Positive TB PPD test :(

[flillia]

I just got back from the doctor - they think that my PPD test came up positive, though they want me to go back in tomorrow to have my regular doctor look at it before proceeding with the xrays..

My question is - I'm supposed to start P1 in a few days. There isn't any patient interaction as far as I know in year 1. Am I going to be allowed to start? I'd hate to have to delay everything for a year because of something like that If so.. if the PPD test is pos and xrays are negative, would they still have a problem with me going?

This is scary

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[ntrn15]

Worry not, you will be allowed to start classes like everyone else. However, you won't be allowed to register for the spring semester until you complete all of your immunization requirements. So, get things done within the first two weeks of school. Hope that helps.

 

[flillia]

Worry not, you will be allowed to start classes like everyone else. However, you won't be allowed to register for the spring semester until you complete all of your immunization requirements. So, get things done within the first two weeks of school. Hope that helps.

Thanks!!

 

[Omegadramon]

I know a guy who actually did test positive and had to be in drug therapy for 6months+. He said it was a terrible experience.

 

[PharmDream10]

I just got back from the doctor - they think that my PPD test came up positive, though they want me to go back in tomorrow to have my regular doctor look at it before proceeding with the xrays..

My question is - I'm supposed to start P1 in a few days. There isn't any patient interaction as far as I know in year 1. Am I going to be allowed to start? I'd hate to have to delay everything for a year because of something like that If so.. if the PPD test is pos and xrays are negative, would they still have a problem with me going?

This is scary

As long as your x-rays don't show active TB disease you should be fine. You will still probably have to take meds for 6 months or so.

 

[norafena]

I know someone who tested + slo but X-rays were fine. I hope that will be your case

MY question is: I took 2 skin tests (1 week apart) even thought the first was neg. The insurance throught school did not want to cover it b/c they claimed there was no need for the 2nd test.
How many did you take everyone? I am concerned....thx

 

[rXcmoney]

I think most schools require a 2 step test. 1 step tests aren't reliable...They can give false negatives. I got charged $50 for mine. Piece of **** health department.

 

[norafena]

I think most schools require a 2 step test. 1 step tests aren't reliable...They can give false negatives. I got charged $50 for mine. Piece of **** health department.

I recall taking only one for immigration. And insurance argued that I did not need asecond...aghhh as you said it is all BS

 

[nnguyenc]

i tested true positive on TB PPD skin test

when I told everyone, they freaked out & ran the other way
needless to say, i was vaccinated with the vaccine before coming to america

so i did have antibodies against it

 

[jawnly211]

many people who were born in asia (korea, china, vietnam) had the bcg vaccine as a child

noticeable from the scar it leaves on the deltoid

if you ever had this vaccine and are required to take the PPD test, you avoid the skin test and only perform the chest xray

the PPD will show a false positive

 

[Hels2007]

many people who were born in asia (korea, china, vietnam) had the bcg vaccine as a child

noticeable from the scar it leaves on the deltoid

if you ever had this vaccine and are required to take the PPD test, you avoid the skin test and only perform the chest xray

the PPD will show a false positive

It's the smallpox vaccine that leaves the scar on the deltoid (the reason that when crossing the borders in 60s and 70s you had to bare your shoulder to show that you had it, as I was told). TB vaccine leaves no marks, but depending on what kind of PPD test is used (sensitivity of tests used in different countries varies a bit), may give a positive, as they detect the antibody (which a vaccine is supposed to produce).

As I have been vaccinated against every non-tropical disease for which there is a vaccine, I do give false positives to PPD, for which I just had to produce documentation of the vaccination and a clean X-ray.

