Positive PPD with history of BCG

  1. I have a long drama about BCG & PPD which some out there may benefit from; especially foreign nurses moving to the US.

    I had BCG as a child (age 2 I think) in preparation for my parents to move to South America. I was told to never accept a PPD because I would react.

    At the age of 21 as a new nurse they gave me a PPD anyway and surprise surprise it was postive. I had to have a CXR then no more PPD's while I worked at that facility.

    The next couple of jobs I took they took my word that I was reactive and that it was due to the BCG and sometimes I would have to have a CXR and sometimes they just looked at my previous reports and left well enough alone. I also thought it was ironic because I thought I was one of the few Americans out there actually protected against TB yet I was always under intense scrutiny.

    I changed jobs in 2002 and my new facility took a CXR report I had from the year before (different places intermittently would decide I needed one) and that was good enough then and the next year. In 2004 they decided I needed a PPD; whatever, I though it was silly and I would react but I'm not afraid of needles. They assured me BCG would only cause a reaction for 15-20 years and I was way past that window. My PPD was negative that year! (2004). So I go back the next year and hold out my arm. That stupid thing started burning and itching hours after I left employee health and I had a nice sized red lump 72hrs later. I was assured when I was being checked by the nurse that this was a reaction to the preservative (nickel) and that the bump didn't have margins (which I disagreed with) so I was negative; see you next year !!

    I should have gotten my doctor to see this bump so he could write a note saying I was "allergic" and shouldn't have another PPD but I heard rumors that our employee health wouldn't accept this (that's wrong but irrelevent now). I went in several days ago to have my annual TB test and let the nurse there know about the reaction and was there anything I could do. She stated she would need a note from my doctor then I could be exempt but obviously he would need to see a reaction to write the note so hold out your arm please. Then she saw my record and my history. "You should have had a CXR last year if you had redness", "Why didn't an RN read your PPD?" (like I'm questioning their procedures!). Apparently RN's, LVN's and techs read them there and it's considered fine but suspicious looking ones should be checked by an experienced nurse. She gave me the PPD and the name of the nurse who should check me today (knowing it would most likely react again).

    Today the experienced RN checked my arm and says oh yea, you're positive, 18mm reaction, not an allergic reaction, clear margins (just like last year's). She says the antibodies produced by the BCG are no longer effective against the disease after a few years but are floating around there kind of hiding out. It took me kind of getting sensitized again (by that first PPD in 2004) and then I reacted last year and again this year. I wasn't happy but at least THIS hospital won't try again to give me a PPD. It took 6 months for the mark to go away last year. No CXR needed but she almost sent me to the County Health department. That would have been an adventure since I work in a large urban area. She also explained about how the CDC had changed their policied about PPD's with people who had BCG back the mid 90's and I've kind of gotten caught in the middle.

    Anyhow; we'll see what they say next year; the story seems to change every year. . .
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    About TiffyRN, ASN, BSN, RN

    Joined: Sep '03; Posts: 2,375; Likes: 2,861

    19 Comments

  3. by   tkhayman
    hi,
    i too converted a few years ago to positive with a skin test. now i need a chest x-ray but the good news is they only have to repeat it, if i present with problems. So i do not have to go through the PPD this anymore.
  4. by   SaraO'Hara
    I came up positive on a PPD in January; my facility usually gives PPDs annually, but I and anybody else who was positive in the past will have a CXR instead.
  5. by   Medic/Nurse
    I, too, have a "PPD" problem.

    I had exposure to a uncle that had TB contracted most likely through cow's milk (seems odd, given todays world - but it was not that long ago.) So as the County Health was treating my uncle and he often stayed with us, we were tested often. Well about 5 years into surveillance, I had a marked reaction to the PPD - there were no margins or induration. Worse than that!
    Within a short time there were hives, itching, wheezing - you get the idea.

    Anyway, it was determined not to be a TRUE positive, but a TRUE allergy. There was some debate that it could be a component in the PPD, but the general medical consensus was - Why risk it? It has been over 20 years and I have NEVER had another PPD. There were never any symptoms, and I have never had a positive CXR.

    Yet, given the industry I work in, it is rarely an issue. Yet, as the law of averages go - there was one employee health nurse that didn't believe it, etc.. She said it is impossible to be allergic. I offered all my documentation, and she then was insistent that "a PPD be placed". Well, at that point - I just backed down asked that she (contact Risk Management/get an ER physician to stand by) and then the HCF representative and Miss Infection Control can sign a statement that they take FULL responsibility for any reaction or consequences that I may suffer. Seems she did recall something about a true "PPD allergy" then. Whatever.

