Help me out here....

[Aunt Slappy]

Inpatient admission from ER of 34 year old male born in Mexico, never smoker, c/o chronic nonproductive cough x3 years, chief complaint to ER is pain with breathing worsening over the course of the entire day since he woke up. CXR shows moderate right pneumothorax of unknown etiology. Chest tube is placed, patient is kept 3 to 4 days while pneumothorax resolves. You know from patient report that he has a recent positive TB skin test.

Would you test the fluid drained from the pneumothorax for TB? Why or why not?

[Aunt Slappy]

I stated he's on 3HP. That's INH + rifapentine with vitamin B6.

I think a NP with over a decade of treating LTBI and a pulmonologist who specializes in TB know what they're doing.

[Here.I.Stand, BSN, RN]

There is a theoretical risk that BCG vaccination can cause false positives on TSTs. However, BCG effect usually wears off many years before an adult pops positive on a TST. I have had BCG vaccinated patients who've had minor reactions to skin tests (5-10 mm) who were negative on a subsequent Quantiferon Gold, but if a person comes into my clinic with more than 15 mm, that's a true positive. They're infected.

My soon-to-be-ex first came to the US at age 19, and at age 29 had a PPD. He had had BCG prior to coming here. I'm not even kidding -- he had a raised red lump an inch across and red streaks all up and down his forearm.

His CXR was clear, and was never dx'ed with LTBI.

[Aunt Slappy]

My soon-to-be-ex first came to the US at age 19, and at age 29 had a PPD. He had had BCG prior to coming here. I'm not even kidding -- he had a raised red lump an inch across and red streaks all up and down his forearm.

His CXR was clear, and was never dx'ed with LTBI.

With LTBI, your xray is expected to be clear. The fact that he was never diagnosed does not mean he wasn't infected. The fact is that your husband is infected with TB and at risk of becoming actively ill at some point in the future, and he should consider LTBI treatment both for his own health and to assist in the public health task of reducing the reservoir of TB infected people.

[nursej22, MSN, RN]

I stated he's on 3HP. That's INH + rifapentine with vitamin B6.

I think a NP with over a decade of treating LTBI and a pulmonologist who specializes in TB know what they're doing.

I stand corrected about his tx. Regimen. I am still surprised that experienced clinicians would start treatment with out at least attempting to collecting cultures.

I am no longer in acute care, but I seem to remember chest tubing with a port for sampling. And we used to use it to instill t PA for loculated empyema.