Positive ppd and BCG

[samantha_2003]

Hi,

Recently, my daughter had a ppd skin test for her new school which came out positive. She is 5 years 11 months. She born oversys and gave BCG their in 1 and a half months old. From 1 year of age, she is in usa. Her last ppd in usa was negative.

She is very healthy, no problem. -ve Chest x-ray. Do she need any medication? Medication may cause some liver damage and it has other side effects too. I am afraid.

Any information will help a lot.

Thanks

Samantha

[National Jewish]

This is an unusual story.  The Purified Protein Derivative (PPD) skin test for tuberculosis may be positive or negative after getting the Bacille Calmette-Guerin (BCG) vaccine.  When the BCG vaccine causes the PPD to be positive, the typical pattern is for the initial PPD to be positive.  The PPD may become negative over time.  It is puzzling that your daughter had a negative PPD followed by a positive PPD after getting the BCG vaccine.

That raises the possibility that your daughter has had a tuberculosis mycobacteria (TB) or nontuberculous mycobacteria infection.  However it doesn’t prove it.  If your daughter’s chest x-ray is at all suspicious she has been infected.  Ask the local TB clinic to see if she MIGHT have been exposed at her school or day care center.  She does need to take isoniazid (INH) for 6 months if there are no other explanations for her positive PPD.

[nurse12hr]

As far as I know, someone who has had the BCG vaccine should NOT have a ppd test.  It will come out positive, and you can have a very severe reaction.

My husb had BCG when he was a child, and didn't know he shouldn't have a ppd when he came to the US.  He had one, and the resulting reaction turned into an abscess and ultimately cellutitis requiring hospitalization.

I don't know why your childs ppd was negative before.  

Call your pediatrician and ask whether or not she should ever have the ppd again.  
She will probably have to have a chest xray now that she has had this positive reaction.  I wouldn't let them give her the medication until you talk to a specialist in pulmonary medicine.  Family doctors don't tend to know a lot about what is done overseas and its impact on our routine testing.

Usually if you have had BCG, they have you take a chest xray instead of a ppd.

[samantha_2003]

Dear Christie,

Thank you so much for your reply.

We had no idea that ppd will come out +ve for BCG.
Yes, she had a chest x-ray after +ve ppd and it's -ve.

Can you please give me an idea about what type of doctors are specialist in  pulmonary medicine? Which kind of doctors are they or what is their practice name? I would be happy to know.

Thanks a lot.

Samantha