<p>I just learned that an elderly man I visited in August is hospitalized with tuberculosis. (It is a form caled “miliary” TB.) He was feeling very unwell during our three-day visit and was coughing the whole time. We were using his kitchenware, if that matters. </p>
<p>Of course I will call my doctor first thing in the morning, but I wonder if anyone knows what to expect in terms of testing and/or possible prophylactic treatment.</p>
<p>You will get a PPD skin test.
If positive skin reaction, you will have a chest x-ray. Positive x-ray means medical treatment and testing for your contacts.
Prophylactic meds are given for positive skin test and negative x-ray. They are taken daily for 9 months.
Once you test positive, your skin test will always react, even after treatments.
Persons who were given the BCG vaccine in the past will have false positive PPD results.</p>
<p>It is my understanding that the skin test detects some sort of antibodies against TB, and once exposed (or vaccinated), a person might have a positive skin test for the rest of his/her life, which does not mean the person has an active or even latent disease. Several PCR-based tests which directly detect the bacterium’s genetic material (and can differentiate drug-resistant TBs) are in the making, but not yet approved by the FDA. Bill Gates’ foundation is sponsoring some of that work.
The good news is that TB is not that easy to catch if you are in good health. My great grandmother died of TB when she was in her early thirties, and her husband lived to be 80.
By all means do get tested, but be very careful with those prophylactic meds. Do not take them “just in case”. Ask lots of questions about their side effects, and remember that overuse of antibiotics generates drug-resistant bugs. Good luck to you, and I hope you are going to be OK.</p>
<p>See the 2005 updated [Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis](<a href=“Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis </P><P>Recommendations from the National Tuberculosis Controllers Association and CDC”>http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5415a1.htm</a>) available at
[CDC</a> NPIN - Tuberculosis (TB) - CDC Guidelines and Recommendations](<a href=“http://www.cdcnpin.org/scripts/tb/cdc.asp]CDC”>http://www.cdcnpin.org/scripts/tb/cdc.asp)</p>
<p>Several of my family members have been exposed to TB (& it showed up in their testing). They were given daily oral medications to take REGULARLY for 6 months or so. They were then re-tested & everything was fine. They now need to get periodic TB tests to show that they do not have TB, as their skin tests will never again be definitively negative.</p>
<p>I have had the same experience as HImom’s relatives. I started testing positive in the TB test after a stint in eastern Europe where it wasn’t unusual to be infected by milk from tubercular cows. </p>
<p>I took the daily pill, still test positive for TB in the skin test, but have never had it and, doctors say, am unlikely to ever get it. </p>
<p>Best advice, other than getting tested and taking the medication if it’s perscribed, is simply to take care of yourself (diet, rest, etc.) – and you’ll be just fine.</p>
<p>My DD always has a positive TB skin test. It’s just the way it is. She has never been exposed to TB unless it was at the shopping mall. She gets a chest x-ray every year or so.</p>
<p>My daughter tested positive and had to do everything mominva said. The health dept said she could have been exposed while in an airplane. I personally think it was during a trek in the Himalayas.</p>
<p>I called the county health department TB/infectious disease officer. H and I need to get the skin test in two weeks (eight weeks following exposure). I believe I had BCG as a small child, and was told I would always test positive on the skin test. The officer denied this, and said that if I test positive, I should assume infection and start treatments.</p>
<p>I challenged her about assuming infection just because antibodies are present–after all, that is the entire basis of vaccination. She said there are more precise tests but I would have to do it through my private doctor. I took this to mean that it is cheaper for the county to administer TB drugs to anyone with a positive skin test, than to do the additional testing to verify infection.</p>
<p>She also said the patient’s home health department coordinates the contact searching, and she was going to call them up to verify the case. Thanks for the replies and useful information, and I’ll post an update after the skin test.</p>
<p>My father was a state physician at AR and OR, TB Sanitoriums in the 49s-50s. We lived on the hospital grounds out in the boonies (Daniel Boone-Booneville)). I was the only one to be tested positive, but then became negative after a few years. My father never was tested positive. Today is his 89th Bday.</p>
<p>
Well, cheaper and easier, certainly. I mean, the county is concerned with keeping the county as a whole free of TB, not with what’s best for your body.</p>
<p>catbird, the comment by the county health officer that the BCG inoculation would have no effect seems weird to me. I, too, had the BCG inoculation (in England, years ago), and was also told that I would always test positive on a TB skin test subsequently. Haven’t discussed it with anyone recently except for QMP’s pediatrician, who agreed with this. I’d see your personal doctor for testing.</p>
<p>Recommendations for positive skin testing in BCG vaccinated persons --From the CDC site (2005)</p>
<p>
</p>
<p>Interpretation of tuberculin skin testing after BCG vaccination – from the CDC’s MMWR bulletin (1995).</p>
<p>
[The</a> Role of BCG Vaccine in the Prevention and Control of Tuberculosis in the United States A Joint Statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices](<a href=“http://www.cdc.gov/mmwr/preview/mmwrhtml/00041047.htm]The”>The Role of BCG Vaccine in the Prevention and Control of Tuberculosis in the United States A Joint Statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices)</p>
<p>In some ways you are lucky.