 

[norafena]

I confirm that it is BCG that leaves a mark in our deltoid area of our arm. That is a tuberculosis vaccine. As mentinned above probably that's what is giving a false pos.
Vaccines do wear off and that is why I tested neg despite my BCG.
I remember discussing this subject with an immigration doctor and he said that hey are aware of the BCG and as long as the chest x-rays is fine the patient is cleared.
You should be fine, if you are a foreigner you are not going to need medication in my opinion.
Good luck

 

[pharmdinfl]

I just got back from the doctor - they think that my PPD test came up positive, though they want me to go back in tomorrow to have my regular doctor look at it before proceeding with the xrays..

My question is - I'm supposed to start P1 in a few days. There isn't any patient interaction as far as I know in year 1. Am I going to be allowed to start? I'd hate to have to delay everything for a year because of something like that If so.. if the PPD test is pos and xrays are negative, would they still have a problem with me going?

This is scary

I actually tested positive the semester before I started pharmacy school as well. I had a negative chest x-ray, so they figured I must have came into contact with someone with TB at the hospital where I volunteered frequently and in turn developed antibodies for it. They did make me take a course of isoniazid, which wasn't awful, but wasn't pleasant either. Anywho, don't worry about the school not letting you start so long as your chest x-ray is negative.

 

[bacillus1]

Are you foreign and from a place where they give a BCG vaccine to babies? If so, that's why it's coming up positive, and you could just tell them that as a heads up.

 

[Gizmo]

I confirm that it is BCG that leaves a mark in our deltoid area of our arm. That is a tuberculosis vaccine. As mentinned above probably that's what is giving a false pos.
Vaccines do wear off and that is why I tested neg despite my BCG.
I remember discussing this subject with an immigration doctor and he said that hey are aware of the BCG and as long as the chest x-rays is fine the patient is cleared.
You should be fine, if you are a foreigner you are not going to need medication in my opinion.
Good luck

Agreed. I also had the TB vaccine as a baby and have the characteristic mark. I test positive when the skin test is done, but my CXR are clear and I have no symptoms, so I was not required to take any course of antibiotics.

I'm not sure if it was mentioned, but from what I was told, once you test positive, you will always test positive, so one should not continue to get the skin test. 1) The reaction will only get progressively worse, and 2) if the technique of the administrator is bad, they may potentially inject into the systemic circulation, which would lead to anaphylaxis. I haven't researched these points, but just wanted to state what my healthcare colleagues have told me.

 

[Aznfarmerboi]

A positive PPD test is nothing to worry about. In fact if you live in major metropolitian cities ie NYC, it wouldnt be surprising if you have it.

 

[brwnricecracker]

I had my PPD two days ago, and today I was deemed positive and did a chest x-ray right away. Aw, Lawd! I freaked out...It looks like a pale pink mosquito bite without the yellow core (does that make sense? ) I feel a very slight induration, could be an understatement. I don't know why my Doc never asked me to do a PPD test for my yearly physicals. I had my first PPD with my pediatrician when I was, like, 17. I've been with this Doc for 6 years now and he never performed a PPD test for me.


I really hope my chest x-ray shows negative. I read there are many causes for a positive PPD, even vitamin-deficiency which I can attest to...


Again, I hope. Is it curable with meds?

 

[hereticmnk]

I had my PPD two days ago, and today I was deemed positive and did a chest x-ray right away. Aw, Lawd! I freaked out...It looks like a pale pink mosquito bite without the yellow core (does that make sense? ) I feel a very slight induration, could be an understatement. I don't know why my Doc never asked me to do a PPD test for my yearly physicals. I had my first PPD with my pediatrician when I was, like, 17. I've been with this Doc for 6 years now and he never performed a PPD test for me.


I really hope my chest x-ray shows negative. I read there are many causes for a positive PPD, even vitamin-deficiency which I can attest to...


Again, I hope. Is it curable with meds?

Are you foreign ? My PPD is always positive because of the BCG vaccine. I took an X-Ray and never ever have to take that awful test again
I dont know how you haven't had the results of your XRay yet. It takes a second to do

 

[joetrisman]

A positive PPD test is nothing to worry about. In fact if you live in major metropolitian cities ie NYC, it wouldnt be surprising if you have it.

