LTBI, man this sucks..

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Phillykid162

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If you've had the BCG vaccine, you will ALWAYS have a positive PPD skin test. It's happened to me about three or four times, and caused panic, before I read up on it. Now when a doc wants to to the skin test I just tell him/her that I had the BCG and they just don't bother. Obviously I am not a doc, but if your chest xrays were fine then I'm pretty sure that you don't need to be on meds. Did you tell the doc that you had the BCG vaccine as a child?

BTW, I've never been on meds for LTBI despite the recurring positive PPD--my docs always realized that the positive was because of the BCG, not because I was infected!
 
nova1983 said:
If you've had the BCG vaccine, you will ALWAYS have a positive PPD skin test. It's happened to me about three or four times, and caused panic, before I read up on it. Now when a doc wants to to the skin test I just tell him/her that I had the BCG and they just don't bother. Obviously I am not a doc, but if your chest xrays were fine then I'm pretty sure that you don't need to be on meds. Did you tell the doc that you had the BCG vaccine as a child?

BTW, I've never been on meds for LTBI despite the recurring positive PPD--my docs always realized that the positive was because of the BCG, not because I was infected!
Click to expand...

Yea I mentioned that I had the BCG. His reasoning was that the induration was too large to only be caused by the BCG. Accordingly, he asked me if anyone in my family had been diagnosed with TB, was anyone coughing ETC..

It puzzles me because no one I come into regular contact with has been coughing. They're gonna have my mom and sis tested just to be on the safe side...

I know this isn't exactly life threatening, but it sucks I won't be able to start Phase I. I was going to work, take one summer course, and volunteer. I haven't exactly had enough exposure to medicine to know this is what I want to pursue, so I really was looking forward to it.

Ah well, next summer then..:oops:
 
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If you indeed had the BCG vaccine as a child, then you will test positive on the PPD, regardless of whether you had recent TB exposure, or not. Thus, the PPD will not be sensitive for LTBI. You need to inform your physician that you had the vaccine, if you are sure you received it.

On the other hand, if you did not receive the vaccine, and you had a positive PPD and a negative CXR, then you should definitely follow your doctor's recommend regimen for LTBI prophylaxis (contrary to what one prior post suggests). Also, ask your doctor about other first-line options for prophylaxis. You may be able to take Rifampin instead, which has a shorter treatment course (4 months).

Anyway, don't worry about it. LTBI is nothing to get excited about. Give your doctor all of the pertinent PMH, including any other times you may have had a positive PPD and if you have had the BCG vaccine. Don't listen to any medical advice here. Consult with your physician instead.
 
endocardium said:
If you indeed had the BCG vaccine as a child, then you will test positive on the PPD, regardless of whether you had recent TB exposure, or not. Thus, the PPD will not be sensitive for LTBI. You need to inform your physician that you had the vaccine, if you are sure you received it.

On the other hand, if you did not receive the vaccine, and you had a positive PPD and a negative CXR, then you should definitely follow your doctor's recommend regimen for LTBI prophylaxis (contrary to what one prior post suggests). Also, ask your doctor about other first-line options. You may be able to take Rifampin instead, which has a shorter treatment course.

Anyway, don't worry about it. LBTI is nothing to get excited about. Give your doctor all of the pertinent PMH, including any other times you may have had a positive PPD and if you have had the BCG vaccine. Don't listen to any medical advice here. Consult with your physician instead.
Click to expand...

Yeah I informed my doctor of everything I knew. Luckily my mom went with me and told me about testing positive previously. Me being unaware of all this, my initial reaction was lol wth? As far as I knew it was my first ppd. He's the doc so I will follow the regimen faithfully...

Medical advice here? :laugh::laugh::laugh::laugh: (No offense)
 
Law2Doc said:
You could have gotten it sitting next to someone infected on the bus, it doesn't take enduring regular contact.
Click to expand...

Oh, I didn't know that... So there are possibly thousands, maybe millions of people who have the inactive bacteria and will never know? :eek:

Anyways thanks for the responses guys, I really appreciate it.
 