If you test positive PPD and undergo treatment for 6 to 9 months, you will NEVER get TB.
If you test positive and don’t get treatment, you will not get someone else’s TB, but if you ever become immune compromised, your own “bacteria” may reinfect you. Put simple: your own bacteria are “walled off”. The antibodies protect you against someone else, but not your own. The purpose of the “prophylactic” (not really proplylactic by definition) is that the medicine kills your own bacteria.</p>
<p>If you go into medicine, you will always get to be the one to Rx TB patients. You will not have to have yearly chest xrays or PPD tests.</p>
<p>You are thus, LUCKY.</p>
<p>HImom. You should see an Infectious Diseas doc knowledgable about TB. You do NOT need any yearly testing if you took the meds. The Univ of Arizona had a big seminar on this topic several years ago. Tucson used to be the place where most TB patients in America were sent due to the climate. It has one of the highest positive PPD ratios in the country for those who grew up there in the 50s - 60s. (ie about 50% of my high school class ('70) had positive PPDs).</p>
<p>Thanks, my$0.02, your post was very informative.</p>
<p>my$.02: thanks for a very informative post (worth more than $.02). Thanks as well, Princess’Dad.</p>
<p>Thanks for your comments. I have never been treated & just don’t have a clearly negative skin test. Two of my sisters & now my niece have tested positive & received treatment. I’ll check as to whether they continue to receive chest xrays for TB.</p>
<p>HI has one of the highest TB rates in the US, attributed to us being such an international place & having so many immigrants from all over.</p>
<p>Princess’Dad - do you mean never as in never, ever or just never as in not from this exposure (as in Hawaiian use of “never”)?</p>
<p>Cat bird,</p>
<p>There is now a blood test to test for TB infection that is not affected at all by the BCG vaccine (as you have found out, whether BCG affects PPD test is controversial). This test is not in very wide use yet, but should be available somewhere if you live in an urban area. I would ask the health department; they should know.
I would advise you to take the PPD test, and if you are positive, seek out the blood test (commonly called Quantiferon Gold). That way you can reassure yourself you are really positive.
If you are positive it is your decision whether to take treatment for latent TB; this is what they call TB that is in your body but not acitve. Latent vs. active TB are the terms.
It is said there is about a 10% chance of contacting TB over your lifetime if you have latent TB. The chance goes up considerably if you are immunocompromised in any way. The treatment is 9 months of daily pills and is considered very safe if you are a healthy person. It is not recommended for people with liver disease.
If it was me, I would take the treatment because, where I work, there are quite a few instances of people coming down with TB late in life when you would least want it; cancer patients taking chemotherapy for instance.</p>
<p>But you are very likely NOT infected. Most people who are infected have been exposed heavily and regularly for quite a while. That is why family members are the highest at risk.
Good luck, you can pm me if you wish. I’m sure you will be OK!</p>
<p>.02 and ok</p>
<p>Never means never unless you are severely immune compromised - just as you won’t get an other disease that your immune function is primed for.</p>
<p>The “latent” TB is NOT due to contacting some other person with TB – it is if you are immune compromised and your granuloma (or wall) breaks down that has walled off your own bug. That is the reason for treatment of a positive PPD - it kills off the bug within your wall. The recommended treatment time is 9 months plus/minus 3 depending upon whom you read. The 6 months is probably ok and has less liver risks.</p>