Very concerned about a friend - positive TB test

EMTandNurse2B · Nov 11, 2005

I don't know much about it, except that you can indeed test positive and not have an active case, and thus not be infective and not have any trouble in school. Our nursing director has tested positive for years, and it hasn't stopped her. Even if she does have an active case, with all the new drugs against it treatement is usually effective, although long. Once she has recovered I don't think it would count against her in getting into school.

lunakat · Nov 11, 2005

One of my classmates is from the phillipines and always tests postive on her TB test. Its no big deal, it's just a bigger hassale becasue she always has to bring in results form a current chest x-ray. She is in 3rd semster and will graduate in May, she is also a a psych tech and the tb thing hasn't held her back at all! So as long as her x-ray is clear I am sure she will have no problems.....

mstigerlily · Nov 11, 2005

2 or 3 students in my nursing class over all the semesters tested positive and they were just random white people, not any particular ethnic group.

Two just required a negative chest x-ray, one had to take meds for 6 months I believe. No one seemed to make a big deal out of it, it's pretty common in the health care field.

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 :)

2

rhp123 · Nov 11, 2005

I have a positive skin test, due to prior exposure to TB. But I never had active TB.

I was told by all the state boards I called and all the schools I called (one lady first told me CXR has to be clear but later she said she was not sure), as long as the person does not have active TB, there is not problem.

malarwen · Nov 15, 2005

Since I know that I was vaccinated with BCG I even didn't bother to get a PPD for the nursing school and got a chest x-right right away. You shouldn't worry about your friend I'm pretty sure that she tested:rolleyes: positive just because of her BCG vaccination.

Nurse Ratched, RN · Nov 15, 2005

There is really no good solid data about the effect of BCG on a TB test over the course of many years. Since my understanding is that BCG only protects against a very specific kind of infantile TB, it shouldn't even be administered beyond infancy, yet some countries routinely give it to folks in high school. Most of our student patients have not had BCG for 17 years, but insist it is the cause of their positive TB test, even in the presence of a chest x-ray that shows old granulomatous disease.

Our facility policy is that we recommend INH for 9 months or Rifampin for four months to anyone who evidences a positive TB test, regardless of CXR results. The vast majority of our patients from Asia decline the treatment, regardless of CXR results.

Bottom line, your friend needs to not get another TB test as she will always be a positive reactor, and assuming her CXR is clear, she will need to decide whether or not to take prophylactic meds to kill the presumably latent TB germs in her body. This should not impact her schooling.

**RosesrReder, BSN, MSN, RN** · Nov 15, 2005

I tested positive for my test too. Followe a chest x-ray, came back negative then did a ISONIAZID treatment for 9 mths. I am starting school in Jan, so it has not affected me at all. I can never get tested for it again though.

essbee · Nov 15, 2005

Sometimes I read the posts from students because I enjoy the questions and perspectives of new nurses. The CDC can be very helpful in answering your concerns about your friend. In employee health the guidelines we followed were pretty simple. If you have a positive PPD (greater than 10mm induration) then you must have a chest x-ray to verify whether there is disease present. If you have had the BCG vaccine, you should have a chest x-ray instead of the PPD because you will most likely test positive. (Having the PPD could also result in a remote chance that skin inflammation/irritation could occur at the test site should you test positive). If you have a positive PPD and you have had the BCG vaccine, a chest x ray should be performed to indicate no disease and INH therapy is not indicated. Your friend most likely will have a negative chest x ray and is also most likely assymptomatic of TB. If you have a positive PPD and a negative chest x-ray, and have not had the BCG vaccine, INH therapy is indicated because at some point you have been exposed to TB but you do not have active disease. You will most likely always test positive once you have taken the INH therapy and subsequent reactions to the PPD may worsen or become inflammed. It is important that the employee answer questions that can also indicate whether you are assymptomatic such as do you have coughing episodes or bloody sputum etc. Most healthcare entities use CDC guidelines(they may also incorporate some guidelines of their own) so don't worry, I am sure your friend will be fine. Keep us posted.

**RosesrReder, BSN, MSN, RN** · Nov 15, 2005

Sometimes I read the posts from students because I enjoy the questions and perspectives of new nurses. The CDC can be very helpful in answering your concerns about your friend. In employee health the guidelines we followed were pretty simple. If you have a positive PPD (greater than 10mm induration) then you must have a chest x-ray to verify whether there is disease present. If you have had the BCG vaccine, you should have a chest x-ray instead of the PPD because you will most likely test positive. (Having the PPD could also result in a remote chance that skin inflammation/irritation could occur at the test site should you test positive). If you have a positive PPD and you have had the BCG vaccine, a chest x ray should be performed to indicate no disease and INH therapy is not indicated. Your friend most likely will have a negative chest x ray and is also most likely assymptomatic of TB. If you have a positive PPD and a negative chest x-ray, and have not had the BCG vaccine, INH therapy is indicated because at some point you have been exposed to TB but you do not have active disease. You will most likely always test positive once you have taken the INH therapy and subsequent reactions to the PPD may worsen or become inflammed. It is important that the employee answer questions that can also indicate whether you are assymptomatic such as do you have coughing episodes or bloody sputum etc. Most healthcare entities use CDC guidelines(they may also incorporate some guidelines of their own) so don't worry, I am sure your friend will be fine. Keep us posted.

Thank you for taking the time to answer the OP. This has been my experience as well so you are right on the dot. :)

nursestudentin05 · Nov 15, 2005

Thank you everyone :)

Her chest x-ray was OK but she will be put on medicine.

And, sure enough, I tested positive also. My skin test was 2cm and I did chest x-ray. They will let me know next week if everything is OK so I can start medicine, they said 9 months. I will do whatever it takes, I will not refuse to take medicine as it would be irresponsible to do so, I plan on being a nurse after all :)

I talked to the nursing school director and she was very nice about it all :) I felt very depressed since I AM an immigrant and the fact that I tested positive is not the nicest news you could hear :uhoh3: She said not to worry about it as long as my chest x-ray is ok and I am taking medicine regularly. They would just need a copy of all the examinations and I am ok to start school in January :)

I just hope my chest x-ray is OK. I don't have any symptoms, I feel fine but there is always doubt, you know, "what if" kind of thing :uhoh3:

Thank you all so much and I will let you know what is going on :)

nursestudentin05 · Nov 15, 2005

If you have a positive PPD and you have had the BCG vaccine, a chest x ray should be performed to indicate no disease and INH therapy is not indicated.

See, I was told that even though I have had BCG (last one at the age of 17, 10 years ago), I will have to take medicine. I was told that USA doesn't recognize the BCG vaccine, and regardless of it, I will need treatment.