Positive Latent TB, no treatment?

[bowlofsurreal]

Hi,

I am a nursing student and start clinicals next May. I decided to volunteer at my local hospital to get some experience. In order to volunteer I had to have a PPD test. My test was positive, my chest x-ray was clear, but I have antibodies in my blood via the QuantiFERON-TB test. The employee health nurse told me I have latent TB and should be treated. After having all these test my mother told me my father contracted TB when I was a child and I was exposed (he was a firefighter/EMT).

My question is should I seek treatment? I currently do not have medical insurance, or a primary health care provider, and I have read that there are serious side effects from taking the INH regimen. I rather not take the medication and just be monitored for active infection as only 5-10% of those with latent TB actually become active (and I am not in any of the risk groups for converting from latent to active).

If I choose not to be treated, how does this affect my nursing career? Will I be forced to take treatment in order to work in a hospital (for volunteering they cleared me for work, but I have to provide documentation from a physician that I am taking treatment or refusing treatment), does this look negatively on me? Not really sure what to do, but I don't like the idea of taking heavy doses of toxic medication prophylactically.

Any thoughts or resources would be very helpful!

thanks,

Kris

[elkpark]

I appreciate this dialogue! Let me ask you a question that comes up constantly in my clinic: we have many immigrants that come to our clinic, and also others that have tested positive in the past but cannot provide documentation. The providers will order another one, I guess for their records. And, I have seen documentation (it is at work-will provide if you want) that it is okay to do another one. Many of the patients will say the same thing, that they were told to never take one again; meanwhile, we have no documentation of the positive PPD, CXR or treatment. Would you say that the provider is correct in ordering one just to be sure, or for his own follow up? Thanks!

When I first converted and did my year of prophylaxis, the folks at the health dept. told me that there was no need for me to take PPD tests any more, because they would always be positive, but no one said I shouldn't do it. After I finished school and started my first nursing job, the crazy infection control nurse at that (small, rural) hospital insisted on giving me a PPD, even though I told her I could tell her in advance it would be positive -- she said the size of the induration "would be diagnostic." When my primary care doc found out (I asked him about this "size of the induration being diagnostic" whooey), he got really upset and said I should never allow anyone to give me a PPD again -- the site can necrose and slough flesh, and I was lucky that I hadn't had any kind of seriously negative reaction (of course, he tended to be extremely (overly?) cautious about most things, but I've read the same thing in other places since then ...) Maybe there are legitimate differing viewpoints on this question?

Over the years, none of my (other) employers have hesitated to take my word about my history (no requests for documentation), and no one since the crazy IC nurse (not a term I use casually; she really was crazy -- it finally turned out she was practicing without a license, and she got fired and in big trouble with the BON) at the small, rural hospital has wanted to give me a test -- but maybe that's because I'm an RN, and they would be less likely to take the word of some "ordinary" person off the street.

This is not my area of clinical expertise, so I have no idea what a definitive answer to your question would be.

[darkbeauty]

I would take the person's word if they have tested positive for a PPD before, but would certainly insist on a chest xray. Employers just need a confirmation that they are not exposing other workers to an active TB person, and a PPD does not necessarily prove that, they would still need further assessment anyway.

[pagandeva2000, LPN]

I will try to remember to bring home the information I have regarding repeating a PPD even after a positive result so that we can compare references, and I'll ask at work. PPDs are a basic requirement for our pregnant patients, and if they report to me that they had a positive one, they were told not to do another one, I don't force them, I document their statement, inform them that they should try and obtain records and to speak to the provider on their next visit. Those that don't argue, I do it. I have not seen an extreme reaction yet, but this needs to be discussed at work.

I learned to do PPDs at work, it was not discussed at all in my nursing program. I have a friend, however, who went to an inservice for the department of health and it seems that we did not use the proper protocol when implanting them...she told me that after we administer, we are supposed to measure the bleb immediately, document that, so that it would be compared when they return in 48-72 hours. So much for receiving correct information from Staff Ed. And, LPNs are not allowed to say if it is 'positive' or 'negative', we are supposed to document the size of the induration, ask about symptoms (at least I do, anyhow), and then report it. I might actually order a PPD lesson from the CDC because it seems that we are not being taught properly.