TB question

Nurses General Nursing

Published

Hey y'all. I have a quick question about Tuberculosis. I was planning on starting the CNA program this upcoming Monday and had all my paperwork/vaccines ready BUT had a major setback. I was born in Mexico so I had the TB shot and when I came to the U.S I had to get all my vaccines again. I tested positive for TB so they put me on a 9 month treatment. A nurse would come to my house everyday and give me medication. My mom kept the paperwork but fast forward 15 years and that paperwork has been lost.

When I went to get all my vaccines at the clinic, the nurse or medical assistant asked me if I had the TB shot in Mexico and I said yes. So then she was looking over at the list of requirements for the CNA program and she gave me the skin test. 2 days later I go back and she reads it as positive. Now this was already on my shot record but it wasn't signed so I don't know if that's why she went ahead and gave me the skin test. I got the X-RAY done like I was told and then another nurse/medical assistant said that I needed a liver test and treatment that lasted for 3-6 months. I told her that I had already gone through treatment as a child and she said that then it was my duty to tell the nurse that gave me the skin test because now I would need treatment all over again and the Doctor couldn't write the letter saying I was clear to start the program. I guess my question is, since I already had that treated, shouldn't I be able to start the program with the X-RAY results? I am beyond mad at the fact that the nurse didn't inform me of this before she gave me the skin test. Isn't her job to know what she is doing? I don't know if the clinic where I got treated has the paperwork as it was over 10 years ago but Imma try to see if they still have it. Thank you.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Regardless if you had TB or not, you were treated, so it essentially wipes the slate clean. You cannot use the Mantoux or the Quantiferon to diagnose active TB infection. You must go by CXR only.

Up Vote Up Vote ×

You're always going to test positive so no need to let them do a skin. Get a new doctor and tell them you had a BCG vaccine in your country and you need an Xray .

Up Vote Up Vote ×

Yes I got the CXR and it was clear. But Doctor still wants to do treatment before giving me a letter saying I am clear. Should I get a second opinion?

Up Vote Up Vote ×
Specializes in Pediatrics, Emergency, Trauma.
Yes I got the CXR and it was clear. But Doctor still wants to do treatment before giving me a letter saying I am clear. Should I get a second opinion?

I would ask why you needed treatment...was there additional blood work or testing done that indicated that you need treatment?

You still state you were treated in the past in your latest post, which means you had TB in the past;

I was thinking on doing that but on my shot record it says: "TB positive 2001" and has the clinic stamp next to it.

again, latent TB can occur in those who had TB.

ETA: This makes it more complicated...you were treated for TB, although you didn't have it?

Hello thanks for answering. Sorry I should have been more clear. I had the TB shot not the actual disease. So when they did the skin test it came back positive. I got treated just to be sure and that was done and over with.

But the nurse that was going over my chart didnt see that it had been signed by a doctor and all I needed was an X-RAY and she gave me another skin test again. So now they're saying I need treatment all over again and I was wondering if I REALLY need treatment or if I would be okay without it. Like did they trigger anything by giving me the skin test?

If you want to get a second opinion, you can, but if that physician wants to treat you, then what?

Up Vote Up Vote ×

I asked them why I needed treatment and they said because the skin test was positive. My X-RAY was clear but since I dont have the paperwork that states I was treated as a child they want to treat me. I was really young so I dont know what the treatment consisted of but this is what I know: Since I was born in a foreign country, I received the TB shot. When I arrived at the U.S they gave me a skin test, it tested positive so they gave me a 9 month treatment. But my mom lost that paperwork and the clinic where I got it doesnt have a record anymore. The reason why I'm so worried about the timing is because I wanted to start the CNA program on Monday.

Up Vote Up Vote ×
I asked them why I needed treatment and they said because the skin test was positive. My X-RAY was clear but since I dont have the paperwork that states I was treated as a child they want to treat me. I was really young so I dont know what the treatment consisted of but this is what I know: Since I was born in a foreign country, I received the TB shot. When I arrived at the U.S they gave me a skin test, it tested positive so they gave me a 9 month treatment. But my mom lost that paperwork and the clinic where I got it doesnt have a record anymore. The reason why I'm so worried about the timing is because I wanted to start the CNA program on Monday.

You can of course get a second opinion. It is not uncommon to run into problems because people do not get the vaccine in the US anymore.

I worked as a manager in the past and all the employees who had the vaccine were sent straight to chest x ray - if negative for TB no further tx needed. Perhaps the doctor is confused about what is needed or there is something on your chest x ray that needs attention. You should ask specifically and if you do not get an answer consider a second opinion.

Tb is more common again and so healthcare providers are more cautious. Having said that - a physician who reads a chest x ray should be able to give you a reason for why you would need treatment.

Up Vote Up Vote ×

This is the best answer I've received all night. You understood what I meant so thank you! I will ask them if there is anything in my X-RAY that concerns them or if they need clarification as to where I got my treatment. Thank you!

Up Vote Up Vote ×

I had a positive PPD about 24 years ago. My CXR was negative. I took INH for 6 months and was told to never have another skin test because 1) it would always show positive and 2) it could cause a serious reaction. As a teacher, I was required to have a CXR every other year. Fast forward to a few years ago when I started in healthcare. The hospital never required any thing from me other than an annual form that stated I didn't have any TB symptoms nor was I exposed to anybody with TB. I started with a different hospital last week. They drew a quantiferon test and told me it was a new requirement for 2016 for all new employees with a positive PPD.

Up Vote Up Vote ×
Specializes in Cardiology.

Hi Chana! I was born in Europe and faced a similar issue these past few years. My PPD results became more red and raised every time I got a PPD implant because of the BCG (TB) vaccine I received when I was 5. When I started nursing school, because of the PPD reading positive, I had to get an X-ray to confirm it was negative and would have to do so every year.

Now that I work in the hospital setting and occasionally have to be tested for TB because of patient contact.

But there's good news for us!

There is an alternative to the XRay and PPD to prove you are immune and not infected with TB---- the Quantiferon gold test! This is the gold standard now and usually is used for people who have received the BCG. It is expensive, so I'm not sure if your insurance would cover it but they may because of your unique background.

Up Vote Up Vote ×
Specializes in Registered Nurse.

I worked somewhere where the patient (a CNA) had the vaccine in Mexico but didn't tell me and she was grossly positive on her skin test. As I recall, the DON required her to have a chest xray and then she was able to work when it was negative. I can see having the blood test also, but that wasn't the decision at the time of the incident I am writing about.

Up Vote Up Vote ×

Get a second opinion. If your CXR is negative there is no reason to get TB treatment. I'm confused why they made you undergo treatment as a child, but if you're in an area of the country that doesn't have a lot of immigrants and is used to seeing only negative PPDs maybe they were just confused? My town is along the Mexican border so this is something we see all the time. Is the doctor that is suggesting treatment this time a primary care doc? Occ health? If your local health department has a TB clinic I would call them and maybe they can see you or even call and educate the doc, because based on what you've said there is really no reason for you to undergo treatment. So sorry you are dealing with this.

Up Vote Up Vote ×
Specializes in Med-Surg, OB, ICU, Public Health Nursing.

My ppd converted in nursing school and I was treated with INH for one year. Years later, when I needed to be cleared to visit patients in acute, employee health sent me to a pulmonogist. If you are getting a second opinion, see a pulmonologist. They can sort it out for you and you can possibly avoid unneeded treatment.

Up Vote Up Vote ×
+ Add a Comment