Positive from TB skin test...

[SteveKarlaMayer 21]

A positive PPD test, skin test, means that one has been exposed to TB and antibodies are present in their body. PPD testing can continue to be performed many times as long as they are negative but once a positive rsult is found that person will ALWAYS show positive from that point. The medically appropriate follow up to a positive PPD is a chest xray to determine if the person has an active case of TB.

With a positive PPD and a clear chest xray a precautionary course of medication can be administered. Stopping this course of treatment does not necessarily result in one developing TB but should be discussed with ones physician.

I know many health care providers that have positive PPD tests and a clear chest xray that NEVER developed TB nor are they latent carriers as latent carriers can spread the disease with out showing signs/symptoms themselves.

TB is nothing to mess with and the testing, disease, and treatment does need to be properly managed by a competent physician

As a paramedic and Bloodborne Pathogens instructor I know this situation all too well.

Hi, how can we detect if a person has a latent TB aside from PPD test? This gave me so much worry because I've been working as a caregiver in our city hospital here and I've been taking care with people with TB although that was many months ago and I did used mask to protect myself. Do you think I would be contaminated then? I'm so scared now. :-S

[Vic20r 14]

Hi, how can we detect if a person has a latent TB aside from PPD test? This gave me so much worry because I've been working as a caregiver in our city hospital here and I've been taking care with people with TB although that was many months ago and I did used mask to protect myself. Do you think I would be contaminated then? I'm so scared now. :-S

Sputum culture and X-ray is the best. We can not speculate if you are contaminated or not. Only if you submit yourself for check up then you will know if you are

[SteveKarlaMayer 21]

Sputum culture and X-ray is the best. We can not speculate if you are contaminated or not. Only if you submit yourself for check up then you will know if you are

Is it also true that if you had vaccination at young age, you'll most likely be positive in PPD test? :-S

[Vic20r 14]

Is it also true that if you had vaccination at young age, you'll most likely be positive in PPD test? :-S

Yes..most likely

[waynelaarni 2]

Positive PPD test doesnt mean that you have tb,its either you were exposed to it or you had vaccination to it,next step if you have a Positive test is chest x ray-if it shows clear no scarring that means you are ok as long as you do not have a symptom of TB. I only found out that i was positive for PPD when i was first employed here and had chest x-ray after that since then close to 7 yrs now,didnt have to do anything w TB test here at work,all i need is sign a waiver because i was already positive to PPD test.

[TBoneTX 43,194]

*** Thread moved from K-1 Process forum to Philippines regional subforum -- topic does not specifically involve the K-1 visa process. ***

[cardilene 26]

Most if not all babies when born were all given the BCG vaccine,

and that helps us fight the disease, when we grow older we are often exposed to some people

who carry the disease, and because of these most often than not, the PPD skin test

would give off a FALSE POSITIVE result, but that doesn't necessarily mean that the

person has TB, the next step of this is to undergo an XRAY to check your lungs,

if it found clear then you have no problem, what I'm curious is that how come the original poster

will undergo a 6 month treatment just after the PPD exam, it seems the OP has undergo the next procedures

just yet,.. of did he,..?

[cardilene 26]

Is it also true that if you had vaccination at young age, you'll most likely be positive in PPD test? :-S

Yes,.. its called a FALSE POSITIVE result,...

my 14 year old son had that result when we had our medicals done last March,

he underwent the XRAY, and was cleared, so off to with his immunizations

the rest is history,...

[Hank_ 9,173]

Good Day!

I am positive on TB skin test. The doctor told me that I have to undergo a medication for 6 months to prevent my tb infection to become active. But I took my medication for 2 months only and stop taking the medicines. My questions are: Since I stop my medication, does it mean that my skin test tb positive is already worse? Does my TB infection will become an active TB already? And should I go back to the doctor to ask another medication again? And should I tell the doctors in Manila that I had been positive to tb skin test and I had been treated. Should I bring the copies of the medical records about positive skin test as proof that I am already treated? Or should I just not say anything at all because I heard from others that there no problem having positive in skin test as long as my x-ray is ok?

Thank You & MABUHAY!!!

Have you been to SLEC, your timeline is blank so not sure where you are in this process.

If you were tested at SLEC they require you to get your medication from them daily and would know if you stopped and would not release your medical records. If you were doing this through you own doctor you just need to wait and see what the testing shows at SLEC.

