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

[Katnip, RN]

We can't give medical advice here per the TOS. You need to see a provider and ask them for the best course of action.

[bowlofsurreal]

I'm not looking for medical advice, I am looking to know about how refusing treatment is seen and if refusing treatment will hinder me in my pursuit of an RN.

thanks!

[Katnip, RN]

Sorry, I misread that.

I believe that most hospitals will require you to be treated before they employ you. We just had a new employee who had the same diagnosis and we required treatment before she could start.

[oramar]

Our health dept provides treatment free of cost but I don't know about other health dept.

[elkpark]

You may be required to report to the health department, and they may require you to undergo treatment. TB is a reportable disease in all 50 states. I had exactly the same experience when I started nursing school -- my previous job was running a soup kitchen and doing crisis work with the homeless, and, when I had a Mantoux test as part of starting school, it came up positive and I was required to "turn myself in" (that's the only way I could think of it, haha) to the health department.

The good news is that the health dept. will provide the prophylactic tx meds and ongoing monitoring for SE/complications at no cost to you. I spent my first year of nursing school making a monthly trip to the "TB clinic" at the health department, which always consisted of me and a bunch a Haitian immigrants. I thought of it as sort of like a nursing "elective" -- I learned a lot about public/community health!

[pagandeva2000, LPN]

I was going to say the same...the Department of Health should treat you for no cost. Actually, I am surprised that it wasn't recommended to you.

[darkbeauty]

I'm not quite sure as to how you were diagnosed with latent TB. A positive PPD is not an automatic latent diagnosis. There are people who test positive from having acquired the BCBG( a vaccine against TB), most commonly offered in foreign countries. And certainly a previous exposure still does not confirm latency, only an MD can diagnose you latent or active, and that is mostly through 3 consecutive AFB smears and cultures. I have never come across a diagnosis through antibodies in the blood. Anyway....there is nothing to worry about. TB regimen is most successful in those who fully complete treatment with perfect adherence. The side effects are fairly mild if there are no other immunocomprimised issues. For the first 2/3 months treatment can be slightly vigirous with side effects such as itching of the skin, yellow/orange twinge urine because of the INH toll on the liver(still fairly safe), some women report funny smell immediately after swallowing pills. But that is nothing compared to the outcome of the treatment. For a latent diagnosis,the treatment is usually 3 months.

I think you need to get rid of the stigma that comes with TB, you have no control over airborne infections therefore you have nothing to be ashamed of. You do not have active TB, the bacteria is dormant and therefore you are not infectious to the public. People who begin treatment are safe and not infectious as early as 7 days upon starting. Treatment of infectious diseases is FREE in all 50 states, including TB. Consult with your primary care provider or public health clinic and they will direct you to the right avenues. And you can resume your nursing training with absolutely nothing to worry about.

[agr8rn, ASN, RN]

call your local health dept as others stated previously.

cdc recommends 9 month of treatment with inh and vit b6 (reduces chance of neuropathy associated w/inh)

having the treatment is not mandatory, however it greatly reduces your chances of developing active tb infection at some later point in your life. most people will not develop active tb, however, if you were to become run-down, ill or immunocompromised, that is when it could surface.

just remember for the future, never take the ppd test again

there will be people who try to make you take it, but don't do it. the reactions get worse every time, and you can get serious scarring and tissue damage.

good luck!

[darkbeauty]

o' yes, no ppd for pos+ results. however once treatment has been completed, your ppds will not turn positive again because the bacteria has been totally eradicated.

tb detection can be complicated for some people. since i work in a healthcare setting, screening is mandatory, and since my ppd comes out positive(the last one i took was very severe almost ten yrs ago), i shoot straight for the chest xray and that clears me. however about 2 years ago i got the tb diagnosis, the two pulminologists i saw were arguing between the bacteria in my lung being active or latent. the problem with me was the chest xrays were negative, the sputum smears were negative, 2 cultures were negative and only 1 culture came back pending. out of a friend's advice, i insisted i get a ct scan which revealed abnormal webbing in my lower left lobe(lll) and still the doctor told me nothing to worry about. i insisted to start on the tb regimen since there was a slight chance and it wouldn't hurt me anyway. they offered to treat me for 6 months, i insisted on 9 months till my cultures were clear and negative for 5 consecutive months. the story i'm trying to tell is, you need to be your own advocate when it comes to your body and health. that severe reaction to the ppd i had years back was a signal something was not right, but since diagnosis depends on chest xrays and sputums, it slipt through.

[LuvMyGamecocks]

I had a + PPD, -CXR, and was referred to the health department. I haven't been yet, but they'll provide treatment at no cost. I'm NOT required to take meds to start at my new job (my first RN job).

[pagandeva2000, LPN]

call your local health dept as others stated previously.

cdc recommends 9 month of treatment with inh and vit b6 (reduces chance of neuropathy associated w/inh)

having the treatment is not mandatory, however it greatly reduces your chances of developing active tb infection at some later point in your life. most people will not develop active tb, however, if you were to become run-down, ill or immunocompromised, that is when it could surface.

just remember for the future, never take the ppd test again

there will be people who try to make you take it, but don't do it. the reactions get worse every time, and you can get serious scarring and tissue damage.

good luck!

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!