Very concerned about a friend - positive TB test

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My friend is from Romania, moved here 4 years ago. She just got accepted into Radiology Tech school and was required to do a TB skin test. The test came positive and she was sent to do a chest x-ray. Of course, she is torn, crying... I have been with her the whole day trying to make her feel better. Anyway, I was doing some research on this and came across information about people from other countries who have received a BCG vaccine as kids. This was a usual thing in Europe and I myself had 3 over the course of 10 years. The article (http://www.cdc.gov/nchstp/tb/faqs/qa_latenttbinf.htm#Latent3) also says that people who have been vaccinated with BCG can also show positive TB test even though their TB may be latent, and they are not spreading the infection.

I am very worried about her and I hope her chest x-ray comes out OK. Her doctor told her not to worry and that she certainly not a rare case of it, that he ocassionally has people who test positive. I guess my question is, if her chest x-ray is clear and she starts therapy, will she have any problems getting into Radiology tech program? If anyone has any experience and doesn't mind sharing, I would be very grateful. Thank you :)

Each healthcare entity has to follow whatever CDC guidelines are, up to and including reporting requirements. If the CDC recommends or requires those who have had the BCG vaccine to take the medication then indeed that is what you should do to be in compliance. However you will find that some places incorporate additional requirements so they can be absolutely sure that they have covered all possible bases. If the CDC does not require it, I do not think persons should have to expose themselves to medications that can have unpleasant side effects, the CDC is afterall the expert in disease prevention. Make sure you are familiar with both CDC rules and your programs rules before you start your education and when you are seeking employment. Remember knowledge is power in nursing.

I tested positive (never had bcg vaccine) and had a negative chest xray. I saw a pulmonologist who was not worried about me and I had to take INH daily for a year. I had to take a vitamin supplement with it---I cant remember exactly--piroxidine? I forget now why but the doc wanted me to take it.

One thing you want to keep is copies of your chest Xray report and get a note from the doc explaining the medication you are on. Keep copies for yourself and be prepared to show them to every place you work. Sometimes I have had to go get more Xrays if whomever I was working for didn't feel that the Xrays I'd had were recent enough. Which really makes no sense! LOL Figures it was school who wanted the Xrays, nevermind that I was seen and tx'd in 92-93!

Anyway, I have great hopes you and your friend will do just fine.

Specializes in Med/Surge.

In switching employers, I recently tested positive for exposure, did the chest xray last Friday, came back negative, and am headed to the doctor this morning to get the drugs that I need to take. Not worried at all about it b/c I have been asymptomatic. The only thing that I don't like is that taking the drugs for such a long time and making sure myinsurance covers the cost.

Good luck to your friend!!

I am from a foreign country, and my PPD was positive 2 years ago when I started nursing school. (I had also received BCG in my home country). My Chest X Ray was negative. The nurse at the health dept. still wanted me to take INH for 9 months. (Which can cause: altered liver function, headache, blood in urine, difficulty breathing, fever, chills, nausea, vomiting, skin rash, seizures, itching, "etcssssss"). She said that the CDC did not care whether I had BCG or not. My PPD was positive and that meant I was exposed to TB. I absolutely refused, refused, refused to take it.

Today, (2 years later) the story has changed. According to new guidelines by the CDC: " It is not possible to distinguish a boosted TST reaction resulting from BCG vaccination (a false positive TST result) and a TST result due to prior infection with M. tuberculosis (true positive TST result) (29). Infection- control programs should refer HealthCareWorkers with positive TST results for medical evaluation as soon as possible." ... If chest X ray negative and asymptomatic, drug therapy is OFFERED but it is not MANDATORY.

Call me crazy but I kinda grew attached to my liver. Unless I am coughing up blood stinged sputum or having fever and chills at night time, I am not taking any medication to treat something that I may/may not have.

More info at:

http://www.cdc.gov/ncidod/hip/guide/tb_excerpt.htm#index

http://www.cdc.gov/nchstp/tb/Federal_Register/New_Guidelines/TBICGuidelines.pdf

I totally agree with kka22- I had a positive ppd in the first few weeks of nursing school (2003), which was done for a pre-employment physical at a hospital. I was harrassed by the infection control person from the hospital as well as the local health department person who both disagreed over how long I should take INH. The whole thing had me scared to death. My nursing program director had her own opinions, but was not worried about my staying in school. When the other students found out, they would get up and move away from me. My doctor was of a totally different opinion than the others. I started the pills, and immediately had all the bad side effects; I was told to keep taking them anyway or I could not keep my new job. My liver has suffered permanent damage, and after about five months on the meds I was vomiting everyday and very sick. My doc took me off the pills and went up against the DON saying she would not allow me to take them anymore. I researched this as much as I could, and I find that everyone has a different opinion as to if you need INH, how long you need it, percentage of organisms killed over time, and if you can ever do the ppd again. Some doctors say you can do the test again, but I'm not willing to risk a large ulcer on my arm to find out! I am still upset about alot of things surrounding all this, but most of all an infection control person telling me how long to take medicine instead of my doctor. If this happens to you, reasearch it yourself- you have to understand what is happening to you and not just take someones word for it!

During those first two weeks I had my 11 year old son tested because I was so scared- his test looked just like mine but was judged negative because he had no risk factors. I forgot to say that they called my test negative at first, and I said they needed to look again because I knew it was a + with a 5cm induration.

The vitamin B-6 is always suggested along with INH to reduce the peripheral neropathy; it really works.

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