Fiancee told to take Sputum test again

[sjr09 155]

If the patient has no history, no risk factors, no s/s of TB, and has a history of having gotten BCG vaccine then a chest x-ray is done to clear a person of TB. I think we are basically saying the same thing though you are probably more accurate in saying all of the above are needed to clear a patient. Presently where I work all employees are given PPD except for those with history of BCG vaccine who have to have a chest x-ray.

Go by the CDC, not your work place! A chest x-ray will not show LTBI

Test all people who are high risk, regardless of BCG history.

Tests for TB infection are not contraindicated for persons who have been vaccinated with

BCG. A history of BCG vaccination should not be considered when deciding whether to

test and determining whether the test result is positive in high-risk individuals (see Point 1

above and Step 2).

Although BCG vaccination can cause a false positive cross-reaction to the TST (especially

within the first 12 months after vaccination), sensitivity to tuberculin is highly variable

and tends to decrease over time. There is no way to distinguish between a positive

reaction due to BCG-induced sensitivity and a positive reaction due to true LTBI.

Therefore, a positive reaction to the TST in BCG-vaccinated persons should be interpreted

as indicating infection with M. tuberculosis when the person tested is at increased risk of

recent infection or has a medical condition that increases the risk of progression to active

TB disease.

[Atencio 43]

The original posters question was why a second sputum specimen is needed.

You guys are the ones that moved the discussion off-topic and I followed up addressing your responses not related to the OP question so I am sorry if you combined the two together.

The simple answer to the OP question is that a second test is needed because of their suspicion. I will add that St. Lukes has had a long history of false positive x-rays.

[Mariye & Ky 172]

If the patient has no history, no risk factors, no s/s of TB, and has a history of having gotten BCG vaccine then a chest x-ray is done to clear a person of TB. I think we are basically saying the same thing though you are probably more accurate in saying all of the above are needed to clear a patient. Presently where I work all employees are given PPD except for those with history of BCG vaccine who have to have a chest x-ray.

Different workplaces have different policies with regard to needing to take meds/how often to have CXRs etc. One should go by the CDC Guidelines! Not your work place

AMEN! AMEN! AMEN!

CDC

TB infection, and a chest x-ray that shows noncalcified fibrotic lesions suggestive of old,

healed TB, treatment decision is based on several factors. These include clinical

suspicion, prior TB treatment history, sputum results and repeat x-ray. All such patients

should be evaluated for active tuberculosis, with a physical exam, chest x-ray and sputa.

If sputa are smear negative and there is no evidence of adequate prior treatment for TB,

treatment should be started with isoniazid, rifampin, pyrazinamide, and ethambutol for 2

months. This regimen has several advantages: it can be used to treat patients who may

have isoniazid-resistant organisms; it may promote better adherence than the 9-month

treatment regimen for LTBI; and it allows patients to start treatment at the first medical

visit, rather than waiting until sputum cultures are shown to be negative for M. tb.

If a culture comes back positive, then treat as active tuberculosis with an appropriate

regimen. If all cultures are negative by two months, repeat a CXR:

a) If the x-ray shows no change, the lesions presumably were inactive. Classify the

patient as having old TB:

i. If the patient has no prior TB treatment history, continue with 2 additional

months of isoniazid and rifampin only.

ii. If there is a history of same prior TB treatment, continue all four drugs for an

additional 2 months.

iii. Other diagnoses should also be pursued as warranted.

b) If the x-ray shows improvement, the lesions presumably were active. Classify the

person as having culture negative active TB:

i. If the patient has no prior TB treatment history, continue with 2 additional

months of isoniazid and rifampin only.

ii. If there is a history of same prior TB treatment, continue all four drugs for an

additional 2 months.

At the end of 4 months of therapy, the patient should receive an end-of-treatment x-ray to

serve as a baseline for future reference. Some patients classified as old TB may show

improvement on the 4-month x-ray; they should be reclassified as having culture negative

active TB.