Yup. I love ID and kinda geekgasm at the idea of getting a positive PPD. I hear if you're around immunocompromised pts enough, its only a matter of time.

 

[hereticmnk]

Yup. I love ID and kinda geekgasm at the idea of getting a positive PPD. I hear if you're around immunocompromised pts enough, its only a matter of time.

The last time I checked being immunocompomised is not contagious in itself (excluding the dz) so you wouldn't really see a positive PPD based on that fact alone

 

[joetrisman]

The last time I checked being immunocompomised is not contagious in itself (excluding the dz) so you wouldn't really see a positive PPD based on that fact alone

No doubt. I was talking about the increased incidence of TB with immunocompromised folks.

 

[hereticmnk]

No doubt. I was talking about the increased incidence of TB with immunocompromised folks.

Oh, that makes more sense lol. But just FYI being immunocompromised isn't technically a RF for TB.. HIV, Chemotherapy, DM etc. is but I see your point.

 

[KARM12]

Oh, that makes more sense lol. But just FYI being immunocompromised isn't technically a RF for TB.. HIV, Chemotherapy, DM etc. is but I see your point.

Being immunocompromised is a risk factor for converting from latent to active disease.

 

[hereticmnk]

Being immunocompromised is a risk factor for converting from latent to active disease.

I do not disagree with you...

 

[brwnricecracker]

I do not disagree with you...

OK, my chest X-Rays came out negative, MD says "nothing unremarkable", "clear passages.." etc. etc. So, why did I get a positive reaction? and what really is "latent TB", what will trigger it? I don't even smoke and no one in my family has a history of TB.

BTW, I still have a faint pinkish splotch...it's barely noticeable unless you stare at the spot for 5 seconds...it's been 3 weeks since I had the test.

Hereticmnk, yup, I am foreign, I came to the States when I was 3. I'm not sure if I'm considered "foreign" or not, I wasn't born in the States.

 

[hereticmnk]

OK, my chest X-Rays came out negative, MD says "nothing unremarkable", "clear passages.." etc. etc. So, why did I get a positive reaction? and what really is "latent TB", what will trigger it? I don't even smoke and no one in my family has a history of TB.

BTW, I still have a faint pinkish splotch...it's barely noticeable unless you stare at the spot for 5 seconds...it's been 3 weeks since I had the test.

Hereticmnk, yup, I am foreign, I came to the States when I was 3. I'm not sure if I'm considered "foreign" or not, I wasn't born in the States.

Did you come from a country like Africa? India? etc. They usually give you a BCG vaccine which is why you had a positive reaction. You have some options--
1) Take an anti TB med (I think its Rifampin .. could be isoniazid, I can't remember))x 6 months empirically (don't need to tho)
2) Take a quanteferon gold test (sp??) for ruling out TB
3) Don't do anything (recommended course of action)

 

[KARM12]

Did you come from a country like Africa? India? etc. They usually give you a BCG vaccine which is why you had a positive reaction. You have some options--
1) Take an anti TB med (I think its Rifampin .. could be isoniazid, I can't remember))x 6 months empirically (don't need to tho)
2) Take a quanteferon gold test (sp??) for ruling out TB
3) Don't do anything (recommended course of action)

You should not be giving medical advice on SDN...especially when it is wrong!

 

[hereticmnk]

You should not be giving medical advice on SDN...especially when it is wrong!

True forgot about that.. but out of curiosity how is it wrong advise if she indeed received a bcg vaccine, had a positive PPD and a (-) CXR

 

[STAR3URY]

I always have positive PPD because of where I come from. In ukraine they gave us TB vaccines so now i have antibodies..lol. Either way you get an X-ray done and if everything is clear u get cleared for 3 years. And u never have to get a PPD again once ur positive u just get XRAY every 3 years as needed.

