Positive PPD

What ever happed to just doing chest x-rays. A co-worker of mine tested positive and was put on INH and got really sick so he stopped taking.

I have always postive, since childhood.

Repeated CXRs are expensive and do have problems related to repeated exposure to radiation. Also, the risks related to clients possibly being pregnant and having CXRs is a growing legal concern.

When I was in my late twenties, they accepted my word that I was not pregnant. Now, ten years later, I have to have a pregnancy test, each time that I have an CXR.

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Yes I had a positive ppd Monday along with me and another co-worker. I thought they would have sent me/her home but they said dont worry it is ok you are just having an allergic reaction. I am a CNA been there for 2 years. Last year mine was neg and all the other ones I have taken have been also. This company does not check people when they hit the door for employment. The other girl has been there 5 months and this is the first time they have eveer done one on her. We worked 2 days they did set up a chest xray to be done today. We took it and the guy that came out he kept saying you all don't look like drug addicts? I was wondering what does that have to do with having a positive ppd. They say if I have a neg chest xray then I dont have it and that I dont need any medication. That you only take meds if you have positive chest xray. Then I asked well what if the chest xray is positive are you going to pay us like workmans comp or what will happen? Well they said they had to prove it came from here. We worked 2 days with a positive reading. I really expected for them to send us home. I dont want to give anyone anything. They act like I am being paranoid. I worry about my family, I worry about my friends and my patients. I dont want to have something then it show up later on and then I am full blown and could have recieved treatment and then putting other innocent people at stake. I talked with other coworkers and they said they have had positive test but, there chest xray was good. I dont understand it. Then they talked about immigrants being in. Ok I said what about the illegal immigrants that are here also. They dont get tested and what if someone misinterperts the test. I am a nerveous wreck! I dont know if they are trying to cover something up or maybe they are doing what they suppose to but, from everyone else post I see that everyone is on meds or at least is offered them. I am calling the health department tomorrow to find out there protocol and so fourht if I am worrying to much. I do know we had a scabies outbreak needless to say it took 5 months before a diagnosis was made. They say the test came up neg.

Since my first year of nursing school I have always had a positive PPD but was told by my PCP it was a "skin reaction", however when I was hired to work ER I didn't have documentation of my previous positive test and had to have another PPD which of course was positive >10mm. They then ordered another CXR and I was told I had "multiple calcified nodules" throughout both lungs which they said meant I was exposed at some point in life and had active TB whenever that occurred (they believe it was in childhood d/t the nodules appearing old), they also suggested that i start a course of treatment however stated it wasn't required unless I was symptomatic which I was not and have not been. So now I get my yearly screenings at work and if I'm ever symptomatic I will need another CXR and at that point decide whether to start treatment. I personally do not see the point in taking hepatoxic meds to "prophylactically treat" a disease which I do not actively have, but everyone has their own opinions, and if you are concerned or symptomatic i.e. unexplained weight loss, low grade fever, night sweats, chronic coughing etc then i would recommend treatment, but remember, a positive PPD does not mean you have TB or that you have latent TB as i do, it could just be that you have been exposed and have formed antibodies for it.

Hope that helps... sorry its kinda long lol

BRAVO to you as a ER nurse. Having been a paramedic for 13 years, I already know that there is no other department that I would want to work in. I will be starting nursing school this fall, and I already spend a sizeable amount of time researching hospitals and trauma centers in the U.S. so that I can be ready to go when I graduate. I look forward to it, and reading your post makes me all the more eager.

...All the more eager to be exposed to TB?

I'm confused.

It's awesome that you want to be in the ED, but I'm not quite sure why this particular thread would make you want to work there!

wow! it never fails to surprise me how much fear, even in our informed, educated, evidence-based population of nurses still runs rampant when it comes to tb.

i am fortunate to never have converted, but i worked with a lot of tb patients and have done a ton of education along these lines. i encourage everyone who is afraid to please go out and at least talk to their county tb clinic representatives- they have a vast knowledge and can really help answer some questions.

basics: mycoplasm tuberculosis is the bacteria which causes the infection we know in our layman's terms as tb. it is an opportunistic infection (like many are) and the bacteria themselves are rather special; they have a very waxy cell wall, which affords them great protection. because of their waxy cell wall, they are 1) very hard to kill - it takes a long time to penetrate all of the bacteria's cell walls with an antibiotic and to kill them all and they are 2) slow-growing. and they thrive in an oxygen-rich environment (lungs!). in fact, your body will often wall-off the infection - imagine your body's immune system constructing a house and boarding up the windows - this "house" is called a granuloma.

the running estimate right now is that one third of the world population is infected with tb.

(you can find the above info on uptodate by typing in "tuberculosis" - and i checked wikipedia's site, which is actually decent, although i don't use wiki for formal references by general rule. you can also reference your microbiology book or your patho book for this info).

latent vs active tb.

latent tb is exactly what it sounds like. one poster questioned why s/he had to take inh or any other drugs if s/he had no signs or symptoms of tb but a positive ppd. well, it's because often people will have no symptoms and no active infection. this status is called latent tb. someone with latent tb still has tb but the bacteria are dormant, and are not causing an active infection in your body. latent tb is not considered transmissible but...

it can convert to active tb. the running estimate from a multitude of websites (from uptodate to pubmed to even wikipedia) state that the conversion rate from latent to active is about 10% for adults. 40% for children.

if you have latent tb and a good immune system, generally you don't convert, but you still have the bacteria. people who are immunocompromised in some way shape or form are more at risk for converting from latent (dormant tb) to active tb.

who is immunocompromised? diabetics. people with hiv. people who have received a transplant. anyone taking steroids for long periods of time. people who have any kind of drop in their immune defense.

alameda county in california has a great synopsis of what tb is and how the infection works - in fact, all of my info from above is from them. read on. they have some great statistics. they are the county with the highest rate of tb infection in california.

alameda county public health department

one problem with tb comes with medication compliance- hence multi-drug resistant (mdr) tb exists. taking a medication for 9 months is daunting, especially when you hear about the horrible side effects. the reason people have to take 9 months worth of meds is from what i stated before: the bacteria that causes tuberculosis has a very waxy cell wall, which is very hard to penetrate - so in order to kill all of those little buggers, you have to keep taking the meds for a long time.

in fact, healthy people 2010 goals related to tb medication compliance are listed here:

hope that helps!