TB question

[tiny_dancer]

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.

[morman]

Ouch. A lot of misinformation here.

A BCG in infancy, or even when given to an adult, does not guarantee a positive Mantoux test. Skin reactivity is variable and wanes with time. The only time that a person is not tested is when there has been a documented positive reaction. In our region, that is considered to be > 5 - 10 mm induration, depending on the age.

A positive skin test or IGRA serum assay only indicates the development of antibodies after exposure to TB without classification as either latent or active. A CXR can certainly strongly indicate primary pulmonary TB but has no relevance in extrapulmonary TB. Either way, it is non-diagnostic. The only way to confirm TB is by a positive AFB culture sample from sputum or other bodily fluid or tissue.

You say that you had nine months treatment as a child in the US without regularly scheduled followup. I would guess therefore that you had received LTBI prophylaxis. Since you have already completed the medication regime, there is absolutely no need to repeat it. Unless...

Is there a possibility that you now have developed active TB? I don't know how you would have any doubts if that is true though.

[TriciaJ, RN]

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?

Yes. My understanding was that the quantiferon gold could distinguish between actual TB exposure and BCG vaccination. It does not sound like you have ever had active or latent TB. You might want to talk to your local public health department and see if they can offer any help getting your records straightened out so you don't have to keep dealing with this.

[DEgalRN]

TB is such a weird disease. One you have a positive TST you always have a positive TST even after being treated for LTBI or active TB. The BCG vaccine can cause false positive skin reactions, but generally speaking that isn't a contraindication for getting a skin test. The fact that you tested positive in youth doesn't mean that you weren't exposed and had LTBI, but there is the risk that you were treated on a false positive. You could get the QFT or T-spot, and if it were negative, you could go on your way and assume that your initial TST was due to the BCG vaccine, and from now on get TB blood tests. If it's positive, it doesn't tell us anything new though, since you have a positive TST.

Have you had any new risk factors? Have you traveled to any high-risk countries? Have you been around anyone with active TB?

As long as you have a clear chest x-ray, there really should be no reason you can't start. Now, there policy may be that any person with LTBI be treated and you cannot work/take classes until you are, and since you don't have proof of previous treatment, you fall into that category.

And that's the question, are they following policy that any positive reaction must be treated? It's archaic and based on a lack of knowledge but we don't really have good testing/retesting options for TB especially since you can be re-exposed.

[morman]

Ah, but OP said that they were given 9 months of Directly Observed Therapy so it must have been deemed either latent or active TB, not just a positive Mantoux.

And does not the States have a central Public Health Department or CDC which oversees the policies and guidelines?

[BeckyRN75]

Since you were under directly observed therapy, the health department that performed it should still have a record of it, especially since pediatric records have such a long retention requirement. I agree with getting a QFT test and a pulmonologist or infectious disease doc's written opinion to present to your employer.

[Halonzo7]

The treatment can actually give you hepatitis (not the viral kind), it's one of the risks of the treatment. Please don't get treated twice, a cxr would be the only appropriate measure in Your situation to rule out active TB. I'm assuming you were given prophylactic tb treatment in the past due to exposure.