 

[cycloketocaine]

True forgot about that.. but out of curiosity how is it wrong advise if she indeed received a bcg vaccine, had a positive PPD and a (-) CXR

Your treatment proposals were not accurate.

 

[hereticmnk]

Your treatment proposals were not accurate.

On the contrary , they are quite accurate. No one gets treated with a full TB regimen given the same circumstances as the poster

Patients who have taken the vaccine usually have PPD results that keep inflating over years (basic immuno concept) until it finally gets to threshold. CXR is done which is usually (-) and the patients are given the choice the choice to take Isoniazid (Not completely sure on the drug, could be Rifampin), take a more accurate TB test or do nothing. Most people opt to do nothing.. Plz correct me if you have more accurate information.

EDIT- You still have to get CXR regularly even if you opt to forego a 6 month tx

 

[hereticmnk]

I always have positive PPD because of where I come from. In ukraine they gave us TB vaccines so now i have antibodies..lol. Either way you get an X-ray done and if everything is clear u get cleared for 3 years. And u never have to get a PPD again once ur positive u just get XRAY every 3 years as needed.

Yup, I never have to take those annoying PPD tests ever again
But yes, I do have to get regular CXR which I don't mind being the hypochondriac that I am

 

[cycloketocaine]

On the contrary , they are quite accurate. No one gets treated with a full TB regimen given the same circumstances as the poster

Patients who have taken the vaccine usually have PPD results that keep inflating over years (basic immuno concept) until it finally gets to threshold. CXR is done which is usually (-) and the patients are given the choice the choice to take Isoniazid (Not completely sure on the drug, could be Rifampin), take a more accurate TB test or do nothing. Most people opt to do nothing.. Plz correct me if you have more accurate information.

EDIT- You still have to get CXR regularly even if you opt to forego a 6 month tx

I am not arguing with your BCG concept...only your recommendation for drug therapy. The CDC (who is the definitive body for these types of recommendations) states that patients with latent TB should be treated with isoniazid once active disease has been excluded. You post above states that you really don't need treatment and doing nothing is the recommended course of action....which the federal government disagrees with.

 

[Socrates25]

Although BCG can cause false positives, in pediatrics we dont care whether they got a prior BCG or not, if their PPD skin test is positive then it is considered latent TB, regardless of whether they got the BCG or not. This is the current AAP Red Book recommendation.

It is 9 months of isoniazid in non-resistant countries like the US. In other parts of the world that are INH resistant, rifampin is the drug of choice.

Obviously you need a CXR to r/o active TB. If you have active TB, I doubt they would let you work in a healthcare facility until completely treated. For latent TB, generally speaking you can still do work/school in a pharmacy/clinic/hospital without any problems.

There's also an alternative blood test for TB called the interferon gamma release assay, which is especially useful for people receiving BCG as there is no cross reactivity. We dont use that routinely in pediatrics because it hasnt been validated in that population yet. But the adult guys may use it routinely for screening of BCG patients.

 

[hereticmnk]

I am not arguing with your BCG concept...only your recommendation for drug therapy. The CDC (who is the definitive body for these types of recommendations) states that patients with latent TB should be treated with isoniazid once active disease has been excluded. You post above states that you really don't need treatment and doing nothing is the recommended course of action....which the federal government disagrees with.

Well an option to take Isoniazid is given for 6 months. And no one is arguing with the CDC but that is what the practice is. How else would you rule out an active TB( No other S/Sx) dz when the CXR is (-) and there is a known offender in BCG vaccine. People who took the BCG vaccine do not have latent TB so I am not sure how that is relevant unless you are implying that Isoniazid mono-therapy is only limited to that indication.

 

[hereticmnk]

Although BCG can cause false positives, in pediatrics we dont care whether they got a prior BCG or not, if their PPD skin test is positive then it is considered latent TB, regardless of whether they got the BCG or not. This is a consensus AAP recommendation.

