Accepted to Med school and Positive TB test

[O'Shag Hennessy]

While going about my compliances for medical school I went and got my TB test a couple days ago. Go into the doctor's office today to be absolutely astonished with a positive TB test and I immediately start freaking out about how this will impact medical school. Does anyone have any insight? I don't want to downplay the effectiveness of the test or my doctor but I don't have any symptoms (even though I know it can be latent) or match any of the risk factors that come with TB (malnourished, HIV, developing nation, minority, etc).

Edit: I left out that I've tested negative for TB in the past and have recently received a chest X ray from being in the hospital with pneumonia and the doctor never said anything then either. Seems like bull**** to me.

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[Osteopath999]

So your chest X-ray also shows positive sign of TB?

 

[O'Shag Hennessy]

Going to a lung doctor tomorrow but my one from 6 months ago (I assume) showed nothing because the doctor's have never said anything to me about TB in my entire life.

 

[AM508]

False positives are possible. I worked in a situation where we needed to get TB skin tests every 6 months and there were a couple of people that could not get the test due to having a past positive rxn, despite never having had TB and having clear chest x-rays. After a pulmonary workup, these cases were ruled a false positive and the folks were able to continue working. I would think you will be fine once your pulmonary workup is complete and there is no significant findings.

 

[ortnakas]

I have a friend (at a different school than mine) who tests positive for TB and just has to get a chest x-ray annually. Assuming your chest x-ray is negative and you're asymptomatic, it should have little impact.

 

[jitterbug778]

I wouldn't worry just yet. The place I work at gives TB tests, and if the skin is positive we suggest a chest xray to rule out a false positive. Also, there is a more accurate blood test you can take. Finally, if you are actually positive, you will have to see an infectious disease doc who will give you meds for a few months. You might not be able to interact with patients, but if it's your first semester of your first year it shouldn't make much of a difference. It sucks, but please don't get too worried just yet!

 

[velodork]

Apparently you can test positive (borderline) after pretty mild exposure to TB. I don't take skin tests anymore, just an annual chest x-ray per my employer's policy. I have a feeling that there are more than a few Healthcare workers out there that this would apply to, so not much to worry about (unless you become symptomatic, of course).

 

[drsmpc]

I got a false positive. Chest x-ray was clear. No reason to worry yet. The skin tests can be subjective I feel. I had 4 nurses scratching on it for 5 mins - with all the blood flow it was bound to look positive!

 

[quickfeet]

I got a false positive. Chest x-ray was clear. No reason to worry yet. The skin tests can be subjective I feel. I had 4 nurses scratching on it for 5 mins - with all the blood flow it was bound to look positive!

yeah... that aint how that test works son

 

[Goro]

I have plenty of students who were born outside the US and got the BCG. Not all of them get + TB tests, but a good number do. And every year when their required PPD turns positive, they have to go for the next round of testing.

If you're really Positive, it's a song and dance you'll get used to.

I have a friend (at a different school than mine) who tests positive for TB and just has to get a chest x-ray annually. Assuming your chest x-ray is negative and you're asymptomatic, it should have little impact.

 

[Drrrrrr. Celty]

If it's a PPD + then it's really debatable and chances are good that you're fine. If it's a T-spot or a Quant-gold then you have TB and you're going to be swallowing pills for 4-6 months.

 

[Drrrrrr. Celty]

I have plenty of students who were born outside the US and got the BCG. Not all of them get + TB tests, but a good number do. And every year when their required PPD turns positive, they have to go for the next round of testing.

If you're really Positive, it's a song and dance you'll get used to.

How about a case of latent/ non symptomatic TB? Would that put a student at grounds for rejection?

 

[Crookster]

I don't know bout you but I have sensitive skin and every time I get the TB tests the person who reads it is a little apprehensive because it looks like I have a little reaction but I never have protrusion of the skin. It' is completely smooth to the touch so I test negative. I would maybe get a second opinion if you think you may have sensitive skin or if you explicitly remember it being smooth to the touch. If you remember it feeling a bump I would go to that lung doc to confirm.

 

[O'Shag Hennessy]

Thanks everyone. Pretty bizarre situation.

 

[allantois]

I have plenty of students who were born outside the US and got the BCG. Not all of them get + TB tests, but a good number do. And every year when their required PPD turns positive, they have to go for the next round of testing.

If you're really Positive, it's a song and dance you'll get used to.

Luckily nobody ever makes me go for the TB test once I inform them of BCG vaccine I got at birth.

 

[Mad Jack]

How about a case of latent/ non symptomatic TB? Would that put a student at grounds for rejection?

Latent TB is latent TB. If you can't see it on CXR and they have no symptoms, you should be fine, but need to get started on treatment. You aren't contagious, and will not progress to being symptomatic while on the antibiotics.

Thanks everyone. Pretty bizarre situation.

You will need to get a follow up CXR and likely a more sensitive TB test to ensure you don't have latent TB. Unless you have active TB, you are fine.

 

[Drrrrrr. Celty]

Luckily nobody ever makes me go for the TB test once I inform them of BCG vaccine I got at birth.

