I diagnosed with TB, active, and I had been around her for a few times trying to fix her cough before I diagnosed the TB. Coincidentally, I had done my annual PPD the week before, and it was negative. Now, one and one half months later, I am 24 hours into my PPD and my arm has some slightly significantg erythema. I know I need to wait until the 48-72 hour mark, but I am concerned because my last test did not even leave any redness. I seem to recall that there is some sort of problem with giving them too close together. Does anyone really know, and can you give a link to reference? I have also heard that there can be a little redness at the 24 hour mark from the injection, but I didn't have any last time. I don't think I feel any induration right now, but I am getting nervous. Any insight will be appreciated. Thanks.

Matt, PA-C

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[CADO2B]

If I remember correctly, they usually wait a few days before measuring the swelling if it's positive. IF you are positive, the physician reading the test will put you on some meds after having cleared you with a negative chest xray. If on the other hand you have a positive with a positive chest xray he/she will probably admit you and treat you with other meds.

IF ever you should need another TB test later down the line, and you know that you'll test positive, just get the xray and elect not to have your skin pricked because it'll swell up bigger and your body might mount an immune response (e.g. anaphylatic shock). Then that wouldn't be good. So try to stay healthy. Did you take precaution when you had encounters with the patient with positive TB? Just curious? You supervisor should have had you masked and taken safety precautions.

My disclaimer here is always check with your physician before proceeding with any tests or medications. I'll send you my (hope this helps) bill :wink:

 

[CADO2B]

Oh one more thing...you DIAGNOSED the patient as having TB? and you're a MSI? How did you do that?

 

[tedsadoc2002]

matthew's credentials indicate that he is a PA (physician's assistant) with certification. I take it that matthew may have diagnosed the person in his capacity of being a PA.

 

[PACmatthew]

CADO2B,

Thanks for your response, but I think I may not have outlined my situation clearly enough. I am a PA-C with a Master's degree and 4 years experience in family medicine. My supervisor rarely sees any of my patients because there is very little between what I do and what he would do for a simple cough. This patient was a young college female who had few risks of TB. She was new to Houston where our air often brings on new cases of asthma in people who are new to the area. She was simply having a chronic cough of a few weeks or so, and initially her symptoms pointed to post nasal drip and slight reactive airway disease. her PFT's showed slight restriction, and she did improve in Rescon (very good med to stop post nasal drip when simple Claritin won't cut it). She also was given an inhaler called Advair which is a combination of an inhaled corticosteroid and a long acting beta agonist. It also helped. However, when her cough would not go away, I did do a PPD. So, I had seen her 2 times before the PPD was positive, and as a PA, I like to spend a lot of time with patients when I have time. Thus, I spent about 20 minutes x 2 in an enclosed exam room with her before we knew this. The question about the mask would be reasonable if we suspected TB, but you can't mask up for every cough. And to let you guys know, my arm is much less erythematous and there is no measurable induration today. Thanks for taking the time though to respond.

Matt