[sjr09 155]

The original posters question was why a second sputum specimen is needed.

You guys are the ones that moved the discussion off-topic and I followed up addressing your responses not related to the OP question so I am sorry if you combined the two together.

The simple answer to the OP question is that a second test is needed because of their suspicion. Agree I will add that St. Lukes has had a long history of false positive x-rays.

Regardless. your playing ball in there court. Not much one can do about it.

Edited December 19, 2010 by sjr09

[Tahoma 2,292]

hi, im waiting for my interview to be sched.. since you're working in a medical field just wanna ask if i am considered exposed to TB cause i am a student nurse around 2006-2008.. but since 2008 i was never involved in health care again.. and then this november i just had my cxr-cause i got so sick and the result is ok.. and i can show saint lukes that plate when my medical exam will be shed.. (again just wanna know if i am considered exposed to tb? im afraid im gonna wait 2months too like the others here if i will tell them that i was a stud nurse before, cause if yes i will try to have an early medical test in St lukes.) THANKS!

Hi elena aguilera...

Don't worry about telling St. Lukes that you worked as a student nurse and you may have been exposed to TB, because St. Lukes will not single you out for anything. You will be required to undergo a chest x-ray like everyone else. St. Lukes will simply look at your chest x-ray to determine whether or not you must undergo the two-month TB culture. It's that simple.

My wife was a nurse in 'Pinas. She did not work directly with TB patients, but she considered herself as having been exposed to TB. She was worried just like you are, so she had a chest x-ray before she went to her medical at St. Lukes, and the x-ray came back clean. However, she knew that the only x-ray that counts is the x-ray taken by St. Lukes.

Fortunately, her St. Lukes x-ray came out clean, so she did not have to undergo the two-month culture. My wife's friend, who went to St. Lukes for her medical at the same time, and who is also a nurse, was not so lucky. The friend had to wait for the two-month culture before she was cleared to go to her interview.

Today, both of them are happily married and living here in the U.S.

Good luck with your medical.

[Mariye & Ky 172]

The original posters question was why a second sputum specimen is needed.

You guys are the ones that moved the discussion off-topic and I followed up addressing your responses not related to the OP question so I am sorry if you combined the two together.

Be accountable for your own self please and answer the OP. We already went to Grad School... have you? LOL

The simple answer to the OP question is that a second test is needed because of their suspicion. I will add that St. Lukes has had a long history of false positive x-rays.

Let me digress.... The OP stated, "...required 2 months for the culture test and it came back negative, but they detected a spot on her most recent X-Ray and told her she will need to retake the Sputum test and wait again 2 months for the results. I dont understand why cuz the negative culture should over ride the abnormal X-Ray spot.

The original X-Ray already showed the abnormal spot thats the reason she did the first Sputum test, now she has to do it again." end OP statement.

It appears to me from the OP's text, that her Doctors are following up as protocol recommends. So we can let that rest and let her Doctor(s) explain to her the why's and because, can't we? If he needs an explanation, then let him ask his own physician, hopefully a pulmonary specialist.

In the States, we do not go by the rules and regulations of other countries healthcare protocols. Our boards are very specific on how we practice. So, while you are relating information in regards to US Standards, leave it to the ones who are schooled and trained in them to do their job.

[Tahoma 2,292]

My fiancee went to SLEC to get her medical results after waiting the required 2 months for the culture test and it came back negative, but they detected a spot on her most recent X-Ray and told her she will need to retake the Sputum test and wait again 2 months for the results. I dont understand why cuz the negative culture should over ride the abnormal X-Ray spot.

The original X-Ray already showed the abnormal spot thats the reason she did the first Sputum test, now she has to do it again.

Has anyone else had this issue come up?

I'm sorry to hear that your fiancée is required to undergo a second culture. The waiting is h*ll.

I have not heard of anyone at St. Lukes who was required to undergo two cultures, so it seems strange to me too. I can only think that the doctors have their suspicions based upon the two chest x-rays.

Good luck with the latest culture...and another long wait!