I think a lot of people tend to not realize that BCG is a thing. I had a lady at a hospital for occupational medicine in a very diverse area of the world fail to grasp that me being born in a certain country likely meant I was going to be BCG vaccined.

In any case I know now to immediately ask for a gamma interferon test and avoid swelling.

 

[yanks26dmb]

I was actually wondering this myself. I just spent two months in India and Africa...and won't be back in the states until three weeks before school starts. If I do somehow test positive for TB, what will happen? Will I be able to start first year on time?

 

[Mad Jack]

I was actually wondering this myself. I just spent two months in India and Africa...and won't be back in the states until three weeks before school starts. If I do somehow test positive for TB, what will happen? Will I be able to start first year on time?

Yes. Unless you've somehow gone into full-blown active TB infection, in which case, you've got much bigger problems, as you've got to have some crazy level off immune compromise going on.

 

[Goro]

This is something for my Clinical deans to answer. I would take a guess that not a rejection, but a deferral and acceptance after treatment.

How about a case of latent/ non symptomatic TB? Would that put a student at grounds for rejection?

 

[cabinbuilder]

Get a Gold Quanterferon test to prove/disprove your infection.

 

[group_theory]

Even if your PPD is positive, as long as you don't have active TB, there's no reason to delay starting medical school. Hopefully your school will have a student health medical director that understands TB and will sign off saying you can start.

If you seroconverted on PPD, you should be treated for latent TB. Even if you have a history of BCG vaccination, if you never underwent treatment for latent TB, the recommendation is to use the Interferon Gamma Release Assay (such as Quantiferon Gold) since it has been shown to be able to not reactive positively to BCG vaccine and will give a positive value for prior exposure history (and now latent TB). If you are positive on the IGRA, you really need to be treated but there's no reason for quarantine or isolation. Neither the IGRA or PPD can distinguish LTBI vs active so you need to go based on symptoms as well as findings (eg., CXR, etc) if you are looking for active TB. And once you seroconvert (either PPD or IGRA), there is no other way to screen for re-exposue (and re-infection) so you'll just have to be on the look out for signs of active TB.

But to answer the OP question - history of negative PPD, recent seroconversion, and negative CXR screams TB exposure (and now has LTBI) and will need treatment for LTBI (and not active TB). But there shouldn't be a need to delay starting medical school or clinicals. If you have signs of active TB, that's another story. However, for specific questions in regard to your case, you should talk to your doctor.

*just my perspective, as a board-certified pulmonologist

 

[deepti1212]

Does anyone know what will be the result of TB blood test on a person who had a past positive history of TB 16 years before and she was treated with DOTS antibiotics for 8 months. Also, the chest xray is negative after the treatment.

 

[Yadster101]

Even if your PPD is positive, as long as you don't have active TB, there's no reason to delay starting medical school. Hopefully your school will have a student health medical director that understands TB and will sign off saying you can start.

If you seroconverted on PPD, you should be treated for latent TB. Even if you have a history of BCG vaccination, if you never underwent treatment for latent TB, the recommendation is to use the Interferon Gamma Release Assay (such as Quantiferon Gold) since it has been shown to be able to not reactive positively to BCG vaccine and will give a positive value for prior exposure history (and now latent TB). If you are positive on the IGRA, you really need to be treated but there's no reason for quarantine or isolation. Neither the IGRA or PPD can distinguish LTBI vs active so you need to go based on symptoms as well as findings (eg., CXR, etc) if you are looking for active TB. And once you seroconvert (either PPD or IGRA), there is no other way to screen for re-exposue (and re-infection) so you'll just have to be on the look out for signs of active TB.

But to answer the OP question - history of negative PPD, recent seroconversion, and negative CXR screams TB exposure (and now has LTBI) and will need treatment for LTBI (and not active TB). But there shouldn't be a need to delay starting medical school or clinicals. If you have signs of active TB, that's another story. However, for specific questions in regard to your case, you should talk to your doctor.

*just my perspective, as a board-certified pulmonologist

I was born in the US but my family and I lived abroad for a couple of years when I was very young (~2-3yrs/old). I also have the classic scar on my left shoulder so I'm pretty sure I got the vaccine. My tb skin test in college came back positive but the chest X-rays have always been clear. My question is, am I going to be expected to get a chest X-ray every year when I begin working as a resident/attending? Wouldn't that be unhealthy? If my chest X-ray is clear then won't QFT results also be clear? Should I get QFT?

Also I never received the INH treatment even after my positive test in college.

 

[velodork]

I was born in the US but my family and I lived abroad for a couple of years when I was very young (~2-3yrs/old). I also have the classic scar on my left shoulder so I'm pretty sure I got the vaccine. My tb skin test in college came back positive but the chest X-rays have always been clear. My question is, am I going to be expected to get a chest X-ray every year when I begin working as a resident/attending? Wouldn't that be unhealthy? If my chest X-ray is clear then won't QFT results also be clear? Should I get QFT?

Also I never received the INH treatment even after my positive test in college.

I have a similar situation in that I'm on the "threshold" with the skin test. I've worked in a hospital for 6 years- when I was hired I had to do a chest x-ray but every year since then I fill out a questionaire to rule out symptoms and call it a day. Thats just my hospital's policy, though.