Positive PPD test

  1. About two months ago, I was exposed in the ER/clinic to a patient who turned out to have TB.. positive sputum and chest xray. Anyway.. We of course were give the ppd series.. my first one was of course negative. But I got my second one yesterday and I woke up with what i thought was a rash.. couldn't figure it out.. couldn't figure it out.. then hours later it dawned on me. I'd gotten my PPD there yesterday!!!!! So, of course I've been stewing all day. I finally decided to measure it, even though I knew it was way more than the 10mm for grossly positive. The induration extends about 30mm. And the redness (which I know basically means nothing) is about 50 mm.. It is tender and itchy as well. Frankly, I'm beside myself. I am confident I don't have active TB, no symptoms, but this really stinks. Has anyone else had a positive TB test? I know I will now have to have an xray, probably a series of them I imagine. Do they generally put you on prophylatic rifampin? And what about my kids? Oh god, if they got sick, I could never forgive myself. I'm sure I'm overreacting a little in the heat of the moment, but I can't help it. Any words of wisdom, encouragement, or just a good old slapping (lol) would be appreciated.
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    About galenight

    Joined: Nov '00; Posts: 260; Likes: 104
    ER RN


  3. by   2ndCareerRN
    After working EMS/urgent cares in Las Vegas for a few years I came up positive on my PPD.

    At the time I was taking niacin for my astronomicaly high triglycerides, so I did not do any preventitive therapy. I get a chest x-ray every 2 years, and watch for sign of active TB.

    That is about all you can do. In the next few days you should be evaluated by employee health and get a CXR. Once those are found to be normal you will be one of the thousands, or more, healthcare professionals who have become exposed, yet do not have active TB.
    Unless you shows signs of active disease, by CXR or sputum, you have what is considered a latent infection. With a latent infection you do not need to worry about spreading the disease. But, you will need to look at your diet and health habits so that you do not become rundown, allowing the infection to become active. Latent TB often becomes active in people who are immunocompromised or immunosupppresed, if they have not had INH therapy when first having a positive test.

    So, first off, do not worry. Worrying about it will not make it any better or worse. Do whatever you need to do to get further evaluation. And lastly, come closer............. now, enjoy the rest of the night.

  4. by   hoolahan
    I'm a PPD converter too. I was never told which pt I was exposed to, but I am quite certain of who it was and it was significant close-contact.

    Since I had done a little infection control, I had tracked a case of a pt who was placed on the prophylactic rx for an exposure. I will never forget it, b/c he was so orange, he glowed in the dark. It was from the INH.

    These drugs are not to be taken lightly. The last recommendation by the CDC is caution if over age 35 for prophylaxis. I was 35 when it happened, so I was on the fence about it. I was freaked out too. I spoke w an ID guy I respect a great deal, and he said even if I did get the rx, the bacillus is not completely erradicated from your body, it will still be dormant in your cells, and if you should ever become malnourished, or immunosuppressed, you can develop TB. There is NO GUARANTEE against getting TB in the future, even if you take the prophylaxis.

    So, I opted not to take the meds. I got a CXR yearly x 2 years, then q 2 years. MY doc still does them yearly. I am fine, and it was 4 years ago. I am finally to the point that I even forgot to tell the pulmonologist I saw the other day about it on my history.

    Take deep breaths. You are going to be OK. Talk with a doc you trust, check out the CDC recommendations www.cdc.gov , and make an informed decision. You're going to be OK.
  5. by   duckie
    It's very possible that you have had an allergic reaction to the solution also. My B-I-L took his second step and the area was bigger than a silver dollar. Took a chest xray and was fine. Some people react positive and they have chest xrays yearly instead of the PPD. Just a thought.
  6. by   galenight
    Thanks all for your support! I'm calming down now..lol
  7. by   Atl_John
    I actually had a small positive reaction when I was 8. I was living in Alaska at the time so we got tested for school pretty regularly. When I got into nursing school and had the test done, I got tested and both times it was negative. So that goes to show it could just be the way the test was done.
  8. by   CCL"Babe"
    I converted over 15 years ago from a very close contact in the ED where I worked ( I was Triage that day). 12 hospital employees that came in contact with this person converted as well.

    I tried the meds - but had to stop when I developed side effects. I had the routine CXRs on a regular basis for a while.

    I have not had any problems.
  9. by   mommyRN07
    Positive PPDer here! I took INH for 6 months. Instead of PPDs, I get CXRs when required. I've never been symptomatic, never had any issues other than the nasty cellulitic-looking skin reaction. Always have had beautiful, clear x-rays. It's not a big deal.

    Quote from Duckie
    It's very possible that you have had an allergic reaction to the solution also. My B-I-L took his second step and the area was bigger than a silver dollar. Took a chest xray and was fine. Some people react positive and they have chest xrays yearly instead of the PPD. Just a thought.
    I guess this is technically true. There probably is some way to determine whether it is allergy vs true reaction, but either way, your body is producing antibodies so the next step is the same. Try not to stress too much.
  10. by   CHATSDALE
    the possibility that you have developed an allergy to the solution in ppd then NEVER, NEVER take another ppd test...it could be fatal
    i had a positive test no sx, neg x-ray, took inh for six months, this was required for anyone working with patients, had another chest x-ray a year later and it was clear
    i had not heard that niacin would cause a positive reaction i took it at one time but it didn't help lower cholestral and made the gout worse so i quit but now i can't remember if i was taking them at the same time as the pos reaction
    to op i am sure that your kids are going to be ok...take good care of yourself, we never know what we are going to be exposed to, it is part of the job and it will turn out ok bless you
    Last edit by CHATSDALE on Jul 14, '07