Phillykid162 said:
I know this isn't exactly life threatening, but it sucks I won't be able to start Phase I. I was going to work, take one summer course, and volunteer. I haven't exactly had enough exposure to medicine to know this is what I want to pursue, so I really was looking forward to it.

Ah well, next summer then..:oops:
Click to expand...

Why can't you start Phase I? Is LTBI, which you are treating, keeping you out of volunteering? If so, that sucks. I don't understand why that is the case.

Anyway, I'm sorry to hear that.
 
nova1983 said:
If you've had the BCG vaccine, you will ALWAYS have a positive PPD skin test.
Click to expand...

Interestingly, Up-To-Date (premiere authoritative source on-line with access through the med school) states that after ten years the reaction from a BCG will wane, and that it does not provide 100% protection. Anecdotally, my mom had BCG, tested positive for ten years, and then became negative.
 
Mobius1985 said:
Interestingly, Up-To-Date (premiere authoritative source on-line with access through the med school) states that after ten years the reaction from a BCG will wane, and that it does not provide 100% protection. Anecdotally, my mom had BCG, tested positive for ten years, and then became negative.
Click to expand...

correct -- bcg's protective effect wanes over time. also bcg vaccination does not always lead to a positive ppd. While the antibodies generated against BCG can cross react with the tuberculin ppd and lead to a positive PPD (usually in the first few months after an immunization), one also has to remember that the countries that still routinely immunize with BCG also have high rates of TB... so the US guidelines say not to consider bcg immunization as a contraindication to placing a PPD, and to treat the skin test in someone with a bcg history as if they never had bcg. really large reactions (>20mm) are much more likely to be due to latent TB than bcg, especially in an adult.
 
edfig99 said:
correct -- bcg's protective effect wanes over time. also bcg vaccination does not always lead to a positive ppd. While the antibodies generated against BCG can cross react with the tuberculin ppd and lead to a positive PPD (usually in the first few months after an immunization), one also has to remember that the countries that still routinely immunize with BCG also have high rates of TB... so the US guidelines say not to consider bcg immunization as a contraindication to placing a PPD, and to treat the skin test in someone with a bcg history as if they never had bcg. really large reactions (>20mm) are much more likely to be due to latent TB than bcg, especially in an adult.
Click to expand...

I think my Doctor would agree, hence the INH prescription.
 
edfig99 said:
on the plus side...
you'll never have to have another ppd placed :) (speaking as someone who is also ppd+ and who doesn't have to get one every year like all those ppd- folks do ;) )

the 9 months will go pretty quick. hang in there. (and stay away from EtOH)
Click to expand...

I don't drink, so that should be easy enough. :cool: Some of the sites i've been to, like cdc, say a healthy amount of Vitamin B6 is recommended with the INH... I was going to buy a supplement when I realized a lot of my diet is rich in it. :laugh:
 
BTW edfig, I looked on you profile (was curious since you're in NYC) and saw that you work at Columbia Presbyterian! I lived most of my life at 162nd and Fort Washington ave!

That hospital is always tied to my family because I used to go there as a kid, and my grandpa, god bless his soul died there a few years back. Is it just me or is Washington Heights now "Little Santo Domingo" :smuggrin:
 
Phillykid162 said:
BTW edfig, I looked on you profile (was curious since you're in NYC) and saw that you work at Columbia Presbyterian! I lived most of my life at 162nd and Fort Washington ave!

That hospital is always tied to my family because I used to go there as a kid, and my grandpa, god bless his soul died there a few years back. Is it just me or is Washington Heights now "Little Santo Domingo" :smuggrin:
Click to expand...

It's always been "Little Santo Domingo"..at least, it has for the last 20 years or so.

i did my residency there and stayed on as faculty for a couple of years up there but don't work there anymore....i guess i should update my profile :D but I do still live up here in Inwood (closer to 207th st and b'way)

anywho...good luck with the ltbi treatment and hope you get to volunteer -- there's no reason you shouldn't be able to since it sounds like you don't have active TB.

cheers
-ed
 
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