TB test- not sure what to do?? Help!

GingerSue · Sep 28, 2007

this is from my drug book:

False-positive reactions may occur with infections caused by nontuberculous strains of mycobacteria or a previous intradermal injection of bacillus Calmette-Guerin, a live attenuated strain derived from Mycobacterium bovis. Large areas of induration (>20 mm) are unlikely to result from BCG.

(positive reactions differ according to the amount of induration - a nodule or area of hardened tissue, not to be confused with the area of redness, which may be larger than the area of induration).

From Lewis:

determine the area of induration in millimetres - red, flat areas are not measured

In Canada, 10 mm is the standard measurement that determines whether tuberculosis is present.

A positive result indicates that the client has been exposed to the antigen. It does not indicate that disease is currently present.

oneLoneNurse · Sep 28, 2007

You need to relax.

twrn03 · Sep 28, 2007

Since your chest xray was negative then it means that you were only exposed to someone who actually had the tb disease. Meaning that you do not have the disease but you have the infection. If you had the disease then your chest xray would have shown some changes with your lungs. To make it simple, you inhaled the tb germs from a person with the disease. You were probaly around this person for some time. Having the infection means that you have the choice to take the treatment to prevent you from breaking down with the disease later in life or if you get sick with something else. The germs are "sleeping" right now. The treatment is usually a drug name isoniazide (INH) (I hope I spelled it correctly) and is taken from 6 months to 1 year. You will not be able to drink alcohol because the drug has an effect on your liver enzymes and so does alcohol. It is beneficial to take because it will kill off the germs. The longer its taken the better chance it has of killing all of the germs. The drug do have some side effects but you can take vit b6 to help ward off some of the effects. And if you do decide the treatment, you should have labwork done every month to check your liver enzymes.

No matter what you decide to do-do not take another tb skin test. It will always be positive and the bump sometimes gets bigger.

Just curious though-you said that the ones reading said that it looked positive-did they measure it? It should have been measured and if it was 10 or greater-its positive. The induration (bump) should have been measured and not the redness.

Even if it is some other non tb strain-most often the chest xray would have still shown some sort of changes. And BCG is not given in the United States and even if you did have BCG it would be out of your system because I believe they give to a babies or children in another country. It would be long gone out of a person's system because it doesn't last long.

I hope that this helped you. I worked in a TB clinic before. You can also find more information on the CDC website www.cdc.gov. It has all the information you wanted to know about tb but were afraid to ask.

Also no matter what you choose to do, you should have a chest xray every year. It could show if you are breaking down with the disease. There is a slight chance that even though you take the preventive treatment (INH), you could still break down with the disease. But also since you are in nursing then your job would require a tb skin test yearly or chest xray if you were ever positive.

Oh by the way, you are not contagious so you should be able to continue with your classes. You will not be able to give anyone the TB disease because you do not have it. People with the disease can spread it and have to stay inside until they complete 14 days of the medication-which is given to them by the health dept nurse or personnel or cdc (depends on the state rules)- it is called DOT or directly observed therapy.

You would have to check with your school to see what they require. They may require that you take the preventive treatment (INH).

Just a little more tidbit- If visiting someone that is sick or coughing up blood or anything- talk to them outside in the sunlight because sunlight kills the TB germs. Stay out of closed quarters that are not well ventilated. And everyone knows about the covering of mouth when coughing or sneezing.

DudeNurseRN · Sep 28, 2007

Hi everyone! I read a few other posts about the TB test and did not see any that fit my situation so I thought I'd post and get your response ( I always get great feedback here)! :)
Here's the scoop: I am in my 2nd semester in RN school and doing very, very well. I had all the pre-clincial stuff done the 1st semester and my PPD test came back "ify" but the nurse passed me.
I had my second PPD done for this new school year and now when the nurse read it, she said it was positive. She had two doctors look at it in the clinic and they too said they thought it was postive. My doc. scheduled a chest Xray and it came back negative. Now what???
Clinicals are supposed to start Tues. and the hospital I am going to wants us to sign paperwork in reference to the TB test and exposure. Do they keep you out of nursing school for that?? I am going to see if I can have a blood test done (I think it starts with a Q- but not sure of the name) to see if I am really positive OR if it was a false positive. I have VERY SENSITIVE skin and get rashes even from hand creme and band-aids. So how knows... may have just been a skin irritation, but there is a little swelling under the skin and it is a bit red. Someone posted on another post that if you are postive and get the PPD test, it is actually bad for you. Anyone know anything about that?? Why it's bad?? I have felt really dizzy and weak today- felt like the pits and couldn't even drive.
Thanks all!! E

