Exposion to tuberculosis

[IKAP]

Hello,

My son who is 10 year old just had the PPD test and we were told that it’s positive measuring 15-16mm. The doctor requested the chest X-Ray which came back normal. My son had 2 PPD tests in the past that were negative. The doctor said to repeat the PPD in 3 months and if it’s still positive my son will be prescribed antibiotics. I can’t even imagine where he’s gotten it from as we live a very healthy life in Los Angeles. I took my son for the second opinion and that doctor said that he doesn’t even need to repeat the skin test in 3 months and should start taking Isoniazid right away for 9 months. Now I’m stuck with two different opinions. I’d really appreciate if you could answer a few questions for me. 1) Should I follow the first doctor’s advice and repeat the PPD? This is what I’d feel more comfortable with because I really want to get the confirmation that the first PPD was ACCURATE (what if it was false positive??) since I still can’t believe in it. My son feels just fine, Thank God! IS THERE a RISK in repeating the PPD when there was a reaction to it before? I keep thinking what if the test wasn’t accurate and I put my 10-year-old on the medicine for 9 months just for nothing! This medicine has its own side effects as far as I know. 2) Have you heard of the QuantiFeron-TB test? 3) If he will take antibiotics how will we know that the treatment was successful at the end? I haven’t heard of any tests that confirm it. If so, how can we tell that the bacteria is gone?
Thank you in advance, Inna

[National Jewish]

A PPD that resulted in 15 to 16 mm of swelling called induration, virtually all authorities would call this “positive.”  In the majority of cases this means Mycobacterium tuberculosis (TB) “infection”, not necessarily “disease”.  Living in Southern California there is a small but real risk that he may have been exposed to someone with communicable TB.  However, it is also possible he has been infected with a different species of mycobacterium, one that is found in the environment, such as Mycobacterium avium.  The environmental mycobacteria rarely cause disease in healthy people.

If the PPD reaction is due to TB exposure, the proper thing to do is to take preventive treatment, such as the Isoniazid for 9 months.  If the reaction is due to environmental mycobacteria (EM), then no action is required.

The Quantiferon (QFN) test is more specific for TB, so it reacts less to the other species.  If you could get it done, I think it would be helpful.

If you cannot get the QFN done, you could repeat the PPD.  If it is receding in size that would be suggestive of EM and would be watched over time.  If it remains questionable, preventive treatment might be your best bet.

[wntinfo]

Hi,

Even the same thing happened for one of my relative, He stayed in a v neat & clean place and never even had any symptoms of TB. During his routine medical check up he was diagnosed for TB, the chest x-ray showed the signs of TB. Whole family was wonderstruck as to how did he & where from he got infected.. God knows still a mystery !!

Ever since hes undergoing treatment and his body is reponding v well for the antibiotics. He has signs of v gud resolution of the xray.

I wanted to know how long will it usually take to get a clean xray report, hes been asked to take medicines for 6months and has completed 1month with gud signs of improvment..
Is it advisable to take xray every month. will it cause overexposure to xrays and hv any impact in future.. Plz advice experts.

[caregiver222]

It is unnecessary to get an x-ray every month and yes, it involves unnecessary radiation exposure. There is no safe threshold of exposure. You will find a different opinion from radiologists, but they are wrong. This is not to say you should never get an x-ray. If in fact, your son has been exposed to TB, he will never be free of the disease. It encapsulates and remains dormant. That is the best you can do. TB is a vicious disease that does not necessarily reside in the lung, contrary to popular belief. The resurgance is due in large part to undocumented illegal aliens. On the positive side, during the 1920's, virtually 100 percent of health care workers tested positive for TB, and dormant TB is exactly that. Assuming your son maintains a healthy immune system he may never again have a flare up.

[IKAP]

Thank you for the replies!
So far I can't find the lab that does QuantiFeron test. Also they say that there is no studies that test would be accurate for children. I guess we will do a repeat PPD. i just hope my son won't get even worse reaction to it.

I have a question to Caregiver222. You said: "If in fact, your son has been exposed to TB, he will never be free of the disease." I was told that taking the Isoniazid should kill any dormant TB. Isn't it true?
Thanks!