Positive Mantoux

explorer · Oct 3, 2004

I've just reviewed some old posts on this subject & found many of them to be very informative. However, I still have a couple of questions I hope can be addressed.
I retired from LTC in Dec. 2003. In Nov. of 2003 I was given my annual PPD with negative results. August of this year I applied for a PRN position at an Assisted Living facility and tested positive for TB exposure. I am assymptomatic; I had the x-ray & am currently on INH.
Questions:
1. Can some people have "false" positive results? The nurse that gave me the test elevated the needle at the injection site while giving the test, resulting in a good bubble, but immediate redness & swelling to the site. Two days later I had a raised, red, itchy spot the size of a quarter. I've never had a nurse give me a mantoux like that in the 15 years I've been tested.
2. Last February I was visiting my daughter on an Army post & while in the Commisary an older man (who looked to be either drunk or sick) coughed forcefully on me as I passed in front of him in the grocery aisle. There was spray & phlegm on the side of my face, in my right eye & hair.... actually, pretty gross! Last month I contacted the Infection Control facility at the Army Post & spoke with the civilian RN director and she pretty much blew me off. She stated that there were NO MALE active TB patients on post or in the nearby city & that the state has one of the lowest incidents of TB in the country. She even said that her department doesn't even give mantoux's anymore because the incidence of TB is so low. What a crock! I still think if I were exposed (& not a false positive) this is where I probably was in contact with someone with TB.
I realize this is lengthy, so if you didn't get bored or "lost" while reading this maybe somebody might know about "false positives" in mantoux testing & have some familiarity with the way I was given the injection.

There are strains of TB coming out of the prision system of Russia, that there is no cure at this time! Tell the RN that a carrier could come her way and she wouldn't even know it untill it was an epademic!

chris_at_lucas_RN, RN · Oct 3, 2004

I retired from LTC in Dec. 2003. In Nov. of 2003 I was given my annual PPD with negative results. August of this year I applied for a PRN position at an Assisted Living facility and tested positive for TB exposure. I am assymptomatic; I had the x-ray & am currently on INH.
Questions:
1. Can some people have "false" positive results? The nurse that gave me the test elevated the needle at the injection site while giving the test, resulting in a good bubble, but immediate redness & swelling to the site. Two days later I had a raised, red, itchy spot the size of a quarter. I've never had a nurse give me a mantoux like that in the 15 years I've been tested.
2. Last February I was visiting my daughter on an Army post & while in the Commisary an older man (who looked to be either drunk or sick) coughed forcefully on me as I passed in front of him in the grocery aisle. There was spray & phlegm on the side of my face, in my right eye & hair.... actually, pretty gross! Last month I contacted the Infection Control facility at the Army Post & spoke with the civilian RN director and she pretty much blew me off. She stated that there were NO MALE active TB patients on post or in the nearby city & that the state has one of the lowest incidents of TB in the country. She even said that her department doesn't even give mantoux's anymore because the incidence of TB is so low. What a crock! I still think if I were exposed (& not a false positive) this is where I probably was in contact with someone with TB.

The reaction you describe is a classic positive reaction. If it had been from the technique alone, it would have resolved within hours and you would have had a clear area 48-72 hours later.

I have been more concerned when given the Mantoux and had it injected under the skin, rather than within the skin. I worry the whole time wondering, if I am positive, just where is that reaction going to pop up?

I did read on the CDC website that if you are tested often enough, you can develop a positive reaction because your body has formed the antibodies to the testing material, not because you have the disease. However, it didn't say what to do in that case, or if there was a way to tell the difference.

So, you might call the CDC.

The army post's RN should have said there were no reported cases in males at that time. Anybody knows that nobody knows what's out there, we just know what's been reported at any given time.

I believe the next time you get coughed on like that, you need to get the individual's name and contact info--there's more potential damage there than from a fender bender, don't you think?

BTW, very, very unusual to have someone in that condition in a commissary, but it sounds like he would have been retired and local. Is it nearby? You might hang out there and see if you can find him again. Hint: elderly retired military usually shop the commissary the same day each week. If he's gotten very sick, he could be in the local VA hospital--not likely you'll find someone to help you there ("do you have any cachetic males who would have lived on or near Fort Such And Such on or about this date?") but you never know.

I agree with you about the probable source of your exposure.

Good luck.

Audreyfay · Oct 4, 2004

AYE KARUMBA! Sure sounds like you found the source. Some people just don't want to listen, do they? Regarding the technique that the nurse gave the TB test, I also worked with a nurse who used to give the test using that same technique. I don't know who in the heck taught them that? I do know that it assured them that they were not giving the solution too deep. I worked with her for 2 years. I never saw any reactions because of her technique. Good luck! Hope all goes well!

ohlpn · Oct 4, 2004

Thanks so much for all the reply's. They were all so informative & re-inforced what I think I already knew. As a post script, my son-in-law says that this nurse was mistaken about the military not being given PPD's. He says all new recruits are given Mantoux tests & he said at least 50 guys in his battalion have tested positive for exposure. I mentioned to the Infection Control nurse with all the soldiers & their dependents being transferred from all over the world I thought the Army would routinely conduct Mantoux testing. She stuck to her guns about there being no active TB, so it was pointless to test for it. What a dope! My daughter & her husband have been doing some follow up on this situation, but I haven't heard anything back on it.

Limik · Oct 4, 2004

Hi ohlpn. I used to work in public health and we were educated continually about current TB protocols. A positive skin test alone is not indicative of TB. You didn't say if the CXR was conclusive. I know the public health Doc's would sometimes advise prophylactic TB treatment even if the CXR was clear. They usually advised this for high risk groups like health care workers because of the variety of people you come in contact with. The only problem I've seen with prophylactic treatment, besides the side effects from the drugs themselves, was that you may not have as good results with subsequent treatments because of building up an immunity to the drugs(the way some people build up resistance to abx over time). From now on of course you should only have CXR instead of skin test because of positive reaction. As mentioned here in another post, I have noticed more of a reaction from some people because of getting frequent skin tests. Good luck!

Limik

z's playa · Oct 4, 2004

I just had my Mantoux repeated because my nurse didn't give me the 2 step the first time. This time when I had it done, the nurse stuck me deep. So deep it hurt AND it bled. I had a bruise but a negative reading. Still...didn't look right.

missnurse01, MSN, RN · Oct 4, 2004

i agree that the source might have been the guy at the comm-my s.o. has one month left of INH and he will be finished with his 9 months of it. He hasn't had any major side effects-other than his wanting the occ beer and can't have it! He did have some elevated liver tests, but not too out of whack. He picked this up in Iraq last year and he did not have anyone cough on him or that looked really sickly. Unfortun, he also said that the military never warned them that this area has a lot of TB and to keep your distance. So, lots of folks coming back from deployment might have been exposed-you never know. His CXR was clear though, and we are almost finished with the meds. So good luck to you!! At least it sounds like you were exposed and not infected. :)