    Well, that is my tale - do not do anything that may place your health at risk. I do end up having a CXR with some changes of employers - but, I keep good records and it is usually not a problem. I will not however, risk an anaphylactic reaction
  6. by   mart18642
    Quote from tiffyrn
    i have a long drama about bcg & ppd which some out there may benefit from; especially foreign nurses moving to the us.

    i had bcg as a child (age 2 i think) in preparation for my parents to move to south america. i was told to never accept a ppd because i would react.

    at the age of 21 as a new nurse they gave me a ppd anyway and surprise surprise it was postive. i had to have a cxr then no more ppd's while i worked at that facility.

    the next couple of jobs i took they took my word that i was reactive and that it was due to the bcg and sometimes i would have to have a cxr and sometimes they just looked at my previous reports and left well enough alone. i also thought it was ironic because i thought i was one of the few americans out there actually protected against tb yet i was always under intense scrutiny.

    i changed jobs in 2002 and my new facility took a cxr report i had from the year before (different places intermittently would decide i needed one) and that was good enough then and the next year. in 2004 they decided i needed a ppd; whatever, i though it was silly and i would react but i'm not afraid of needles. they assured me bcg would only cause a reaction for 15-20 years and i was way past that window. my ppd was negative that year! (2004). so i go back the next year and hold out my arm. that stupid thing started burning and itching hours after i left employee health and i had a nice sized red lump 72hrs later. i was assured when i was being checked by the nurse that this was a reaction to the preservative (nickel) and that the bump didn't have margins (which i disagreed with) so i was negative; see you next year !!

    i should have gotten my doctor to see this bump so he could write a note saying i was "allergic" and shouldn't have another ppd but i heard rumors that our employee health wouldn't accept this (that's wrong but irrelevent now). i went in several days ago to have my annual tb test and let the nurse there know about the reaction and was there anything i could do. she stated she would need a note from my doctor then i could be exempt but obviously he would need to see a reaction to write the note so hold out your arm please. then she saw my record and my history. "you should have had a cxr last year if you had redness", "why didn't an rn read your ppd?" (like i'm questioning their procedures!). apparently rn's, lvn's and techs read them there and it's considered fine but suspicious looking ones should be checked by an experienced nurse. she gave me the ppd and the name of the nurse who should check me today (knowing it would most likely react again).

    today the experienced rn checked my arm and says oh yea, you're positive, 18mm reaction, not an allergic reaction, clear margins (just like last year's). she says the antibodies produced by the bcg are no longer effective against the disease after a few years but are floating around there kind of hiding out. it took me kind of getting sensitized again (by that first ppd in 2004) and then i reacted last year and again this year. i wasn't happy but at least this hospital won't try again to give me a ppd. it took 6 months for the mark to go away last year. no cxr needed but she almost sent me to the county health department. that would have been an adventure since i work in a large urban area. she also explained about how the cdc had changed their policied about ppd's with people who had bcg back the mid 90's and i've kind of gotten caught in the middle.

    anyhow; we'll see what they say next year; the story seems to change every year. . .



    i know what you mean. i had a bcg as a child and one as a teen (a buster so of speak)
    (before i went to south america and then came to the usa), and one year my ppd would not react, and the next 3 years it reacted to the point that my whole arm got involved. the health department wrote me a note stating "not to give ppd, because of bcg given in the past, just cxr..............and more. well i moved to pensacola fla,i lost that particular letter........when i went to sign up for a job at a local hospital i found out by the nurse that i have to have a ppd or i wont get hired, i told her that after my last ppd i reacted to the point that my whole arm got involved; nevertheless she told me that i have to have it anyways( she was an experience rn....at least i was told), my personal doctor told me that no, i needed a chest x ray q2years. i let them know about it and they insisted that they needed a ppd for their records. at this point, i thought they do not need me here so i did not take the job.
    i think they need to do more research on this issue, and educate more. sometimes i whish i would have never gotten that bcg.
  7. by   ZootRN
    I've got BCG as a child, but apparently never converted, as my PPD was always negative.
  8. by   NurseLatteDNP
    I have the same issue. I was born in Croatia, where all the children get a BCG. We got tested there every year in school, and we were supposed to have a red reaction. That was a good thing.
    So when I got tested here in the US health department, I was happy when I got the red reaction on my skin:uhoh21:. Well the nurse was not that happy, and I did not know why. So she told me I need to get started on TB medication right away, no chest x ray needed, and even after I told her about BCG, she said that did not have anything to do with my positive reaction . Needless to say she made me look dumb and embarresed in fron of the whole staff. So I refused to take any medications until I see my primary doctor. And I am glad I did. She told me that I should NEVER again take a TB test, and explained that in the US it is not common that people get BCG. From now on I can only do the chest x-rays, and she wrote a note for me so I can present it to my future employers.
    But I get so tired of explaining everybody why I can't take the test, and what BCG is, every year when we get tested at my hospital.
  9. by   hollyberry678
    I too got BCG in Europe as a child. I thought the policy was 5 years btwn CXR's? Anyone have the definitive/current answer?
  10. by   suzanne4
    In the US, it is minimum of yearly PPDS, and some facilities want every six months. CXRs are done at the same required time, never heard of it being every five years.