(for those that complain about having to stay near Manila/SLEC during this time... this is why, they want to verify that you took all the medication)

[82regal 0]

I agree with Bri and Mar. It seems like there are some people here who are feeding you wrong information but what Bri and Mar said is correct. A positive skin test does not necessarily mean you have TB as I have said previously. Since your x-ray came back clear then you should be ok. You can go back to your doctor and ask for another set of medication. However, St. Lukes will not be acknowledging any of your doctor's findings. They will only care about the x-ray test that they will perform on you. St. Lukes will not perform the skin test on you. Only minors will get the skin test from st. lukes. Since I assume that you are an adult then you will undergo an x-ray examination. SPUTUM TEST will be performed by ST.LUKES and this will only be done if your x-ray came back with something unusual. Since your x-ray came back clear, you should not have to go through that. All other advice given here regarding getting sputum test regardless of your clear x-ray is laughable. It would be a waste of time and money since there is no use for it and since St. Luke's will not even honor that sputum test. If I were you, I would wait to see what St. Luke's have to say.

Best of luck to you and I hope you get better information from people who actually know what theyre talking about.

P.S. All the information you need have already been said in this topic.

[82regal 0]

you are correct sir or madam it dont matter if you have a primary doctor only st. lukes matters they are the ones who have the final decision to pass you or not, to the original poster just do what st. lukes says there is no other way around this i am going threw this right now with my fiance

[Mayang M 0]

Well, St. Lukes will take xrays. If they find anything, which they will since he had TB apparently, your son will be subject to a sputum test. You will have to wait at least 2 months for the results to come in. I hope that everything works out. Are you sure he did contract TB? or was it just a positive skin test? Please explain the situation a little bit further.

Thank you. My son's case was a primary complex cause he was just a yr old then, it was treated though, however you mentioned that St Luke won't consider outside test or findings other than the test they are going to do....would this mean we have to wait for 2-3 months and re schedule our interview date if we already have?And so the request for expedite would also be of no use..;(

[ca_babe 129]

Thank you. My son's case was a primary complex cause he was just a yr old then, it was treated though, however you mentioned that St Luke won't consider outside test or findings other than the test they are going to do....would this mean we have to wait for 2-3 months and re schedule our interview date if we already have?And so the request for expedite would also be of no use..;(

Where are you in the process right now? Your timeline is blank. If SLEC does require the sputum test then yes, you have to wait for 2-month sputum culture result to find out if he's cleared or not and you won't be able to go to the interview either even if they have approved your expedited processing request. My case has been approved for expedited processing as well and I was told that my mom can go to the interview anytime. However, she had to undergo the sputum test so we have to wait for the results then. I am annoyed because I want her to be here before I give birth but now, she won't be here until after I give birth because of her medical. However, it's more important to me that she's healthy and she gets treated right away if her culture turns out positive. Immigration only comes after her health and the health of those she's around.

[Juliet and Steve 93]

Let’s start from the top. Warning: I am long-winded and I give you permission to ignore this whole monologue—you are warned.

A tuberculosis test commonly done and most pertinent here is the Mantoux skin test. It is also called PPD (purified protein derivitative), TST (tuberculin skin test) and Pirquet test.

This test is done by injecting a tiny amount of purified protein derivative also called tuberculin just under the top layer of the skin, usually on the forearm creating a tiny “bleb” or bump. The tester measures the bump and notes it. The testee must return within a certain amount of time (minimum 48 hours, maximum 72 hours). The tester then measures induration. Induration refers to tissue that turns somewhat firm or hard, it does not relate to redness. A positive test is usually an area of induration that exceeds a certain size usually 4 millimeters. For a person on drugs that affect immune response the minimum size will be smaller than that on a person whose immune system is not compromised.

Note: You cannot get TB from tuberculin or the TST.

When a person’s induration exceeds the minimum they are said to have a positive test, though to the person it may not feel positive about the result at all. About 15 of the 350 million American will show a + TST.

Now why would a person have a positive response? Let’s take 1000 people with a positive TST. Depending upon where the 1000 grew up we can divide them into two groups.

One group will be those who were vaccinated with BCG as a child.

In some countries where TB is common a vaccine called BCG, or bacille Calmette-Guérin vaccine is commonly given to children to prevent miliary TB and meningeal TB (miliary is disseminated TB in various sites in the body but not the lungs, meningeal is TB of part of the brain). In other countries this vaccine is not given for various reasons. In the US TB is quite rare and the powers that be have decided that the vaccine may actually create more problems than cures. This being said, in fact, in the US, some children (and adults) are recommended to have the BCG vaccine. Children with a mother or father who has active tuberculosis that is in the process of being treated may fall into that category. Another category can be health care workers or people that are exposed to numerous individuals who are known to have active Mycobacterium tuberculosis strains resistant to both isoniazid and rifampin, which are the two 1st line treatment drugs.