There's also an alternative blood test for TB called the interferon gamma release assay, which is especially useful for people receiving BCG as there is no cross reactivity. We dont use that routinely in pediatrics because it hasnt been validated in that population yet. But the adult guys may use it routinely for screening of BCG patients.

But you cant possibly tell an adult he has latent TB because of a (+) PPD, BCG (+), and (-) CXR. I can see the utility in being cautious with a child.

I did not know that Interferon gamma release assay has not validated in "peds"... but I guess then again.. what is

 

[Socrates25]

But you cant possibly tell an adult he has latent TB because of a (+) PPD, BCG (+), and (-) CXR. I can see the utility in being cautious with a child.

I did not know that Interferon gamma release assay has not validated in "peds"... but I guess then again.. what is

I dont know what the current recommendation is for adults, but I know as recently as 2004 the CDC recommended ignoring BCG status in terms of interpreting tuberculin skin tests, especially for testing populations with higher pre-test probabilities of infection.

I agree with you that screening of BCG patients with PPD in populations with a low pre-test probability is problematic due to high false positive rates. But I havent heard differently from 2004 when the CDC still recommended screening BCG patients with the TB skin test and acting on those results regardless of the prior BCG exposure.

 

[hereticmnk]

I dont know what the current recommendation is for adults, but I know as recently as 2004 the CDC recommended ignoring BCG status in terms of interpreting tuberculin skin tests, especially for testing populations with higher pre-test probabilities of infection.

I agree with you that screening of BCG patients with PPD in populations with a low pre-test probability is problematic due to high false positive rates. But I havent heard differently from 2004 when the CDC still recommended screening BCG patients with the TB skin test and acting on those results regardless of the prior BCG exposure.

By acting on the results, do you mean order more diagnostics like CXR (a no brainer) and a IFN-gamma (like a quantiferon TB test) to rule it out. I do not think anyone would disagree with the CDC on that one (Although a IFN-gamma test might not be all that essential because if there are no other S/Sx, it is highly unlikely the person is going to have TB). I just hope no patient thought he/she had latent TB just based on those parameters because that would be .. extreme. I think tx options are still offered to the patients. (Iso x 9 or iso x 6 or rif x 4mo etc.).

And it makes perfect sense to be more cautious with a child because in an adult, who is given the BCG vaccine, repeated PPD tests can cause increasing readings with successive tests (antigen to the protein). A child should not have any compelling reason to have a positive PPD. So in conclusion, I do not know if they should classify a (+) PPD with (+) BCG + a (-) CXR as latent TB

 

[AmericanDesi]

Did you come from a country like Africa? India? etc. They usually give you a BCG vaccine which is why you had a positive reaction. You have some options--
1) Take an anti TB med (I think its Rifampin .. could be isoniazid, I can't remember))x 6 months empirically (don't need to tho)
2) Take a quanteferon gold test (sp??) for ruling out TB
3) Don't do anything (recommended course of action)

Isn't it Isoniazid for 9months with Vitamin B6?

 

[rxlea]

Isn't it Isoniazid for 9months with Vitamin B6?

9 months is preferred.

The vitamin b6 for neuropathy is recommended for people with other conditions like diabetes, HIV, etc or if the person is malnourished, pregnant, nursing.... Doesn't hurt for others to take it but neuropathy in otherwise healthy people is rare.

 

[BuckRx]

And it makes perfect sense to be more cautious with a child because in an adult, who is given the BCG vaccine, repeated PPD tests can cause increasing readings with successive tests (antigen to the protein). A child should not have any compelling reason to have a positive PPD. So in conclusion, I do not know if they should classify a (+) PPD with (+) BCG + a (-) CXR as latent TB

BCG doesn't prevent TB infection, but rather prevents some of the more dramatic outcomes.

Also generally a kid will test +PPD due to more recent BCG, where an adult getting first time PPD will have diminished BCG immunity.