    The new literature out from CDC suggests and recommends that those of you that are testing positive on the PPD, and had BCG as a child be treated. The window is about fifteen years for the BCG to last in your system. And most of you are past that. Due to the increase of TB cases that are now presenting in the US, most are going ahead and treating.

    Especially if you were from a country that had a high rate of the disease, such as the Philippines and Eastern Europe. And this is also per the inectious disease physicians that I consulted with when the issue came up in the International forum.

    You are positive when you get to the US, it means that you were exposed to the virus. US Embassy will also require treatment.
  11. by   NurseLatteDNP
    Quote from suzanne4
    In the US, it is minimum of yearly PPDS, and some facilities want every six months. CXRs are done at the same required time, never heard of it being every five years.

    The new literature out from CDC suggests and recommends that those of you that are testing positive on the PPD, and had BCG as a child be treated. The window is about fifteen years for the BCG to last in your system. And most of you are past that. Due to the increase of TB cases that are now presenting in the US, most are going ahead and treating.

    Especially if you were from a country that had a high rate of the disease, such as the Philippines and Eastern Europe. And this is also per the inectious disease physicians that I consulted with when the issue came up in the International forum.

    You are positive when you get to the US, it means that you were exposed to the virus. US Embassy will also require treatment.
    My primary physician told me that I will test positive for the rest of my life, just because of BCG. And she also said, there is no reason for any treatment, since I was never exposed to it, have a negative chest x ray and I never traveled to any affected countries.
  12. by   MiaNJ
    Quote from kiyatylese
    My primary physician told me that I will test positive for the rest of my life, just because of BCG. And she also said, there is no reason for any treatment, since I was never exposed to it, have a negative chest x ray and I never traveled to any affected countries.
    I also got the BCG in the early 80s, but I never was exposed to any affected person, etc. I was only for a trip to East. Europe that my family had to go, and was required at the time. So when I got the PPD in school when I was 12, it was positive and they made me take INH treatment for about 9 mos. The doc at the time told me that I would always test positive for PPD, not just 15 yrs, and I could never have one ever again.
    Recently when I was applying to nursing school, I told them that I could take the PPD, but was forced to take one anyway. Needless to say, it was positive. I told them that I already had the INH as a child and was told I just needed a chest x-ray. That came out negative,and I was told to get one every 2 yrs.
    But if someone tests positive with a history of BCG, I don't know why it would be assumed that they are possibly infected with active TB. The treatment is not easy to take (9 long mos) and has side effects, some can be major. I remember getting sick sometimes while taking the pills. I wouldn't want to retake that treatment, and would be afraid of harmful long term effects.
    My whole family had the BCG and they always tested positive for PPD. My grandmother never got x-rays regularly since she wants to avoid radiation, and she's over 85 now and healthy as can be. Neither are my parents, siblings, etc. I think people should realize the BCG can end up in positive PPD for a long time, sometimes indefinitely and it doesn't mean the person is infected.
  13. by   doodlemom
    The last 2 jobs that I've had just asked me for the last CXR report and as long as I am asymptomatic, I don't take any more CXR's. Once a year they ask me a series of questions and I sign a form. Before, I never had any problem with it - I would just say I have a positive PPD and they would get CXR yearly. It's very common for health care workers to have a positive PPD. I'm surprised that you have had such a hassle.
  14. by   gauge14iv
    Recent CD Recommendations - halfway down the page -

    http://www.cdc.gov/nchstp/tb/pubs/ss...3infection.htm

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