> False Positive or Inactive Infected (Carrier)?

[shaffja]

Two weeks ago my wife tested positive for Tb (the test required for her employment)...

 

I was very confused because she had passed her physical to come to the US only 3 months prior and I had the understanding that she had had a vaccine when she was a teenager. So I did some research and found out that the BCG vaccine often used in the past in China can cause a false positive reading. So we go to the doctor today and take the chest X-ray. He tells us that she has inactive TB. I mention BCG, but he say the 18mm reaction to the Tb test is too big to be a false positive from the BCG!! So, he suggest she begins a regimen of INH (isoniazid). One pill per day for 9 months!

I don't know what to do!? All medications have side effects and this one has a medication induced hepatitis as a side effect. However, the doctor said most likely this Hep is reversable and they would do a liver panel every month.

I don't want to be in denial and put my wife at risk for active Tb some day, but at the same time I don't want to put my wife at risk by taking the medications for 9 months and getting a form of hepatitis and who knows what other side effect either!

 

Does anyone else have any experience with this?

 

 

Help please.

[Kalli and Greg Oveson]

Two weeks ago my wife tested positive for Tb (the test required for her employment)...

 

I was very confused because she had passed her physical to come to the US only 3 months prior and I had the understanding that she had had a vaccine when she was a teenager.  So I did some research and found out that the BCG vaccine often used in the past in China can cause a false positive reading.  So we go to the doctor today and take the chest X-ray.  He tells us that she has inactive TB.  I mention BCG, but he say the 18mm reaction to the Tb test is too big to be a false positive from the BCG!!  So, he suggest she  begins a regimen of INH (isoniazid).  One pill per day for 9 months! 

I don't know what to do!?  All medications have side effects and this one has a medication induced hepatitis as a side effect.  However, the doctor said most likely this Hep is reversable and they would do a liver panel every month.

I don't want to be in denial and put my wife at risk for active Tb some day, but at the same time I don't want to put my wife at risk by taking the medications for 9 months and getting a form of hepatitis and who knows what other side effect either!

 

Does anyone else have any experience with this?

 

 

Help please.

230606[/snapback]

I have no answer for you, but the prudent thing would seem to be a second opinion from another doctor.

[Randy W]

I think this has happened before - hopefully someone will be along with a link for you. It WAS a false positive, if I remember correctly.

 

Here's an article to read about the BCG vaccination and false positives

Edited July 13, 2006 by Randy W (see edit history)

[woainilin]

Two weeks ago my wife tested positive for Tb (the test required for her employment)...

 

I was very confused because she had passed her physical to come to the US only 3 months prior and I had the understanding that she had had a vaccine when she was a teenager.  So I did some research and found out that the BCG vaccine often used in the past in China can cause a false positive reading.  So we go to the doctor today and take the chest X-ray.  He tells us that she has inactive TB.  I mention BCG, but he say the 18mm reaction to the Tb test is too big to be a false positive from the BCG!!  So, he suggest she  begins a regimen of INH (isoniazid).  One pill per day for 9 months! 

I don't know what to do!?  All medications have side effects and this one has a medication induced hepatitis as a side effect.  However, the doctor said most likely this Hep is reversable and they would do a liver panel every month.

I don't want to be in denial and put my wife at risk for active Tb some day, but at the same time I don't want to put my wife at risk by taking the medications for 9 months and getting a form of hepatitis and who knows what other side effect either!

 

Does anyone else have any experience with this?

 

 

Help please.

230606[/snapback]

Sorry this happened to you and your wife. I do not have an answer but wish you the very best. I hope there is a easy risk free solution.

[LeeFisher3]

You might want to take a look at this CDC Fact Sheet BCG Vaccine.

 

Testing for TB in BCG-Vaccinated Persons

Many foreign-born persons have been BCG-vaccinated. BCG vaccination may cause a positive reaction to the tuberculin skin test (TST), which may complicate decisions about prescribing treatment. Despite this potential for BCG to interfere with test results, the TST and the QuantiFERON®-TB Gold test (QFT-G) are not contraindicated for persons who have been vaccinated with BCG. The presence or size of a TST reaction in these persons does not predict whether BCG will provide any protection against TB disease. Furthermore, the size of a TST reaction in a BCG-vaccinated person is not a factor in determining whether the reaction is caused by LTBI or the prior BCG vaccination

 

 

Texas Dept Health Services

BCG-vaccinated persons who have a positive reaction to the tuberculin skin test, but who do not have TB disease, should be evaluated for treatment of latent TB infection. The possibility of TB disease should be considered for BCG-vaccinated persons who have symptoms suggestive of TB.

