exposed to TB

klone, MSN, RN · Apr 9, 2014

If you have a positive PPD, you will need to have a CXR to rule out acute illness. And you may continue to have positive PPDs for several years (or never, or always), in which case, you will need to get a CXR to prove that you do not have TB. However, in the absence of new risk factors or signs of acute illness, you may not need to continue getting CXRs except perhaps with a new employer.

Also, you could have a quantiferon drawn - sometimes that will be negative even if the PPD is positive.

elkpark · Apr 9, 2014

Back when my Mantoux test turned +, a kazillion years ago, I was specifically told not to let anyone give me any more skin tests -- not only are they pointless because they will always be positive, but retesting can cause a reaction with negative effects up to sloughing skin from your forearm. Lots of healthcare workers are +, and so are many members of the general public (but you don't know unless you have a job that mandates the testing). I heard a speech by a public health expert many years ago in which he stated that probably everyone who lives in any decent-sized city has been exposed to TB, just by virtue of the range of people you are exposed to, in close quarters, in urban daily life.

I've never had any problem with employment because of my + status. I just tell Employee Health when it's time to do the pre-employment testing, and no one has ever batted an eye. They are v. used to this (the most reaction I get is a question about whether I completed the treatment at the time, and not everyone has even asked that). For many years 'way back when, I had annual CXRs in lieu of further testing; more recently, the usual practice is just to have + employees complete the weird little questionnaire each year in lieu of testing (Have you been having any fevers of unknown origin? Night sweats? Have you been coughing up blood? I'm always tempted to answer, "Why, yes, I have. Is that bad? Should I have said something?" But I'm afraid employee health might not enjoy my warped sense of humor as much as I do ...)

When I first turned, I did complete the year of INH therapy through the public health department. I was in nursing school at the time, so it was like a private Public Health tutorial (I was in a hospital-based diploma program, and we didn't have any public/community health content in our program, so I was the only student in the program who got that exposure). The TB clinic at the public health department was always me and a bunch of Haitian immigrants. The clinic nurses knew I was a nursing student (and, apparently, I was also their only compliant client), so they made a big fuss over me, explained everything in great detail, explained lots of "extra" public health stuff, etc.

nurseprnRN, BSN, RN · Apr 9, 2014

All the infectious disease docs I know say that if you ever ride public transportation you've been exposed to TB and will probably have a positive skin test as a result. Have the chest xray to document that you have no active disease and go on about your business. No new employer will care if you tell them that. :)

elkpark · Apr 9, 2014

Have the chest xray to document that you have no active disease and go on about your business. No new employer will care if you tell them that. :)

Well, it's not quite as simple as "go(ing) on about your business." TB is a reportable disease. Every state in which I've ever lived, new + PPDs had to be reported to the public health department, and you had to follow their guidelines about prophylactic treatment. Has that changed?

nurseprnRN, BSN, RN · Apr 9, 2014

They are not as crazy about it as they used to be-- I got elevated liver enzymes on the meds after a few weeks and they said I could just stop taking them and not to worry.

martymoose, BSN, RN · Apr 9, 2014

So, it's not a big deal to a potential employer? especially if I was to go looking for jobs right now? They haven't tested us yet,

I was worried as the market is oversaturated as it is, that this would be another strike against me, and they could hire some one who negative . I already have the strike of age against me.....

Thanks

SquishyRN, BSN, RN · Apr 9, 2014

So it's not a big deal to a potential employer? especially if I was to go looking for jobs right now? They haven't tested us yet, I was worried as the market is oversaturated as it is, that this would be another strike against me, and they could hire some one who negative . I already have the strike of age against me..... Thanks[/quote']
Lots of healthcare workers come up with positive PPDs because once you're positive, you're always positive. The important thing is not to have the active disease.

elkpark · Apr 9, 2014

They are not as crazy about it as they used to be-- I got elevated liver enzymes on the meds after a few weeks and they said I could just stop taking them and not to worry.

Yes, but you did have to report to the public health department and start the meds, right?

ryan8410 · Aug 24, 2014

Anyone have experience with reading an actual positive PPD? I ask because I'm about to start with a new employer and had my one step PPD on a Monday, read 48 hours later and no redness, swelling, or in duration. Two days later (96 hours since). I've got some mild reddening and swelling/induration at the site. I should first have mentioned that I had my annual test done July 25, read 72 hours later and was told it was positive with an induration >10 mm I questioned the first test as it was a new and very inexperienced MA who administered the ppd. My first thought was she went in too deep as it was more painful than usual...almost like an IM. Horrified with the result, I had a chest xray and right away left the outpatient clinic and went over to the dept of health and had one of the nurses examine my arm. She said that because she could not palpate a border edge on one side, she would score as a negative with 0mm induration...any who....chest xray negative....wasn't offered any further follow up. Week later, offered a position at a hospital, so had to do all the tests necessary with employee health...explained previous result and provided documentation and images..... so the RN checked with one of the hospitals infectious disease specialists, who also happens to be the director of my countys department of health, and got the okay from him to administer another one step. So here I am now (6 days since) with induration >5mm since yesterday..... is it possible to have a delayed response after 72 hours and be positive? I've googled this question over and over and can't find any definitive results.... I really wish someone could just give me a blood test. Any insight to this would be greatly appreciated!