Latent TB

[RenaissancemaN]

Hey, I just read a bunch of posts on allnurses about Latent TB and got really good information. I still have one question...Once latent TB is diagnosed and treated (if treated), when is the next time they should be screened for active tb? is there a routine to have chest xrays done once a year if you have been diagnosed with latent tb in the pass? Or do you just wait and if you become symptomatic then get a chest xray?

Thanks!!!!

[Ardneth]

Back when I was younger I worked in a hospital and was exposed to TB. After two positive skin tests, I was put on 9 months of INH preventive treatment and then given forms from the county TB control officer to give to any future employers that due to treatment, said patient does not need another skin test or chest x-ray for employment purposes.

Once you pop positive on a PPD, they will get a second to confirm. After that, no matter what anyone says, you should never take a PPD again. The reaction gets worse each time and can result in necrosis and severe scarring.

[JoytoWorld]

The frequency for repeat CXR depends on your MD decision and your facility's policy. Also check with your county public health dept NP or MD for advice. The public health dept has to follow the rules set down by your State. You wanted to talk to MD/NP, no one in less authority for final advice. However AFB smears are more definitive of answers to the TB dilemma.

Also the public health dept should have a set of screening questions for you to answer each year to determine if further testing or repeat CXR needs to be done more frequently. Screening questions will be Q's like "Do you have increased coughing for unknown reason (like asthma, cold virus infection etc.)." [Yes/No]. You should perform the screening questions annually to guide your decision making.

Reread Dark Beauty's responses on the topic.

[classicdame, MSN, EdD]

The CDC has an actuarial table indicating recommendations for this. This recommendation is not law of course, but would be hard to defend going outside the recommendation as it is evidence-based. Bottom line, depends on the work environment and the individual. I agree the MD should have a say and always follow facility policy, or do more than required.

[tyvin, BSN, RN]

Where I am; I do a yearly CXR. The individual is offered meds but doesn't have to adhere and there is no backlash. In fact; here in Hawaii, there are many nurses who have the latent TB and choose not to take the meds due to there harsh results on the liver and the length of treatment (which isn't guarenteed to work).

Our state is a melting pot of all kinds of people from everywhere and it doesn't surprise me that I have it. When asked where I think I got it; whewwww.....well I lived in Hawaii since I was 11 so take your pick; we have foreigners from all over the earth relocating here, vacationing here, and passing through. There's a good amount of traffic, combine that with the tropics and you have a good breeding ground for many things.

Watch for symptoms that would indicate an active infection; the number one is night sweats according to our teachings as well as the unusual cough. I have lived with the latent TB for 10 years and don't believe it will ever express itself in a full blown infection. In fact I haven't thought about it for a few months now until I saw this thread. I do the yearly chest just to make sure there's no little spot developing. My doc says a yearly isn't necessary and my work says to do what the doc says but I do the yearly anyway.

Mahalo,

[DC Collins, ASN]

My doc says a yearly isn't necessary and my work says to do what the doc says but I do the yearly anyway.

Mahalo,

Aren't you afraid of cancer related to those CXRs?

DC ED RN

[Belle Epoque]

Aren't you afraid of cancer related to those CXRs?

DC ED RN

The cancer risk in the US is around 0.9%. Benefit vs. risk. It all depends on what your chances are of developing active TB.

I agree that qyearly may be too frequent to justify the benefit, especially if asymptomatic. Maybe q3 years? Discuss pros and cons with your practitioner as every case varies.

[tyvin, BSN, RN]

You've convinced me; every three years sounds good.