What does a positive TST for a person who had the BCG mean? Well, usually it means that they have been vaccinated and do not have TB. But they could have TB. One reason that BCG is not commonly used in the US is that the vaccine which prevents miliary and meningial TB doesn’t always protect against pulmonary (bronchii, lungs, etc). So in this case the test does not tell us if the person has TB or not. Therefore they are labeled as LTBI (Latent Tuberculosis Infection). They may or may not have TB, we do not know.

The word “latent” might better be replaced with the word “possible.” Latent, using the definition from thefreedictionary.com is: “1. Present or potential but not evident or active.” Since we do not know if a BCG vaccinated person is simply reacting to the vaccine or may be reacting to active TB we must assume that infection might be present.

Let’s look at group 2. This group was likely exposed to the TB bacteria at sometime in their life.

Many think that it’s real easy to get TB if you are exposed to an infective person when in fact, it’s not particularly easy.

Let’s back up a bit and look at TB. Let’s consider cats for instance. Cats are harmless, correct? Well, one might pet a tabby cat but might be advised against petting a leopard or lion. The tabby cat might scratch you, but the lion might take your arm off.

Most TB is readily curable. All TB is curable, but we may need to remove the word “readily.” A nine month regime of the medication isoniazid cures most TB—but not all. It seems that throughout the world for various reasons person placed on isoniazid were not prescribed enough medication for a proper duration of treatment. And then there were people who thought “I feel fine, why should I continue taking this nasty stuff? “ Mycobacterium tuberculosis bacteria can be tough and so the weaklings got killed off and the strong ones over time learned to resist isoniazid. Now we have isoniazid resistant M tuberculosis. For these people we now need to add a second medication, usually rifampin.

But over time those on isoniazid + rifampin for various reasons did not complete the treatment, or the treatment was not long enough, and eventually (resistance does not necessarily start with just one person, it may take many thousands of people to create a resistant strain—but then this strain may spread and eventually infect many) we now have isoniazid + rifampin resistance. Now we have the “lion” in the room known as multi-drug resistant TB. (MDR TB)

One reason TB is so important is that if MDR TB is bad, there is a worse monster called XDR TB or Extensively Drug Resistant TB which is resistant to isoniazid + rifampin + a fluoroquinilon antibiotic + at least one of three other drugs. When you hear about people being arrested, it is likely that the person is infected with XDR TB. They are, in effect, walking bombs, because it is extremely difficult to cure them or any that they may infect. Let them walk about untreated and you’ll eventually have others with XDR TB. XDR TB is very, very difficult and very expensive to cure. XDR TB is very rare so I won’t say much more about it but I’ll use it to explain something else.

It’s easy to become infected with TB if you kiss, or share a toothbrush with, or are in the room if they cough right?

If you said yes you are not alone, but you are misinformed. It’s not that easy to become infected.

TB is spread by tiny airborne droplets inhaled. When a person coughs or sneezes minute droplets form which travel generally several feet and no farther. Therefore to become infected one must be in close proximity to an infected person who is coughing, sneezing, singing or creating tiny droplets for several hours.

Yes, if you inhale a few M. tuberculosis bacteria you are unlikely to become infected because your immune system can fight and destroy them. But what if you sit next to someone on an airplane who is coughing and who has, let’s say the dreaded XDR TB? Scary thought and indeed recently an international traveler arriving in America was discovered to be XDR TB +. Upon discovery the manifest of the plane he was on was identified. The seats within 5’ were identified, and public health then contacted and required mandatory testing and observation of those within that zone. End result recently publicized by CDC (Center for Disease Control) was nobody was infected.

So it takes repeated close exposures to infect a person. But it does not take repeated exposures to create antibodies and that is what the TST looks at. So if you were a child and your grandparent had active TB and you visited him or her and were exposed, and your body killed the bacteria, you are not infected but your body “remembers” the bacteria and it is this memory that is activated by the tuberculin (purified protein derivative) and reacts to it with a + TST, but you are no longer infected or infective.

So now we have five groups.

Group 1: Those who received the BCG vaccine and do not have any live bacteria in them.