I doubt very much that you have TB as TB is somewhat hard to aquire unless you have a family member that you live with who has it. The test are only able to tell if you have been possibly exposed to TB, this is the definition of a positive test. I believe the xray confirms if you have active TB. A negative sign to me would mean you don't have active TB.

As far as keeping you out of the nursing program. Sounds like they are doing things by the books testing with you. The xray if I remember protocol correctly is stating that you are Negative for TB and are okay to go to work/school. Even on the chance you had TB, you'd get ABX have to take them for many moons, but you'd get better and life would go on.

My experience with positive skin reactions has been this. I had a friend when I was in NA school who had a positive skin reaction, went had the xray, which came out negative, she showed this information to the school, went through school with me, and now had a job as an NA.

I could tell you not to worry, but that wouldn't help, and wouldn't be productive. So I WILL tell you to call you school, specifically the nursing department, which I am sure has delt with this before, to hear it "directly from the horse's mouth", that everything is okay for you to go to clinicals.

sheri_w · Sep 28, 2007

When I first started my job (25yrs ago) they used the tine tests, I never had any kind of reaction. The first year they switched to the PPD, I had a huge flaming reaction. Apparently must have been allergic to something in the vaccine. They put me down as neg since I had never reacted before. The reaction has gotten smaller each year.

snowfreeze, BSN, RN · Sep 28, 2007

Your positive reaction is due to an immune response from the injection. You have antibodies in your body to the TB tine test. You don't have TB, you may have been exposed at one time, you never had TB as your chest x-ray was negative. Many people in the health care industry test positive but have negative chest x-rays and continue to work without restrictions. You need to always state that you had tested positive and need a chest x-ray for your test instead of the injection.

suzanne4, RN · Sep 28, 2007

There is no blood test that you can have done that tests for TB. Mantoux tests that are positive just mean that you have developed antibodies after being in contact with someone that has had the disease. That is why a CXR is done to verify if you truly have it or not.

And if truly worried, then the AFB is done and that is is done of sputum, preferred a fresh specimen in the morning.

Having a positive TB skin test does not keep one from working in a hospital, nor from attending school. This is something that you may wish to discuss with your primary physician or an infectious disease specialist, some may want you to go ahead and get treated for it with pills for about six months, but this does not mean that you are infected and can spread it.

Best of luck to you.

leslymill · Sep 28, 2007

My first year out of nursing school, I tested positive. Once positive always positive. Used to have a chest x-ray every year, now it is every two years to limit radiation exposure. Took INH and Rifampin for about 3 weeks and developed an allergic rash back in 1981. Chest x ray has always been negative. Not stress yourself. Ton's of people can't take the skin test.

sharona97, BSN, RN · Sep 28, 2007

When I first started my job (25yrs ago) they used the tine tests, I never had any kind of reaction. The first year they switched to the PPD, I had a huge flaming reaction. Apparently must have been allergic to something in the vaccine. They put me down as neg since I had never reacted before. The reaction has gotten smaller each year.

Isn't their thimersol in the PPD, that can bring on skin sensativitiesthat make a ppd appear reactive, red but no nodule indicates a normal read?

justme1972 · Sep 28, 2007

At my school if you have a positive skin test, you are required to have a negative chest X-ray.

BugsRme · Sep 28, 2007

Infection Control RN here. A previous poster gave a wonderful outline of TB infection versus active, contageous TB disease. There is a releitvely new blood test out called the Quantiferon Gold. In the CDC's most recent guidelines for TB prevention the Quantiferon Gold was suggested as good was to see if the PPD positive was a true positive for Mycobacterium Tuberculosis.

Consider getting the Quantiferon Gold blood test done and if it indicates you may have been exposed to Mycobacterium Tuberculosis, you will want to consult with your doc or aTB clinic for advice.

A positive PPD with a negative chest film should not hold you out of clinicals. Good Luck!