Respiratory Disorders Expert Forum
possible TB re-exposure
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possible TB re-exposure

Hello,

Back in 2010, I found out I had been exposed to Tuberculosis through a routine skin test required by my job (teacher). A couple of weeks later, I was contacted by the county health department and offered to begin a 6-month regimen of INH antibiotic. I began my INH course on 12/29/2010 and completed it on 06/02/2011 -- 6 months in total with a little card from the health department certifying my compliance.

My concern is that yesterday, I was coming home from vacation when a homeless-looking man (a smoker) coughed right in the direction of my friend and I. It was pretty disgusting, to say the least. It also got me worried that my friend and I may have been re-exposed to TB.

I don't know whether it makes a difference or not, but I am currently on a 160mg-800mg dose of generic Bactrim DS/Septra DS for a sinus infection.

My main question is should I worry about possible re-exposure to TB infection ?

If so, do I need to take another INH regimen?

I am 32 years old, f.y.i.


I also want to add that I'm on a corticosteroid  (beclomethasone 80mg, 1 puff, 2x daily) for asthma treatment, if that makes a difference?

Thanks for any help you can provide.

242587_tn?1355427710
The incidence of pulmonary tuberculosis is relatively low in America but somewhat higher in homeless individuals or others without access to regular medical care.  Thus, while unlikely, there is a definite possibility that you may have been exposed to TB.  There has been an increase in forms of the tubercle bacillus (bacterium), resistant to conventional therapy, in recent years and so, under the circumstance in which your exposure occurred, this too would be a possibility.  For this reason, the repeat administration of INH without further diagnostic studies would be inappropriate.

I suggest that you contact your local State Public Health Department to report your exposure and concern.  They would be expected to evaluate you, first with a chest X-ray (if you have not had one in recent times) for a good baseline and another at 3 and 6 months.  They would also want to perform serologic (blood) testing for TB (called a Quantiferon Gold test) sometime within the next 30-60 days and collect a sputum sample anytime in the immediate future, should you be able to produce sputum.

The most important step to be taken is for them, possibly in concert with your doctor, to arrange for close follow-up (bi weekly or monthly) of your health during the next 6-12 months, the premise being that should you develop any sign of recent tuberculous infection, appropriate treatment based on X-rays and lab studies would be instituted in a most timely fashion.

All the preceding is cautionary but most important.  For your own sense of well-being you should remember that, 1) the likelihood of your being infected by this single, albeit disgusting, exposure is low and, 2) if infected, your young healthy immune system and appropriate therapy administered at the outset of infection would, with high probability  result in a complete cure you of any TB infection.

Remember, that all the preceding is dependent upon your being closely monitored for any sign of infection, for the next 6 months and so you should accept nothing less than that.

Good luck
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