TB Test?

[Algophiliac]

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So, I've got all of my shots, but is there a way to avoid taking a TB test?

I ask this, because I'm recently suffering from a lowered immune system response (very low white blood cell count, no, it's not HIV or AIDS), and am experiencing sensitivities to everything that even looks at me funny. Taking Aspirin caused me to vomit for hours and had me bedridden for two days. I can't take any medications without weird reactions, and my liver enzymes elevate through the roof, according to all blood tests I've taken so far, when I even come close to strong chemicals, like Clorox, which I used to work around.

All of that said, I know it's important to prevent the spread of TB in the healthcare setting, but I have never been previously tested for TB. Is there a way to avoid testing, or have testing take another form, so I don't suffer from it? I'd hate to have my dream die because of my freaking immune system.

 

[TribalSeeds]

You can do the test yourself after you get the shot. All you have to do is go in and get it. Wait 48-72 hours and then rub your thumb over where the shot was injected. If you have any size tender 'hump' then you likely have aids or something else...

 

[Zedor]

Good questiob for a premed forum...go to see your doctor

 

[Barcu]

Ask your doctor.

 

[boobelle]

So, I've got all of my shots, but is there a way to avoid taking a TB test?

I ask this, because I'm recently suffering from a lowered immune system response

<snip>

All of that said, I know it's important to prevent the spread of TB in the healthcare setting, but I have never been previously tested for TB. Is there a way to avoid testing, or have testing take another form, so I don't suffer from it? I'd hate to have my dream die because of my freaking immune system.

Talk to your doctor.

But, my thoughts are that having never been tested before, being immunodeficient and, I assume, having been exposed via clinical volunteering are all reasons you SHOULD be tested.

Also, if you're concerned about a false negative, 1) the PPD is a screen, so you would go on to have confirmatory testing and 2) there are different PPD interpretation criteria based on your immune status. A positive result on a screening test does NOT automatically mean you actually have the disease--it just screens who is at higher risk and needs more definitive testing to diagnose. If you can't handle a localized area of redness/swelling on your arm, you might have more pressing issues than a TB test.

In terms of making you sick, the PPD doesn't actually contain TB, so you can't contract TB from the PPD even with a weakened immune system. Allergic reactions are very rare.

Also, if you're really as ill as you state, you probably shouldn't be putting yourself in a clinical situation (be it premed volunteering or medical school) where you would be exposing YOURSELF to a variety of illnesses...many of which are more common and, if you're leukopenic or neutropenic, just as threatening to your health. Get yourself healthy, then pursue medicine.

 

[DrBowtie]

You can do the test yourself after you get the shot. All you have to do is go in and get it. Wait 48-72 hours and then rub your thumb over where the shot was injected. If you have any size tender 'hump' then you likely have aids or something else...

LOL. Actually many AIDS patients can't mount the immune response required for a PPD test to be conclusive.

 

[boobelle]

You can do the test yourself after you get the shot. All you have to do is go in and get it. Wait 48-72 hours and then rub your thumb over where the shot was injected. If you have any size tender 'hump' then you likely have aids or something else...

No, if you have a "tender hump" it suggests you have TB...which is the entire point of the test.

 

[DAPI]

Yes, most hospitals say a negative chest x-ray will suffice. But I would be more worried about getting sick from patients then having a reaction from a 0.1 ml under the skin injection 😕

Also, due to the lowered immune response, they may require you to have an x-ray due to not being able to produce a response.

 

[Algophiliac]

I have talked to my doctor, who decided the best course of action is to convince me not to put myself in a clinical setting. Sigh. He also said there is nothing else (in terms of a TB test) that I could substitute it with, but I'm hoping he's wrong/uninformed?

However, this will not be a clinical setting that exposes me to much disease--shadowing during a surgery? I honestly don't see how I can contract anything dangerous, and I have already been struggling with my health for so long. I am worried it will impact my application for medical school, if I keep putting these things off for my health. Definitely financially, at the very least.

My doctor also never mentioned anything about not being able to produce a response, hmm. That's interesting. For some reason I assumed a lowered immune system would result in a worse response, not a lack of response.

 

[boobelle]

My doctor also never mentioned anything about not being able to produce a response, hmm. That's interesting. For some reason I assumed a lowered immune system would result in a worse response, not a lack of response.

