+PPD, -CXR, INH or not??

[raine91]

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I'm an MS III who had a positive PPD for the first time a week ago (no known exposure, contact, travel, etc... yes... it sucks). i had my cxr which was negative. So the question now is whether or not to take the 9 months of INH.... if I weren't applying to residencies in about 6 months, I wouldn't take it. But... I am wondering if not having taken it will prevent me from being able to go to some programs (i mean university programs that might be more anal??). Any help?? Part of the reason I don't want to take it is that I'm going to be out of the state for 3-4 of the next 9 months doing away electives, so I won't be able to have liver enzymes drawn, etc. So what do people think about whether or not some residency programs will give me a hard time about this? Thanks very much.

 

[(nicedream)]

I'm an MS III who had a positive PPD for the first time a week ago (no known exposure, contact, travel, etc... yes... it sucks). i had my cxr which was negative. So the question now is whether or not to take the 9 months of INH.... if I weren't applying to residencies in about 6 months, I wouldn't take it. But... I am wondering if not having taken it will prevent me from being able to go to some programs (i mean university programs that might be more anal??). Any help?? Part of the reason I don't want to take it is that I'm going to be out of the state for 3-4 of the next 9 months doing away electives, so I won't be able to have liver enzymes drawn, etc. So what do people think about whether or not some residency programs will give me a hard time about this? Thanks very much.

Why couldn't you get your blood drawn when you're away? I'm sure wherever you're going has labs.

 

[LanceArmstrong]

I'm an MS III who had a positive PPD for the first time a week ago (no known exposure, contact, travel, etc... yes... it sucks). i had my cxr which was negative. So the question now is whether or not to take the 9 months of INH.... if I weren't applying to residencies in about 6 months, I wouldn't take it. But... I am wondering if not having taken it will prevent me from being able to go to some programs (i mean university programs that might be more anal??). Any help?? Part of the reason I don't want to take it is that I'm going to be out of the state for 3-4 of the next 9 months doing away electives, so I won't be able to have liver enzymes drawn, etc. So what do people think about whether or not some residency programs will give me a hard time about this? Thanks very much.

You should take it and more importantly have proof that you finished your course otherwise they'll make you repeat it. I probably wouldnt worry about liver tests, make sure you take your B6.

 

[Future DOctor]

First of all how big was the induration? If no exposure, it needs to be over 10. If it was positive, I would consider if the test caused a hematoma under the skin- in other words, if no exposure or risk factors, I would recommend to have the test retaken before considering antimicrombial therapy (including INH).

My humble opinion

 

[SurgeryChef]

I'm an MS III who had a positive PPD for the first time a week ago (no known exposure, contact, travel, etc... yes... it sucks). i had my cxr which was negative. So the question now is whether or not to take the 9 months of INH.... if I weren't applying to residencies in about 6 months, I wouldn't take it. But... I am wondering if not having taken it will prevent me from being able to go to some programs (i mean university programs that might be more anal??). Any help?? Part of the reason I don't want to take it is that I'm going to be out of the state for 3-4 of the next 9 months doing away electives, so I won't be able to have liver enzymes drawn, etc. So what do people think about whether or not some residency programs will give me a hard time about this? Thanks very much.

That sucks - same thing happened to my husband. He's not even in the medical field!!! Makes me wonder what he's been up to but anyway...

You should probably talk to you doctor about this. When this happened to us, the doctor didn't present it as a choice. Basically if you have a positive PPD this is what you need to do. I won't lecture about what could happen when you're old and immunosuppressed in a nursing home :-D

 

[deleted87716]

So the question now is whether or not to take the 9 months of INH.

The CDC recommendations for latent TB may be found here.

This article (abstract only) in the NEJM may also be helpful.

Most doctors would probably recommend that you receive prophylaxis, as you fall into one of the higher-risk groups (hospital worker).

 

[missylee]

Same thing happened to me when I started third year. I don't ever remember being exposed to anyone with TB (although I did have the BCG vaccine when born) and my chest x-ray had small nodules that weren't typical for TB. So after doing serologies for a bunch of fungi and all being negative, I decided to take INH and B6...for 12 months. I remember reading somewhere that the longer you take it, the less chance it has of reactivating. Anyway, the drug is cheap (87 cents with insurance) and I get my LFTs drawn once in a while. I probably haven't been infected with TB, but at least every time people ask for a PPD and CXR, I can show them that I took the drug for a year and everything has been taken care of. If I were you I would take it. Less explaining to do...and you never know.

 

[DrMom]

duplicate, so closing.