Conflicted over starting INH - page 2

I had a PPD last week for an adoption physical and it came back positive. My last PPD for nursing school was in July and was negative. I'm pretty sure I was exposed at a homeless shelter for the... Read More

  1. by   galenight
    A number of years ago I tested positive for TB after a known exposure to someone with active TB. Of all the people who came in contact with this patient, I had the most contact and am the only one who tested positive. It was definitely indurated and not just a local reaction. I was referred by my employer to the local health department who ordered a cxr. An overzealous radiologist, knowing the reason for the exam, thought maybe, just maybe there was something fishy in my right upper lobe. The doc at the health department doubted it, ordered a course of Zithromax and a repeat xray, which was normal. Long story short, I took the INH faithfully for six month. I wanted to do everything I could to ensure that I remained healthy so I could support my children and keep them from getting it. I took the required vitamin b6. I had two side effects. One, was when I ran out of the B6 and didn't get more right away I began to have a bit of peripheral neuropathy. The second side effect I had, which I cannot explain, is I had sore breasts. Not intolerable, mind you. I've never heard anyone else with that side effect. The soreness resolved as soon as I stopped the INH. I'm glad I took it. I feel like I did the right thing for myself and my family. Because of other health issues, I have had my liver tested and the results have been normal. If I had to do it all over again, I wouldn't change a thing.

    Good luck with whatever you decide.
  2. by   mrsalby
    I tested positive when I began work at the hospital. Occupational Health sent me immediately for an xray. I was referred to public health and I denied the INH tx. I have to sign the test sheet each year that I had a previously positive PPD and that is all I have had to do. I didn't have to repeat xray.

    Fast forward 2.5 years. I have since been diagnosed with Ankylosing Spondylitis and have tried different tx for it without great effects. So, another tx suggested by MD to stop its progression is Enbrel. Enbrel suppresses your immune system and there are risks of latent TB becoming active. Soooo, I had to have another chest xray and I had to do a blood test called quantaferon, some say quanta gold, or a gold top when at the lab. This tests for the TB and mine came back "reactive" and apparently is said to be a more definitive test.

    Sooooo, I was referred once a gain to PH and I started INH and vit B about 3 weeks ago. I am doing fine with it. I take it after dinner. I have minimal nausea if I take it without food.

    Hind sight...I wish I would have taken it sooner because of the delay with the Enbrel tx. Apparently after 3 months on INH, I can begin the Enbrel.

    You could always try it and see how it makes you feel. Good luck with your decision.

    Mrsalby
    Last edit by mrsalby on May 25, '07
  3. by   eedirin26
    I had a BCG shot in 1992, so will always be positive even with a negative cxr. I was also put on INH and was supposed to be on it for 9 months. I was taken off of it after one months as I had various reactions - swollen lymph nodes, mouth sores, etc which the doc wasn't sure if the INH caused or not. After a month of rest from meds, I started taking Rifampin and I have been on it for 1.5 months now and have had no side effects from it.

    Other students in nursing school with me taking INH had none of the side effects I suffered. Because your friend had a reaction to it does not mean you will also.
  4. by   NurseLatteDNP
    Quote from Didi2007
    I had a BCG shot in 1992, so will always be positive even with a negative cxr. I was also put on INH and was supposed to be on it for 9 months. I was taken off of it after one months as I had various reactions - swollen lymph nodes, mouth sores, etc which the doc wasn't sure if the INH caused or not. After a month of rest from meds, I started taking Rifampin and I have been on it for 1.5 months now and have had no side effects from it.

    Other students in nursing school with me taking INH had none of the side effects I suffered. Because your friend had a reaction to it does not mean you will also.
    I also had 2 BCG shots while I was living in Croatia. My doctor here in Texas told me that I will not need to take any medications (INH), because an exposure to TB is not the reason why my test was positive.
  5. by   suzanne4
    Quote from anonymurse
    I'm really, really tempted to get a BCG shot. I mean, it just might keep me from getting TB, maybe a 60-80% shot (English results) at not getting it if exposed. American health thinking is that BCG isn't so great because you'll turn positive for the rest of the life and they can't tell when you get it. What? Would any of us who are vulnerable prefer to have no shingles shot, even if it improves our odds against shingles only a little over half? So why should TB be any different? Because it's on public health turf? Hey, let me see . . . no vaccine, then take liver-killing meds that don't confer immunity, maybe after infecting my family, then maybe reactivation . . . versus vaccine that might preclude infection in the first place . . .
    Funny thing is that the BCG was required in many of the third world countries and we are seeing a higher incidence of TB in that population, so do not think that the vaccine will keep you free from TB. If you follow proper protocol at work, you should not be exposed.

    And nurses that have come to the US to work, and have had a BCG in the past, many times are now having to have the PPD given to them if it has been more than 15 years or so since the vaccine. Most infectious disease physicians are not treating them with medication as the positive that far out means that they were exposed to TB in the past. The BSG vaccing alone is no longer considered to always give you a positive PPD bacause of the vaccine, but because of contact and the environment that they were in.
    Last edit by suzanne4 on May 26, '07
  6. by   anonymurse
    Quote from suzanne4
    Funny thing is that the BCG was required in many of the third world countries and we are seeing a higher incidence of TB in that population, so do not think that the vaccine will keep you free from TB. If you follow proper protocol at work, you should not be exposed.
    Well from what I was reading, for an unknown reason the shot's efficacy (diet? exposure prior to vaccination? storage and expiration compliance?)depends on where you get it. You're right about third world results; however England requires it and their results range from 60 to 80%.

