Positive PPD

[JenTheSchoolRN, BSN, RN]

It is the time of internships for our upperclassmen and several go out to intern at medical facilities. I work with our college counselor to make sure students are UTD on immunizations (including in the case a very necessary flu shot) and read PPDs placed by their PCP or local clinic.

First time I saw a positive PPD! Student had a record of negative PPD 2 years prior so I was confused. Ended up calling their PCP and finding out they had a Quantiferon test done last March due to a history of positive PPD I wasn't aware of - which was negative.

(Student went to a clinic that wasn't their PCP so they did the PPD without knowing the history as well.)

I also talked with the parent to find out that the student had the BCG vaccine which may be reason for positive PPD. I learned a lot more about PPDs today - nice refresher for me to bank!

[ruby_jane, BSN, RN]

WOAH!!

So...student should always be a CXR only due to previous positive. I am glad the blood test was negative but as the student will always skin test positive and we're looking to document changes...I am surprised the doc ran a Quantiferon.

Of course things may have changed in the TB game since I worked it in 2012...

[JenTheSchoolRN, BSN, RN]

Just now, ruby_jane said:

WOAH!!

So...student should always be a CXR only due to previous positive. I am glad the blood test was negative but as the student will always skin test positive and we're looking to document changes...I am surprised the doc ran a Quantiferon.

Of course things may have changed in the TB game since I worked it in 2012...

I'm thinking they did that to avoid repeat CXR every 1-2 years - with it no more CXR and no more PPDs.

[BostonFNP, APRN]

42 minutes ago, ruby_jane said:

WOAH!!

So...student should always be a CXR only due to previous positive. I am glad the blood test was negative but as the student will always skin test positive and we're looking to document changes...I am surprised the doc ran a Quantiferon.

Of course things may have changed in the TB game since I worked it in 2012...

Many guidelines have moved IGRA testing to the preferred method of screening children >5.

[SchoolNurse91, BSN, RN]

I had a student a couple months ago with active TB. That was fun.

[ruby_jane, BSN, RN]

59 minutes ago, Hyperflycemia said:

Many guidelines have moved IGRA testing to the preferred method of screening children >5.

Yes....but if they've already had the skin test we're getting into the category of "the skin test said this but the blood test said that."

Since the student is a late adolescent with a BCG and at least one documented positive test...theoretically she should have a CXR whenever she needs a TB test. Because relying on one Quantiferon test is not best practice; she was negative at that time. She's done a lot since then....

15 minutes ago, kelleyk1991 said:

I had a student a couple months ago with active TB. That was fun.

When I was the county health nurse a school nurse became my DOT provider and saved my bacon daily. She very calmly and practically said that since the kid was there anyway, she could take care of it. I will always think fondly of nurse Julie, who has moved on to bigger and better things.

[SchoolNurse91, BSN, RN]

2 minutes ago, ruby_jane said:

When I was the county health nurse a school nurse became my DOT provider and saved my bacon daily. She very calmly and practically said that since the kid was there anyway, she could take care of it. I will always think fondly of nurse Julie, who has moved on to bigger and better things.

This kiddo had a small cough and told everyone he had TB. I told him "Well, I'm calling the Health Dept.." I thought he would never fake an illness again.

Welp.. few days go by and we were having a press conference to inform the whole city he had TB. Never in my wildest dreams would have thought he actually had TB.

[JenTheSchoolRN, BSN, RN]

52 minutes ago, ruby_jane said:

Since the student is a late adolescent with a BCG and at least one documented positive test...theoretically she should have a CXR whenever she needs a TB test. Because relying on one Quantiferon test is not best practice; she was negative at that time. She's done a lot since then....

To educate myself even further, I did more research. Apparently, given that this student did have a BCG, the CDC actually recommends the Quantiferon testing.

https://www.cdc.gov/tb/topic/testing/testingbcgvaccinated.htm

Interesting.