Positive PPD

[manfred11]

As a part of regular medical examination for renew my job contract I had the PPD test too and it was positive.
I need to stress that I am originally from country in which BCG vaccination is obligated and now I work in any other country where there is not BCG vaccination.
I am curious about this finding because a nurse measured both induration and erithema and it was 15 mm. I think that induration was not larger than 10 mm, but anyway it is abnormal finding according to some criteria (e.g. those in the US).
I would like to emphasize that I received BCG vaccine as a infant, but I am not sure if I received still additional dose of this vaccine.  However, my previous PPD test which was done two years ago was negative - induration was about 6-7 mm, but it is negative according to criteria in my country.
I don't have any symptoms and I feel entirely healthy. I am 37 years old.  
Afterwards it was done the chest X-ray too and this finding is very confusing to me.
Radiologist described "two very small nodules (diametar about 3 mm)with unclear significance in the right upper lobus." There are not any other pathological changes on the X-ray.
I don't know if my finding could be interpret as a normal finding because I followed BCG vaccination or it is maybe PPD conversion due to an occasional contacts with people who have active tuberculosis.
I heard that latent mycobacterial infection is now very modern diagnosis in pulmology. If it would be my diagnosis, could you tell me whether this diagnosis can interfere with my work ability.

[National Jewish]

TB control policies for health care workers in the US have generally inferred that a positive PPD in an adult who received BCG in their youth is due to intercurrent TB infection and not due to the BCG.  This is based on the fact that most people who were given BCG as a child no longer react to the PPD by the time they are 37 years old.  Also, we do not believe that childhood BCG protects against the development of pulmonary TB as an adult.  In your case, the abnormal chest x-ray with right upper lobe nodules also suggests latent TB infection.  Thus, it would be the usual practice to recommend treatment for latent TB infection for someone in your situation.

One thing you could do is to see if anyone in your community can do a QuantiFERON-TBŪ Gold (QFT).  This is a blood test used to find out if you are infected with TB bacteria.  The QFT measures the response to TB antigens (proteins) when they are mixed with a small amount of your blood.  This is a new test that some health departments and physicians are using.  This method may help distinguish reactivity due to BCG from that due to TB.