Regardless, +PPD and +BCG doesn't tell us that you don't have latent infection.

 

[BuckRx]

Yup. I love ID and kinda geekgasm at the idea of getting a positive PPD. I hear if you're around immunocompromised pts enough, its only a matter of time.

The last time I checked being immunocompomised is not contagious in itself (excluding the dz) so you wouldn't really see a positive PPD based on that fact alone

I think what he's saying is that immunocompromised patients are much more likely to infect you, and thus working around them is a risk factor for infection.

 

[Ackj]

If you're born in America, have not traveled abroad, have not had vaccination, but have a +PPD and -CXR, it has to be latent disease, right? I mean, how else would you get a +PPD? We had a student a few years ahead of us that was pretty much that clinical picture, and being that she was a health student, potentially coming in contact with patients, they treated her. She even got DOT, which surprised me, but I guess that's fairly common for people with busy schedules juggling work and school, not just for the noncompliant folks.

 

[Socrates25]

If you're born in America, have not traveled abroad, have not had vaccination, but have a +PPD and -CXR, it has to be latent disease, right? I mean, how else would you get a +PPD? We had a student a few years ahead of us that was pretty much that clinical picture, and being that she was a health student, potentially coming in contact with patients, they treated her. She even got DOT, which surprised me, but I guess that's fairly common for people with busy schedules juggling work and school, not just for the noncompliant folks.

DOT lets you reduce the frequency of medication from every day to 2-3 times per week instead, so some people choose that option.

 

[Socrates25]

If you're born in America, have not traveled abroad, have not had vaccination, but have a +PPD and -CXR, it has to be latent disease, right? I mean, how else would you get a +PPD?

No, it doesnt "have to" be latent TB. False positives are common when you screen low risk populations for TB, which is why most experts and guidelines advise only risk-based screening in nations that have low prevalance of TB (such as USA), with exceptions for "healthcare" workers who may come into contact with immunosuppressed persons.

The powers that be at the NIH and CDC have decided that even though there is a significant false positive rate, its better to err on the side of treating people who dont have true latent TB vs missing people who do.

 

[hereticmnk]

BCG doesn't prevent TB infection, but rather prevents some of the more dramatic outcomes.

Also generally a kid will test +PPD due to more recent BCG, where an adult getting first time PPD will have diminished BCG immunity.

Regardless, +PPD and +BCG doesn't tell us that you don't have latent infection.

BCG does very much reduce the occurrence of TB (50% RRR according to some meta-analysis). But evidence suggest that this efficacy is reduced over time.

I never said +PPD and +BCG will tell you that you dont have latent TB. I was arguing that there is no way to tell a patient he/she has latent TB based on +ppd, -cxr and known to have gotten the bcg vaccine. Now if the person takes a IFN-gamma which is positive and he still has a -cxr, then we are talking..

 

[BuckRx]

BCG does very much reduce the occurrence of TB (50% RRR according to some meta-analysis). But evidence suggest that this efficacy is reduced over time.

There are studies that show exactly what you say, but overall the literature is far from conclusive on prevention of primary infection. Jury is still out at CDC and WHO on whether BCG protects against transmission for this reason. Right now the idea is that BCG does not appear to prevent TB implantation in the lungs, but may prevent lymphatic/hematogenous spread.

I never said +PPD and +BCG will tell you that you dont have latent TB. I was arguing that there is no way to tell a patient he/she has latent TB based on +ppd, -cxr and known to have gotten the bcg vaccine. Now if the person takes a IFN-gamma which is positive and he still has a -cxr, then we are talking..

Sorry, I think I misread the context of your statement in that case. I guess I was trying to allude to the statement above regarding erring on the side of caution. Although, the measurement required to diagnose LTBI is altered based on past BCG.

But like you said most clinics are going to use IFN-g and not bother with skin test on BCG patients.