TB Quantiferon Gold positive -_-

[cyanide12345678]

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Went through pre employment health screening and my TB Quantiferon gold is officially now positive.

Getting chest xray obviously. But has anyone gone through workman's comp for these things? I mean i obviously got exposed at work at some point.

Also any opinions on 3 months rifampin + isoniazid vs 4 months ritampin only regimen, for what I'm assuming will be latent disease.

 

[Groove]

Sorry to hear that man, I keep waiting to seroconvert myself one of these years. I remember reading one time that our specialty and physicians in general have a not so insignificant conversion rate. I forget what the number was... If it were me, I'd do the 3 month regimen. Just get it over with without having to stretch it out another month unless you can't tolerate the isoniazid side effects.

 

[cyanide12345678]

Sorry to hear that man, I keep waiting to seroconvert myself one of these years. I remember reading one time that our specialty and physicians in general have a not so insignificant conversion rate. I forget what the number was... If it were me, I'd do the 3 month regimen. Just get it over with without having to stretch it out another month unless you can't tolerate the isoniazid side effects.

Actually did a little research on the quantiferon gold test. It seems to be a terrible test. 29 false positives in healthcare workers who get serial testing for every true positive. See attached nature paper. 10 year risk of false positive is 24 percent for any one with serial testing. Guess I'm going to repeat the test before i give myself 3-4 months of medications. Also my levels were pretty low, based on the article, i was positive for the 0.35 cut off, but pretty much negative for any other cut off used.

I'm really thinking this was a false positive now. I mean....i didn't get TB in Pakistan and somehow i get it in Ohio 😂😂😂?

Serial testing for latent tuberculosis using QuantiFERON-TB Gold In-Tube: A Markov model - Scientific Reports

Healthcare workers (HCWs) in low-incidence settings are often serially tested for latent TB infection (LTBI) with the QuantiFERON-TB Gold In-Tube (QFT) assay, which exhibits frequent conversions and reversions. The clinical impact of such variability on serial testing remains unknown. We used a...

www.nature.com

 

[thegenius]

Actually did a little research on the quantiferon gold test. It seems to be a terrible test. 29 false positives in healthcare workers who get serial testing for every true positive. See attached nature paper. 10 year risk of false positive is 24 percent for any one with serial testing. Guess I'm going to repeat the test before i give myself 3-4 months of medications. Also my levels were pretty low, based on the article, i was positive for the 0.35 cut off, but pretty much negative for any other cut off used.

I'm really thinking this was a false positive now. I mean....i didn't get TB in Pakistan and somehow i get it in Ohio 😂😂😂?

Serial testing for latent tuberculosis using QuantiFERON-TB Gold In-Tube: A Markov model - Scientific Reports

Healthcare workers (HCWs) in low-incidence settings are often serially tested for latent TB infection (LTBI) with the QuantiFERON-TB Gold In-Tube (QFT) assay, which exhibits frequent conversions and reversions. The clinical impact of such variability on serial testing remains unknown. We used a...

www.nature.com

If you repeat it, just do the....eh.....shiiit....what it's called. The injection under the skin. Dammit what's it called.....
PPD! Jesus

 

[deleted1079620]

Actually did a little research on the quantiferon gold test. It seems to be a terrible test. 29 false positives in healthcare workers who get serial testing for every true positive. See attached nature paper. 10 year risk of false positive is 24 percent for any one with serial testing. Guess I'm going to repeat the test before i give myself 3-4 months of medications. Also my levels were pretty low, based on the article, i was positive for the 0.35 cut off, but pretty much negative for any other cut off used.

I'm really thinking this was a false positive now.

Just a med student, but our entire class was given the quantiferon TB test in the spring, and we had 30+ false positives out of 155-ish tests. Not sure if we got a bad batch or if it’s a crap test.

 

[d2305]

INH is a nasty drug.

 

[gutonc]

It's a crap test. I popped positive at one of the hospitals I have privileges at in town a few years ago. Retested 6 weeks later and was negative. None of the hospitals in town are even screening anymore.

 

[bravotwozero]

Why’d you get quantiferon instead of a PPD? Most places do PPD, as far as I know…

 

[FrustratedFamDoc]

Bad test. Has to be drawn and handled in a very specific way by the lab or it has a high chance of false positive. Already seen 3 false positives in my patients.

 

[Mr. Vandemar]

Why’d you get quantiferon instead of a PPD? Most places do PPD, as far as I know…

Strangely the last two hospitals I've been at have not even offered PPD and quantiferon is the only option.

 

[bravotwozero]

Strangely the last two hospitals I've been at have not even offered PPD and quantiferon is the only option.

But you don’t even need to do the test in house, you can get a PPD pretty much at any CVS minute clinic…

 

[cyanide12345678]

Why’d you get quantiferon instead of a PPD? Most places do PPD, as far as I know…

They only did quantiferon. I actually didn't know the high false positive rate. I've had Bcg vaccine as well so personally I've always been under the impression that i can get false positive PPDs, though the last few i remember being negative.

 

[bravotwozero]

Ah, didn't realize you had that vaccine. Yeah, you'll test positive no matter what then...

 

[Franzd'Epinay]

Ah, didn't realize you had that vaccine. Yeah, you'll test positive no matter what then...

Unless I'm mistaken or things have changed recently, the official ID stance is that a positive PPD with a history of a BCG vaccine is much more likely to be LTBI than a false positive.

As to why so many people (not all) with the BCG vaccine test positive... well, they get the vaccine because they are in areas with higher prevalence.

 

[wholeheartedly]

Obviously get retested.

Per my discussion with our state TB coordinator, even in a very low prevalence area with a known and documented work exposure, it’s still next to impossible to get workman’s comp to cover it.

Quite a few places, including my facility, switched to quantiferon because we only had a 50% success rate in getting people to show up to get the TST read and it was a lot of ridiculous hours of chasing ppl down

 

[cyanide12345678]

Obviously get retested.

Per my discussion with our state TB coordinator, even in a very low prevalence area with a known and documented work exposure, it’s still next to impossible to get workman’s comp to cover it.

Quite a few places, including my facility, switched to quantiferon because we only had a 50% success rate in getting people to show up to get the TST read and it was a lot of ridiculous hours of chasing ppl down

I talked with an infectious disease doc. They are pretty adamant in recommending treatment and assuming a true positive instead of repeat testing.

According to the ID specialist, I'm high risk, so the data on false positive in health care workers doesn't apply to me. My risk factors being born and raised in Pakistan for the first 19 years of my life, being an ER doctor, and visiting Pakistan twice for 10 days since my last negative test. This specialist was in fact recommending the weekly option with rifapentine and isoniazid for 12 doses over 3 months.

 

[GeneralVeers]

I talked with an infectious disease doc. They are pretty adamant in recommending treatment and assuming a true positive instead of repeat testing.

According to the ID specialist, I'm high risk, so the data on false positive in health care workers doesn't apply to me. My risk factors being born and raised in Pakistan for the first 19 years of my life, being an ER doctor, and visiting Pakistan twice for 10 days since my last negative test. This specialist was in fact recommending the weekly option with rifapentine and isoniazid for 12 doses over 3 months.

That's a joke. Get another TB test and if negative, you have saved yourself from months of annoying treatment.