    And I figure proper protocol at work doesn't have me covered if my co-workers don't follow it, or if I sit on a plane next to someone who's infected.
  7. by   heron
    OP ... take the INH ... your positive PPD means you have been exposed to active Tbc and, trust me, you do not want to progress to active disease. In Mass. it is legal to force treatment for tb and syphilis ... this may also be the case in your state ... you ought to check it out. I took care of many pts with active tb while working in a state public health hospital. Most were people with AIDS ... but many were ordinary folks from the community. Tb is nothing to fool around with, especially the resistant forms we are starting to see now. In getting prophylactic treatment, you are not only protecting yourself but your family and community as well.
    Do you remember reading about a disease called consumption during Victorian times? That was Tb ... not only can it really tear up the lungs, but it can invade other organ systems, as well. I remember one of my pts who had Tb meningitis ... not a nice way to die. PLEASE get treatment ... if INH isn't right for you, ask your provider for alternatives ... check with your state dept of public health re their recommendations for tx. Good luck - Heron
  8. by   caroladybelle
    Quote from anonymurse
    I'm really, really tempted to get a BCG shot. I mean, it just might keep me from getting TB, maybe a 60-80% shot (English results) at not getting it if exposed. American health thinking is that BCG isn't so great because you'll turn positive for the rest of the life and they can't tell when you get it. What? Would any of us who are vulnerable prefer to have no shingles shot, even if it improves our odds against shingles only a little over half? So why should TB be any different? Because it's on public health turf? Hey, let me see . . . no vaccine, then take liver-killing meds that don't confer immunity, maybe after infecting my family, then maybe reactivation . . . versus vaccine that might preclude infection in the first place . . .
    Sorry, not a very good idea.

    I've had BCG. My understanding is that confers very little immunity. This is not like a regular vaccine where there is really good immunity conferred. It is also iffy as to how long that immunity lasts. But it does mean often that you will have to be CXRd for checkups rather than PPDd - a much more expensive test and also exposes one to radiation repeatedly.

    The other issue is that if you do get an iffy CXR, it does not matter that you had BCG - you will need to provide sputum and still be required to do INH in many cases. In my case, it bought me a Bronchoscopy and over a year of INH, despite being negative on sputums obtained from the Bronch.

    Interestingly, I had NO bad effects from INH and my liver tests were fine. But you do need to watch alcohol intake and avoid red wine. I started the drug the weekend after having had some sangria and it elevated my BP. The MD (an attending at Cornell) said an occasionally drink was okay, though can have a more major effect, but to avoid the red wine.
  9. by   katfishLPN
    [font="comic sans ms"]i converted to positive quite a few years back. i know i was exposed by one of our patients that had all the sx. of tb and had a + ppd. she was set up for a sputum culture but died before it was done. anyway i took inh for 6 months with the vitamin b supplement. as they say do not drink alcohol:biere: . [font="comic sans ms"]i think the pharmacist mentioned it but did not emphasis it. i drank 2 bud lights once and i had the most scary reaction. every time i closed my eyes i had a beautiful laser light show going on and i felt as if i was going to have a seizure!! it was horrible. the inh itself just made me feel as if i was looking at the world with my head cocked half way to the side. i also had to get my liver function studies done every month. i was very frightened and i did exactly as they told me!! i think you better take what you need to take. maybe if you have a bad reaction they can switch you to something else but it is definately nothing to mess with!! good luck with everything and take care of yourself!!!!:icon_hug: :spin:
  10. by   MonkeyRN
    Thanks to everyone for replying. I went to the doc on Friday and she prescribed INH for 9 months. She said they don't do liver function tests anymore while on it which I thought was odd. She also didn't mention the need for me to take B6, neither did the pharmacist. She said I need to take it in case I ever become immunosuppressed. The reason I'm so reluctant to take it is several friends looked at my PPD reaction and they all thought it was negative. It was just the nurse at Kaiser that deemed it positive. It was red but was only slightly raised right where the needle went in.

    I'm going to take it because I'd rather be safe than sorry. I'll grab some B6 supplements today. I already don't drink alcohol so I'll be safe in that area
  11. by   caroladybelle
    I didn't take B6 with mine and did okay.

    Many MDs do do the LFTs at least a couple times during therapy.
  12. by   TazziRN
    Quote from Puck Monkey
    Thanks to everyone for replying. I went to the doc on Friday and she prescribed INH for 9 months. She said they don't do liver function tests anymore while on it which I thought was odd. She also didn't mention the need for me to take B6, neither did the pharmacist. She said I need to take it in case I ever become immunosuppressed. The reason I'm so reluctant to take it is several friends looked at my PPD reaction and they all thought it was negative. It was just the nurse at Kaiser that deemed it positive. It was red but was only slightly raised right where the needle went in.

    I'm going to take it because I'd rather be safe than sorry. I'll grab some B6 supplements today. I already don't drink alcohol so I'll be safe in that area
    If you doubt the results you can request the PPD be redone. I have little faith in Kaiser, if it were me I would want the test repeated.
  13. by   justpoorfect
    This year our college health nurse required me to take a 2 part PPD, the second one week after the first. Is this going to become the new standard for healthcare workers? She said it is because you can be exposed, but your body may not build up enough response to show a significant reaction with the first PPD, whereas the second will be definitive. Anybody else have this?

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