The PPD test is an indirect screen...it's actually a test of the immune system (by checking to see if it's ever encountered TB and therefore is poised to react to the tuberculin protein) rather directly identifying the disease itself...which is why it also can't distinguish between active disease or latent disease, and why people who have received the TB vaccine also may test positive. The redness/swelling of a postive PPD is actually just the immune system reaction, it's not a local site of infection.

If your immune system is so depleted it couldn't react to the bacteria in the first place or react appropriately to the tuberculin of the PPD, you won't get as strong of a response...which is why a smaller reaction counts as "positive" for an immunocompromised patient. So while in a patient with no TB risk factors you need a reaction of >15mm, an HIV+ only needs a reaction of >5mm to be considered a positive test.

An alternative screen is the interferon gamma release assay for TB, but it's similarly a test of the immune system rather than a direct TB test. A chest X ray looks for pulmonary TB.

But, I think the more important point is that your doctor is telling you it's risky to be in a clinical situation....both to you and your potential patients. And, again, it's particularly risky to YOU to not know your TB status in your situation. Remember, just because a patient is there for surgery doesn't mean they don't ALSO have H1NI, or TB, or any of the other many infectious diseases out there. Will you be scrubbing in? What if you get a needlestick and get exposed to HIV, Hep C or any other blood-borne illness and because of your situation have a higher risk of conversion? What about the OR tech or med student or surgeon who is sick but came to work anyway?

It all depends on what your specific health problem is, but if your MD is seriously recommending that you avoid clinical exposure it's probably for a reason. It's the same reason why when a neutropenic patient (very low counts of one type of white blood cell) is admitted to the hospital, they get an isolation room and everyone is required to wear masks/gowns/gloves...it's to prevent transmission of infection TO the patient, because my mild cold could be devastating or even lethal to someone with severe immunosuppression.

If there are elements that can/may get better, I still agree that you need to focus on your health first. Your exposures will only get worse in med school or residency, and the system is MUCH less forgiving for having to take extended periods of time off....it would be even more horrific (emotionally and financially) to have to quit medical school because it quite literally is making you too sick to function. But if you feel unsure, get a second opinion.

 

[vickpick]

get a chest x-ray rather than the skin test. simple.

 

[RetroBA]

get a chest x-ray rather than the skin test. simple.

Chest x-ray is definitely not the solution, and neither is asking a bunch of pre-med and med students online.

The skin test looks for latent infection. Chest x-ray is typically used as a follow-up test after a patient has a positive PPD, looking for active pulmonary TB disease. If a PPD is out of the question for you I'm sure someone out there can give you another option, there are blood tests that test for this as well, as above post has mentioned.

Talk to your doctor with your concerns rather then bringing them up on a forum. Have him refer you to someone who can give you the answers you seek (Infectious disease, or possibly hematology or immunology).

I work for a couple of infectious disease doctors and we have consults come in all the time with questions/concerns much like this.

 

[Asyouwereatrio]

Chest x-ray is definitely not the solution, and neither is asking a bunch of pre-med and med students online.

The skin test looks for latent infection. Chest x-ray is typically used as a follow-up test after a patient has a positive PPD, looking for active pulmonary TB disease. If a PPD is out of the question for you I'm sure someone out there can give you another option, there are blood tests that test for this as well, as above post has mentioned.

Talk to your doctor with your concerns rather then bringing them up on a forum. Have him refer you to someone who can give you the answers you seek (Infectious disease, or possibly hematology or immunology).

I work for a couple of infectious disease doctors and we have consults come in all the time with questions/concerns much like this.

Couldn't the OP get a Quantiferon Gold TB test?

http://en.wikipedia.org/wiki/QuantiFERON

That being said, I think the OP should consider his/her health status and revaluate the situation. Your health is important and medical school/clinical settings can be a "nasty" place. Just keep that in mind! 🙂

 

[pkwraith]

You're not going to be able to get a chest x-ray without a positive test or a history of positive tests. I never get TB tests anymore, since I've had the BCG vacine, so I'm always positive, so I just skip to a chest x-ray (which is typically good for two years, compared to the screening test which is only good for one year). As far as volunteering/employment in healthcare, I've never had a single issue with using chest x-rays. It's just a matter of keeping accurate health history/documentation of previous TB tests and chest x-rays.

But, it's unlikely that you'll be able to get an xray without a better reason than stated in the OP.

 

[Caesar]

SDN is not the place for this type of question.

Contact your physician.