Doc Helen I need some answers please...

[raquel_1208 1]

My 10-year old daughter was given TD, Hepa A, HPV, Polio shots and have undergone another TB skin test here in Los Angeles so that she can start school. After 2 days a red spot appeared on her arm and it turns out she was positive and needed an x-ray. How come she became positive? She had her skin test last Dec. 26 at St. Lukes back in the Philippines and it was negative. The nurse told my daughter about taking some anti-TB medicines and that freak me out. Can you please enlighten me about this? I don't have TB history.

[warwick8 0]

Relax....wait for the xray because sometimes even if kids (esp Filipinos) are positive with their skin test. it doesn't necessarily mean an active PTB test. A positive skin test may mean an active disease OR a previous infection or a BCG vaccine. What is standard at the clinics is to do an xray if a child is asymptomatic and turns out to have a positive skin test before initiating treatment. However, if the child is symptomatic with a postive skin test, the doctor may start treatment without doing an xray.

If your child was negative 2 months ago, doesn't mean he/she won't turn positive in the succeeding months. It mightbe because at the time of the skin test, the disease was not active yet and she acquired it in the 2 months span or maybe of a technical error on the one who administered the skin test (too low a dose, did an intramuscular instead of an intradermal injection).

I hope i was able to help you

[raquel_1208 1]

Yes, thank you very much for your reply. She will have her xray tomorrow and I'm hoping it will turn out fine.

[warwick8 0]

don't worry, Racquel Leave it all up to Him

[jj1028 3]

hi.. even if your child's xray turn out normal, they will still require her to undergo medication (6-9 mos. isoniazid) as they are so aggressive in treating TB here in the US, taking medication doesnt mean she has a TB.. dont worry it doesnt give out side effects on her whether she has or doesnt have a tb.. its just a preventive measurement as they have a rare case of TB here in the US.

[payxibka 10,045]

The skin test returns false positives all the time....

[raquel_1208 1]

hi.. even if your child's xray turn out normal, they will still require her to undergo medication (6-9 mos. isoniazid) as they are so aggressive in treating TB here in the US, taking medication doesnt mean she has a TB.. dont worry it doesnt give out side effects on her whether she has or doesnt have a tb.. its just a preventive measurement as they have a rare case of TB here in the US.

Taking medication for 6-9 months is not really what I want for my daughter since she or I doesn't have TB history and are very healthy right now. So if there are other options that we could do to avoid that I would like to know more.

[sj5 4]

hi.. even if your child's xray turn out normal, they will still require her to undergo medication (6-9 mos. isoniazid) as they are so aggressive in treating TB here in the US, taking medication doesnt mean she has a TB.. dont worry it doesnt give out side effects on her whether she has or doesnt have a tb.. its just a preventive measurement as they have a rare case of TB here in the US.

I think it depends which states?

My daughter had medical examination here in USA for school requirements but there is no prescriptions.

Isoniazid side effects

If you experience any of the following serious side effects, stop taking isoniazid and seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
• unusual weakness or fatigue;
• nausea, vomiting, or loss of appetite;
• abdominal pain;
• yellow skin or eyes;
• dark urine;
• numbness or tingling in your hands or feet;
• seizures;
• blurred vision; or
• confusion or abnormal behavior.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. Edited February 28, 2008 by SJ

[warwick8 0]

It's in the doctor's discretion to start a patient with treatment even if the xray is negative. Most doctors will not start treatment however aggressive they are if the patient is without symptoms and has no contact with a TB case. This is because Isoniazid or TB drugs is not without side effects. Most of my patients (kids) complain of tummy ache after taking the drug esp in the morning. And once u start treatment, you have to continue doing so for 6-9months. Every single day. You can't miss a dose for more than 3 days or you might have to restart all over again. So see, most doctors will not start treatment unless warranted

[raquel_1208 1]

Docjazzie you made me feel better this time . By the way the xray result was negative.

[warwick8 0]

I'm glad the xray is negative

God bless, Raquel

[nicole/philip 0]

The skin test returns false positives all the time....

i agree. when i worked in the US as an x-ray tech, i did a lot of chest x-rays on people who had postive skin test that usually turns out negative in chest films. goodluck.

philip

[vsmtghdy 2]

Sorry for the late reply, I was busy at work. Yes, they are right, even if you had a negative skin test that does not guarantee you will stay negative. Between the time the first and the new TB skin test was done, patient can be exposed to the infection and there's a lot of reason to have a false positive result.

A CXR is usually done and it may not be a guarantee that if you have a negative results that the Doctor will not start on anti-TB medications. This will still depend on the Physician. But they still usually start on anti-TB meds as prophylaxis for kids (for 6 months). Any medications have side effects. Isoniazid should be taken on empty stomach, and that's why most will have some stomach pains or discomfort but this usually disappear as the patient takes the drug regularly. The other most common side effects is "jaundice" (yellowish discolorations of the skin and sclerae (eyes), which may indicate a liver toxicity with the medication.

We just had TB mask fitting and skin test last month in the hospital I am working. One of my co-employee (CNA) had a positive skin test and CXR was done which revealed negative and they started her on medications.

Good Luck!

[raquel_1208 1]

Sorry for the late reply, I was busy at work. Yes, they are right, even if you had a negative skin test that does not guarantee you will stay negative. Between the time the first and the new TB skin test was done, patient can be exposed to the infection and there's a lot of reason to have a false positive result.

A CXR is usually done and it may not be a guarantee that if you have a negative results that the Doctor will not start on anti-TB medications. This will still depend on the Physician. But they still usually start on anti-TB meds as prophylaxis for kids (for 6 months). Any medications have side effects. Isoniazid should be taken on empty stomach, and that's why most will have some stomach pains or discomfort but this usually disappear as the patient takes the drug regularly. The other most common side effects is "jaundice" (yellowish discolorations of the skin and sclerae (eyes), which may indicate a liver toxicity with the medication.

We just had TB mask fitting and skin test last month in the hospital I am working. One of my co-employee (CNA) had a positive skin test and CXR was done which revealed negative and they started her on medications.

Good Luck!

Thanks doc helen. I appreciate your professional opinion about this. Kids here in the US are so fortunate compared to the Philippines. All the vaccines they gave my daughter are free and I recently got a free health coverage for her from her school. It includes dental care, doctor visits, prescription medicines, mental health, vision and hospital services. So if ever they start to medicate her, she could avail it at low or no-cost at all.