Did you see a positive PPD result?

Nurses General Nursing

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What does it REALLY look like? How often do you see a reaction but decide that it is not positive? What exactly do you go by? Also after years of having the PPD test done over and over, do you see a more severe reaction?

It's just that it seems to be getting worse every time I have it done, yet it's allways read as negative.

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Specializes in Education, Administration, Magnet.
What does it REALLY look like? How often do you see a reaction but decide that it is not positive? What exactly do you go by? Also after years of having the PPD test done over and over, do you see a more severe reaction?

It's just that it seems to be getting worse every time I have it done, yet it's allways read as negative.

The area is red and 10 mm or larger in diameter. The skin also becomes swollen on that spot.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
What does it REALLY look like? How often do you see a reaction but decide that it is not positive? What exactly do you go by?

Simply put, a positive reaction is a papule approximately 2 cm. It just means the individual has been exposed to the TB bacteria.

The individual should have a chest X-ray done. Approximately 15% of people with a positive test will develop TB. With medication, this reduces to approximately 3%.

The only stats I am familiar with regarding how often the test is positive are statistics on nursing home/LTC residents. Approximately 50% are positive upon admission, using the two-step PPD screening. But, that is not general population.

Anyone??

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What does it REALLY look like? How often do you see a reaction but decide that it is not positive? What exactly do you go by? Also after years of having the PPD test done over and over, do you see a more severe reaction?

It's just that it seems to be getting worse every time I have it done, yet it's allways read as negative.

Mine this year turned red and swelled at the injection site to about the size of a dime (I was switching jobs and had just had one 2months before this that didn't do this so I was pretty freaked out, but the OH nurse said it didn't matter unless it was like that when they read it) almost every thing had cleared up by 48hrs (I had no swelling left) so it was read as negative?

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Mine this year turned red and swelled at the injection site to about the size of a dime (I was switching jobs and had just had one 2months before this that didn't do this so I was pretty freaked out, but the OH nurse said it didn't matter unless it was like that when they read it) almost every thing had cleared up by 48hrs (I had no swelling left) so it was read as negative?

I would check with your local health dept. The redness is nothing but an induration (lump) should have been measured and you should have been referred to the health dept. They will probally re-test you. It is very important that the nurse read your test in the 48-72 hour window. If you don't show up in time for it to be read they need to give the test again. I would not be overly concerned. You haven't mentions s/s of Tb such as unexplained weight loss, night sweats, cough, or coughing up blood. If you do test positive you will probably receive a chest x-ray. I give 300 plus tests a year and seldom have a positive reactor. None have had the s/s. Those employees or pts do not get the test but we fill out a s/s form every year.

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Does a doctor have to read the skin test or can a nurse??

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Specializes in Education, FP, LNC, Forensics, ED, OB.
Does a doctor have to read the skin test or can a nurse??

A nurse usually interprets the test.

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Does a doctor have to read the skin test or can a nurse??

A nurse can and usually does read the test. If positive we call the health dept and the MD but the health dept then takes over while keeping the primary md informed. At least this is how it's done in my area.

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Specializes in Cardiac Telemetry/PCU, SNF.

According to when I did clinicals at the health department (if memory serves), 10mm is positive for at risk populations (recent immigrants, immunocompromised individual, health care workers and the like), 15mm for the general public. You're not measuring the redness, but the induration.

I had a patient who had a positive reation and probably had a 20mm bump on the arm with significant redness surrounding it. It was kind of a shock as you get used to seeing negative results so seeing a positive throws you a bit.

Cheers,

Tom

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Specializes in Education, FP, LNC, Forensics, ED, OB.
According to when I did clinicals at the health department (if memory serves), 10mm is positive for at risk populations (recent immigrants, immunocompromised individual, health care workers and the like), 15mm for the general public. You're not measuring the redness, but the induration.

I had a patient who had a positive reation and probably had a 20mm bump on the arm with significant redness surrounding it. It was kind of a shock as you get used to seeing negative results so seeing a positive throws you a bit.

Cheers,

Tom

In HIV-infected individuals, the measurement is 5 mm or greater.

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Specializes in Gerontological, cardiac, med-surg, peds.

Excellent advice :) These links may also be of help:

http://www.vh.org/adult/provider/internalmedicine/PulmonaryCoreCurric/TBCase/PositivePPDImage.html

http://www.nlm.nih.gov/medlineplus/ency/imagepages/3037.htm

http://www.nlm.nih.gov/medlineplus/ency/imagepages/2823.htm

An area of induration 10mm or more in 48-72 hours indicates exposure to and/ or infection with TB. A reaction is measured in millimeters of induration (hard swelling) at the site.

Indurated--hard knot (not necessarily red). A reaction of 5mm or greater is considered positive in persons with HIV infection.

A positive reaction does not mean that clinically active disease is present but indicates exposure to TB, infection with TB, or the presence of inactive (dormant) disease. Often, a person's immune system is strong enough to ward off active, symptomatic TB disease after infectious exposure; only 10% of people infected with TB will ever come down with the active disease. The remaining 90% will show no signs of infection, nor will they be able to spread the disease to others. Dormant infections can eventually become active, though, so even people without symptoms should receive medical treatment. Once you have TB, your skin test remains positive for life.

After positive reaction, CXR is done to rule out active disease.

SS active infection: progressive fatigue, lethargy, nausea, anorexia, weight loss, low-grade fever with night sweats, persistent cough with sputum streaked with blood, mucopurulent sputum.

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According to when I did clinicals at the health department (if memory serves), 10mm is positive for at risk populations (recent immigrants, immunocompromised individual, health care workers and the like), 15mm for the general public. You're not measuring the redness, but the induration.

I had a patient who had a positive reation and probably had a 20mm bump on the arm with significant redness surrounding it. It was kind of a shock as you get used to seeing negative results so seeing a positive throws you a bit.

Cheers,

Tom

So is the positive a really HARD lump that is so obvious you couldn't miss it? My fist one of the last two step PPD gave me a red area of about the size of a penny. The second step however was a red area at least the size of a quarter and only I can always palpate a small spot (probably less than 10 mm or just around 10 mm) that is so soft and hard to distinquish, with no precise boarders that it probably would be impossible to measure and no nurse ever assessing the result has recognized it. The skin is not raised and you cannot "see" the swelling. Only I can, when I sort of "dink around" (for the lack of a better word), ya know... So would the swelling of a positive be obvious at first sight and really hard with clearly distinguishable boarders?

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