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Tuberculosis: Do I need tested?

Recently, I spent about a half hour in a small, enclosed room with a patient which MAY have TB.  I am an ultrasound technician.  My patient had incidental findings of significant pleural effusion and a multi-septated liver cyst.  Her history: she is a nurse. She said her daughter does not HAVE TB but is a "carrier" and has finished being treated for TB.  It has been two years since my patient has been tested for TB.  I reported my findings as well as the patient's history to four doctors...all of whom seemed relatively unconcerned about our exposure.  I am uncomfortable, however, and would like your advice.  Should I contact my employee health and infectious control and ask that this patient be followed up to determine if she does, indeed, have TB and should I be tested.  I do not want to invade her privacy....but I am concerned not only for myself but also my family as well as my co-workers and future patients health.  If she is diagnosed with TB, will I be contacted by the CDC since I have had recent contact with her?  What are my rights?
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Avatar universal
I am not a nurse or doctor. Just speaking from my own hystery and problems. I was exposed to someone with active TB in 1996. I was working in a hospital where I would get mandatory physicals each year. This included a TB test. One year it came out positive. I was told then and now that it can take 3 months for your TB test (Mantaux Test) to show positive. You may be a carrier which is Latent Infenction TB. You can have the infection but your immune system is protecting it from becoming activated. The first year or two is crucial since a Latent infection (which they call the TB bacteria "sleeping") has more of a chance to get activated. I was well and in good health until 1 1/2 yrs. ago. I've come down with autoimmune arthritis, etc that is systemic. Now I'm weak and afraid that my latent tb could activate. Also, latent can become activated if you become diabetic or it can come out when you're aged as the immune system get lowered. I need immune-surpressant medications in order to control my inflammations. By taking these meds, even pregnisone, will activate my TB. Since I'm systemic, these meds can save my life. There is a very toxic antibiotic for the latent TB called (ionized) INH to be taken 9-12 months. When I first got exposed, the cut off point to take this med was 35yrs old. That's becuase it's filtered through the liver and the younger a person is, the faster and better the liver/kidneys work. The INH can be filtered faster. Then they changed the proticol to 50. ( I believe to be true). No one ever told me that. Now I'm 58 and in poor health and in desperate need for the meds I was speaking of. My infectious disease doctor really does not want me to go onto the INH. As is, my liver enzymes go High. But now I have no choice. It's very possible that my body would not be able to tolerate the INH and I would have to go off of it. I believe that once you go off this med, you can't go back on because it may be resistant.

I had thought I'm okay and didn't worry about it in 1996. But one doesn't know what lays ahead of them. If a person would need chemotherapy for cancer and were +PPD for Latent TB, that could cause a problem. I never thought I would get sick.

In my opinion, if I were you, I would go see an internest that's subspecialty is in infectious disease. I don't know when you were exposed but if it's past 3 months or maybe more, I myself, would have a Mantaux Test. If it tests positive, you don't need another one, Once positive, you're always positive. If your Mantaux test comes out negative after a few months, I would have another Mantaux test a few months later just to confirm your results.

If your patient has latent TB, you really don't know if it has been activated. The signs of it doesn't always have to come out as a cough.

Try to find out how many months your patient was treated for. Some doctors say 6months is okay and it can be taken with food. That doesn't do it with my doctor or from other places I read. My doctor wants me on the INH for NO LESS than 9 months which is standard but since I'm ill, he really wants me to take it for 12 months-ON AN EMPTY STOMACH. If your patient indeed take her INH for only 6 months, it's possible that she still has it and since she stopped early, in my opinion, she just may have activated it but not showing signs.

I would also call the Health Department.  Regarding your rights, I don't know about it. I don't think there's a problem with calling her and asking what meds she took and for how long and if she took them on an empty stomach. It's up to her to give you that information or not.
Good luck.  
Helpful - 1
242588 tn?1224271700
MEDICAL PROFESSIONAL
Your concern is warranted and your questions appropriate.  Nurses, doctors and technicians such as you are often at increased risk of contracting tuberculosis (TB), especially if working with an indigent population.  There are many causes of pleural effusions, including TB.  Even a negative culture and smear of pleural fluid, for TB does not completely rule-out that diagnosis.  The history of her daughter being treated is significant, be it prophylactic therapy because of documented skin test conversion or because of an abnormal x-ray.  The importance is that the daughter might have been contagious at some point, which is unlikely for someone described as a “carrier”, or that both mother and daughter might have been exposed to a given individual with active TB.

You should contact employee health and infection control.  Employee health, having a responsibility to identify all risks to all employees’ health, is in a position to investigate and determine if the diagnosis of TB is or should be a consideration for the patient in question.  You should also contact your state’s Public Health Department to express your concern and to elicit their advice.  Employee health, infection control and the Public Health Department should bear responsibility for follow-up on your patient.  It would be inappropriate for you to do so on your own.  But, do not depend on them or the Center for Disease Control (CDC) to contact you.  You would do well to work through employee health and/or infection control in your institution and contact them in 1 to 2 months to confirm that they have followed-up.

You mention that it has been 2 years since your patient has been tested.  Assuming the testing was either a TB skin test and/or a chest x-ray, it would be important to know if either has changed other than the pleural fluid, over the past 2years.  If you have been TB skin test negative in the past, it would be wise to repeat your skin test.  Skin test conversion, from negative to positive, usually occurs 4 to 8 weeks after infection and reflects the development of cellular immunity and tissue hypersensitivity.  Eight weeks or more after the exposure/infection would, thus, be the optimum time to perform the skin test.  However the skin test reaction is falsely negative in 20 to 25% of otherwise immunocompetent normal adults at the time of diagnosis.  Thus a negative skin test should not be perceived as the definitive test, especially in people with x-ray changes or other typical features of TB.

Do not be dissuaded from taking action, by the opinions of the 4 doctors who “seemed relatively unconcerned”.  You do have a right and a responsibility to protect yourself and your family and with your institution an obligation to protect, your co-workers and patients in your hospital.

Good luck.
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