Group 2: Those who received the BCG and at some point developed active pulmonary or extrapulmonary (we’ll get back to this word later) TB and killed it. These do not have TB but test positive.

Group 3: Those who received the BCG vaccine and developed active TB and still have it.

Group 4: Those who did not receive the vaccine but were exposed to TB and whose body killed it.

Group 5: Those who did not receive the vaccine but were exposed to TB and still have active bacteria within them with or without symptoms.

So you see a problem here. Regardless of the group that a person who test + is in, in reality you do not know if you are positive or not so for most of these any medical practitioner will usually recommend a nine month treatment with isoniazid. It’s simple—if you are infected you have a 99%+ chance of being cured. If you are not, it’s no big deal. Yes these are potent antibiotics but for most the inconvenience and mild to moderate adverse effects are worth making sure that you never have active TB.

Why is the radiograph (x-ray picture) so important? Simply because most TB is located within the airways (pulmonary) and TB usually creates distinctive scarring that shows up from the x-rays.

Now, if you have a positive TST and a positive radiograph is your goose cooked? Nope. Many, if not most of these case will result in the bacteria being destroyed by the body though leaving a scar visible on the radiograp. But in some cases the body only manages to hold the disease in check with little or no symptoms and that person when they sing or yell, or cough can spread the disease.

So if you have a + TST they do the radiograph (x-ray). If the radiograph shows nothing suggestive you should be good to go. You will likely be offered a 9 month treatment but I do not believe that you will be required to take this. But if the radiograph shows suggestive symptoms then you will have to do the three sputum samples. This breaks into two paths: + sputum or (-) sputum.

If negative by microscopy or positive my microscopy the sputum samples are cultured for 6 weeks, results defined within 8 weeks.

If positive either immediately under a microscope or after the 6 weeks incubation, you are actively infected with TB. You have a problem and will be directed as to how to deal with it. If the sputum is + it will be cultured and challenged with antibiotics to define its level of resistance, if any. This is done by taking a petri dish and culturing the + bacteria that was grown from your sputum. Then a number of small disks are laid upon the cultured bacteria. If after a day or so a ring appears around a disk extending a certain number of millimeters then your strain of M. tuberculosis is killed by that medication. Hopefully all the disks show that they effectively kill the surrounding bacteria. If not then you are resistant but it would be extremely rare to show resistance to all the disks. Based upon this testing your medical practitioner will prescribe what medication you need and for how long.

If your sputum microscopy and 6 week culture is defined as negative you still may be offered the 6 months of isoniazid but you are not forced to take it. You will still be labeled as LTBI but you may travel to America.

People have focused on radiograph identification and sputum results, and it has been incorrectly said that if you are LTBI then you have sleeping bacteria but this is not necessarily so. You “might” have sleeping bacteria, or you might not. LTBI does NOT mean you are either infected or infective but you might be or might become so later or might have no live M. tuberculosis in your body to ever become active.

In reality most here have ignored that in fact radiographs and sputum samples are not the only things looked at. And TB does not need to be confined to the lungs. Extrapulmonary TB exists and can affect the kidneys,the mandible (jaw), the inner ear, the skin, the genito-urinary system, and skeletal system. When you fill out your questionnaire be assured that the reviewer looks for clues of any disease which includes possible extrapulmonary TB. When they do the physical and palpate areas they will be looking for suggestion of TB know as lymphadenitis which can be TB of the lymph nodes. So there is much more investigative work done than simply the TST and the radiograph.

Realize too that RP (Republic of Philippines) is one of the countries where the TB incidence is greater than 20 cases per 100,000 people. Therefore testing is different related to immigration as it is in another country such as Norway which has a TB rate of less than 20/100,000.

In such countries here is the flow charts:

Applicant age 2-14 years of age:

Medical History + Physical Exam + TST

If TST shows induration >10mm then chest x-ray then (See ****)

If Applicant age 25 or more:

Medical History + Physical Exam + chest x-ray then

****(both 2-14 and age 15+)

If x-ray is suggestive then 3 sputum smears and cultures

If smear and/or culture is + then drug susceptibility testing is done.

For the OP. You did not complete your 6 months of isoniazid, ok, you and probably a million others. If your radiograph is negative that will probably end it. If + then you’ll do the cultures.

I suggest that you be open and truthful. And no matter what it’s a process that usually is not so difficult to get through. The public health system will be supportive.

[Hank_ 9,173]

If anyone read all of that - take two aspirin and schedule a weekend of drinking...