[Dean Hall]

I had the exact same situation with my (step) son. His first tb test was required for school entrance. This showed a false positive which then required a chest xray. The doctor then prescribed the treatment with monthly liver biopsys for 9 months.

 

I did not feel that this was justified.

 

A second, and much older doctor did the immigration interview, determined that the skin test would not be reliable, and went directly to the xray.

Second opinion - no further action necessary.

 

Bear in mind that these are all personal decisions and responsibilitys.

 

 

Dean

[LeeFisher3]

Stopped by the local health department today and got the basic runaround concernng TB, they provided me a link to the New England Journal of Medicine which turned up the QuantiFERON®-TB Gold Test. I would personally print out this link and demand this test prior to any treatment to prevent unneeded treatment from the doctor.

 

Transmission of Mycobacterium tuberculosis from Health Care Workers.

 

Thus, previous BCG vaccination should generally not influence the interpretation of a tuberculin skin test in persons who were vaccinated more than 10 years earlier. However, foreign-born health care workers frequently attribute positive skin tests to BCG vaccination and are less likely to recommend isoniazid for themselves or for members of their family than for others.

 

The tuberculin skin test has low specificity, but there are newer tests that are more specific for M. tuberculosis. These tests include whole-blood assays that detect the release of interferon gamma by cells incubated ex vivo with M. tuberculosis peptides or proteins. In May 2005, one such assay, the QuantiFeron-TB Gold (QFT-G) test, was approved by the Food and Drug Administration for the diagnosis of latent M. tuberculosis infection. This assay uses, as the stimulating antigens, synthetic peptides based on two proteins that are secreted by all strains of M. tuberculosis and pathogenic strains of M. bovis (early secretory antigenic target 6 and culture filtrate protein 10) but that are absent from BCG vaccine strains and most nontuberculous mycobacteria.

[shaffja]

Thank you so much for this information. I am very surprised that there is not more people inquiring about this on CFL.

 

I have a doctor from the local health department suggesting the 9 month pill a day treatment. This is not a cure, but supposedly decreases the chances from the TB going active from 1 in 10 to 1 in 1000.

 

Call me paranoid, but I am worried this doctor is being recruited by a drug company to find people to use in studies (maybe by the drug manufacturers). I asked about alternate drugs and he blew me off. He did the same this when I asked about a more definative test. He didn't even mention the QuantiFERON®-TB Gold Test.

 

My wife's step mother is a doctor in China and she told her not to take the medication.

 

I am going to contact the CDC and also get more information about her getting the QuantiFERON®-TB Gold Test and go from there.

 

Anyone else out there with more info?

[MikeandRong]

I don't know how this works in your area, but could you just go to a different doctor, even if it were in a far away different town? I know some companies require you to go only to the assigned/contracted doctor, and this may be the case for conditional employement. If I were in your shoes, I for sure would go somewhere else. Perhaps to a large city, espically if it were to have a teaching hospital there. They are for the most part, up to date on all the new drugs and techniques, and would jump at the chance to rule over this tunnel vision doctor you are seeing now.

[obxtrainman]

I don't know how this works in your area, but could you just go to a different doctor, even if it were in a far away different town? I know some companies require you to go only to the assigned/contracted doctor, and this may be the case for conditional employement. If I were in your shoes, I for sure would go somewhere else. Perhaps to a large city, espically if it were to have a teaching hospital there. They are for the most part, up to date on all the new drugs and techniques, and would jump at the chance to rule over this tunnel vision doctor you are seeing now.

231500[/snapback]

I believe Charleston is the capital of West Virginia. The medical facilities there are some of the best I've ever been to. They managed to keep me alive after a drunken woman hit me head on going over 100 MPH. The hospitals there are connected to the universities. After having been in these facilities, I have never felt comfortable about others. I still to this day look at the floors, and cracks and crevices every time I visit a hospital, or Dr's. office. The filth in these places are staggering as compared to the different hospitals in the Charleston area.