Positive quantiferon test prior to starting residency.

[AlGamaty]

I am an incoming intern, and I just had my pre-employment check-up earlier this week. On Friday I was informed that my quantiferon test came back positive. I am scheduled for a CXR on Monday. This result was a surprise to me. I am completely asymptomatic and I have not been to a high-risk country in my life. I haven't left North America in over 5 years.

I'm anxious about the possibility of this affecting my employment.

My understanding of the situation is: If it's latent TB, I would just have to take the antibiotic course (INH + rifapentine) and I can go to work normally as LTBI is non-infectious. If it's active TB (which I highly doubt considering my low exposure risk), I would have to be isolated until I produce 3 negative sputum samples. That would likely delay my start date.

Realistically, this is a fairly common situation among healthcare workers so I shouldn't be too concerned about my start date being delayed, or worse, being terminated from the program right? I've been having nightmares of that.

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[GoSpursGo]

This happened to me starting fellowship. Had to go through treatment for latent TB and was fine

 

[DrMetal]

I am an incoming intern, and I just had my pre-employment check-up earlier this week. On Friday I was informed that my quantiferon test came back positive. I am scheduled for a CXR on Monday. This result was a surprise to me. I am completely asymptomatic and I have not been to a high-risk country in my life. I haven't left North America in over 5 years.

I'm anxious about the possibility of this affecting my employment.

My understanding of the situation is: If it's latent TB, I would just have to take the antibiotic course (INH + rifapentine) and I can go to work normally as LTBI is non-infectious. If it's active TB (which I highly doubt considering my low exposure risk), I would have to be isolated until I produce 3 negative sputum samples. That would likely delay my start date.

Realistically, this is a fairly common situation among healthcare workers so I shouldn't be too concerned about my start date being delayed, or worse, being terminated from the program right? I've been having nightmares of that.

When you did leave North Americs 5 years ago, where did you go? Have an exposure? Sounds like latent TB. Comply with treatment and you'll be fine

 

[AlGamaty]

When you did leave North Americs 5 years ago, where did you go? Have an exposure? Sounds like latent TB. Comply with treatment and you'll be fine

I was in the UAE (which also has a very low incidence of TB similar to North America, according to the CDC). I've never visited or lived in a "high-risk" country in my life. I have no exposures that I can recall. I had a prior PPD done in 2017 which was negative.

I feel like it could have been a false positive considering my low exposure risk. Maybe they will let me redo the QFT to confirm. Regardless, I will comply with treatment if they put me on it. I just want to start on time and avoid any delays.

 

[AlGamaty]

This happened to me starting fellowship. Had to go through treatment for latent TB and was fine

Thank you for sharing your experience. I am hoping that's all it is for me.

 

[DrMetal]

I was in the UAE (which also has a very low incidence of TB similar to North America, according to the CDC). I've never visited or lived in a "high-risk" country in my life. I have no exposures that I can recall. I had a prior PPD done in 2017 which was negative.

I feel like it could have been a false positive considering my low exposure risk. Maybe they will let me redo the QFT to confirm. Regardless, I will comply with treatment if they put me on it. I just want to start on time and avoid any delays.

If you honestly think it a false positive, have it rechecked. No sense in initiating treatment if it's really not there.

 

[LucidSplash]

I think you’re conflating the concept of “low risk” as “no risk.”

You’re not going to lose your residency position. Just go through the evaluation process. The hospital who wanted you to get the test is going to have a SOP for what to do in the event of a positive test and it won’t include firing you. Stop freaking out and get yourself together. Get the CXR and have the followup appt and go from there. You can ask to repeat the QFT gold but it will likely depend on the institutional policies if they allow that. But also if I’m not mistaken, serial QFT is associated with over treatment so not sure that will get you the result you want anyway.

You’re on the pathway, nothing to do but see it through.

 

[AlbinoHawk DO]

Unlikely to be active, but even if it was, you don't need the 3 negatives anymore. You just need to be on therapy for 5 days, and that's it per the new guidelines

 

[comp1]

I mean you just finished med school. You were likely exposed to TB repeatedly during your clerkships. We're all at elevated risk.

 

[theshellyb]

I got latent TB from a bus in San Francisco. The lady at the health department was asking me all these questions before giving me my isoniazid - "Were you in jail, were you in Asia, were you in the military" etc etc, no no no - then she asked if I took public transit, I did, she asked what lines, and told me the 49 bus was the "TB Express" - I'm guessing because it connects recent immigrants in Chinatown with immunocompromised residents of the Castro. ANYWAY, I took my 6 months of isoniazid and never had do to another TB test in my life and now I just answer an annual survey asking if I'm coughing up blood so on balance I say I came out ahead.

 

[goodoldalky]

The lifetime progression of LTBI to active pulmonary TB in a person who is otherwise completely healthy is around 5%. (More like 10% with comorbid conditions such as DM). This is exceedingly low.
Generally, however, if there is a plan to screen, there is a plan to treat, which will mean 12 weeks of meds. But none of that should delay your start date.