Administration of PPD to someone with a previous positive reaction

[MissBrittanyRN]

From my understanding, one should not have tuberculin skin testing performed if they have had a positive PPD in the past. I have a friend who was adopted from a foreign country when she was a teenager, who is not sure if she had a positve PPD. She needs to have one done for work so I explained to her what it was. After explaining, she is pretty sure that she had a PPD that was raised at some point in time. I explained to her that redness is ok, but she thinks that she remembers it being raised. She does not recall having a chest xray. I was wondering if it just unnecessary for someone with a past positve ppd to have another test, as they will continue to test positive, or if someone in that situation would truly be put at some type of risk for having a ppd administered after having a positive ppd before.

[SteffersRN87, BSN, RN]

I had a postive PPD about five years ago. The doctor wanted the 2nd test done just to confirm it wasn't a local skin reaction. My red and raised areas took about 3 months to go away. I was told that I should never have a PPD test again. Rather, I should have a CXR to confirm that I do not have active TB. I also took INH for 9 months.

[litchi]

It is unnecessary to continue to test after a positive result--any subsequent skin tests you have will more than likely be positive as well. If you continue to test, you run the risk of the reactions becoming severe. That's why chest x-rays are used to rule out active TB after you've tested positive.

The big question is, did your friend really test positive or is she misremembering? I'm guessing that she doesn't have access to her medical records to see if a positive result was documented or not. Is it possible that, being from another country, your friend had the BCG vaccine? Those can show positive test results as well.

Either way, she should talk to her doctor about it. They can decide if it's worth it to do the skin test or just do a CXR instead.

[NRSKarenRN, BSN, RN]

ppd tuberculin skin testing

what if i have a positive test for tb infection?

tb skin test: the test

is there anything else i should know?

once you have had a positive tb skin test, it is not necessary to have another one the next time there is a question of your exposure to tb. your ppd reaction will usually remain positive, and the skin reaction to subsequent tb skin tests may become increasingly severe.

a negative tb skin test may cause mild itching or discomfort at the injection site. you may not respond to a tb skin test (even if you have tb) if you have had a recent viral infection, a "live" vaccine (such as measles, mumps, chickenpox, influenza), or if you have overwhelming tuberculosis, another bacterial infection, or are taking immune suppressive drugs such as corticosteroids

[MissBrittanyRN]

Thanks everyone. I don't think she had TB, or at least if she did, I would hope that she was treated, which she definiately does not remember, and probably would remember if she was actually treated. I did not even think of the BCG vaccine, which she may have received. Who knows, growing up in what they still call orphanages, she may have been exposed. I just recommended that she let whoever she goes to know, and they may or may not go right ahead with the cxr. I just wanted to be sure that there was not a risk of a bad reaction if she actually received a ppd. Although a ppd is not necessary, as once positive always positive, I did not know if it was actually dangerous. Thanks NRSKaren for the info about a possibly increasing severity of reactions! And thanks everyone else for your input.

[nursejoy1, ASN, RN]

I can't find the article, but I read that it could cause severe skin reactions up to and including sloughing of skin on the entire body- I had a positive and will refuse to ever take again. I did a Chest x-ray and now do yearly sputums.