CPSO registration q

[sangria]

Under section g) Medical Conditions, (viii) states "Do you now have a communicable disease or are you a carrier, whether asymptomatic or otherwise of an infectious agent of a communicable disease (ie. TB, hepatitis, etc)?" 

 

Had the BCG vaccine. My TB skin test is positive. CXR normal. I know that makes it latent TB, so the answer to this question is a yes? Obviously I'm not going to omit anything, but what would that mean to my license or to other things like insurance?

 

Thanks.

[ellorie]

I would just call the CPSO and ask what to do in that situation.  I never mess around with trying to figure out what they mean.

You could consider getting a Quantiferon to differentiate whether you are a carrier or whether it's a false positive due to BCG.

Either way, we all pay into the CMPA so it won't affect your malpractice insurance. 

[Hanmari]

6 hours ago, ellorie said:

You could consider getting a Quantiferon to differentiate whether you are a carrier or whether it's a false positive due to BCG.

OP, I was in the same shoes as you and actually got this done and it came back negative. Not because CPSO demanded it but because my family doc referred me to an ID doc who said I might as well find out for sure. As I understand it my result is a rare occurrence but goes to show it does happen.

The downsides are that you have to pay for it and that if you end up in my shoes, you will need to pay for the test every time you need a TB test done (since TST in your case would no longer be considered reliable) instead of being able to just get a CXR and pass it off as latent.

As for the actual CPSO requirement yes definitely call them to ask. I answered no but that was only because I did the quantiferon.

[ellorie]

The same thing happened to me - I have really sensitive skin, so every time I get a TST it blows up - not indurated, just swollen and red.  Anyway, someone who wasn't that good at reading them said it was positive, and I didn't want to be stuck with a "positive" forever, so I got a Quantiferon, which was negative.

However, I then went back to getting TSTs, and ever since then it's been read as negative, because it was never truly indurated.  So that was an easy out for me.  Yearly Quantiferons would also be a pain.

[bearded frog]

A positive mantoux test from BCG does not mean you have TB, or have ever had it, latent or otherwise. It's simply a false positive. The IGRA would be positive if you actually had latent TB.

[ellorie]

1 hour ago, bearded frog said:

A positive mantoux test from BCG does not mean you have TB, or have ever had it, latent or otherwise. It's simply a false positive. The IGRA would be positive too, if that was the case.

I think the IGRA can be negative if you've had BCG but aren't a carrier - the Quantiferon is more specific than the TST.

[bearded frog]

44 minutes ago, ellorie said:

I think the IGRA can be negative if you've had BCG but aren't a carrier - the Quantiferon is more specific than the TST.

Sorry, that is what I meant - the IGRA would be positive if you had latent TB.

[sangria]

On 5/4/2020 at 8:50 PM, Hanmari said:

OP, I was in the same shoes as you and actually got this done and it came back negative. Not because CPSO demanded it but because my family doc referred me to an ID doc who said I might as well find out for sure. As I understand it my result is a rare occurrence but goes to show it does happen.

The downsides are that you have to pay for it and that if you end up in my shoes, you will need to pay for the test every time you need a TB test done (since TST in your case would no longer be considered reliable) instead of being able to just get a CXR and pass it off as latent.

As for the actual CPSO requirement yes definitely call them to ask. I answered no but that was only because I did the quantiferon.

 

On 5/4/2020 at 10:06 PM, ellorie said:

The same thing happened to me - I have really sensitive skin, so every time I get a TST it blows up - not indurated, just swollen and red.  Anyway, someone who wasn't that good at reading them said it was positive, and I didn't want to be stuck with a "positive" forever, so I got a Quantiferon, which was negative.

However, I then went back to getting TSTs, and ever since then it's been read as negative, because it was never truly indurated.  So that was an easy out for me.  Yearly Quantiferons would also be a pain.

It's negative! Thank you both! For future reference for anyone else, there's a 90 something fee at Lifelabs, and turnaround time is 7-10 days. I'd been living with the label of a positive TST for years and I hated it. 

On 5/9/2020 at 12:02 AM, bearded frog said:

A positive mantoux test from BCG does not mean you have TB, or have ever had it, latent or otherwise. It's simply a false positive. The IGRA would be positive if you actually had latent TB.

Yes, I'm well aware. Hence the post. But how it was taught even at my school was that it is presumed latent TB if TST is positive, and a history of the BCG vaccine can be ignored in the interpretation. That's what I learned in class, and also what has been told to me by multiple physicians over the years.

What I got was "yeah well you had 20mm+ so it's very positive" and "Sure if you really want, you can get the Quantiferon but it's not covered. But it's more likely that you picked it up somewhere." I was told that it was 500 bucks at one point, and I could not shell out that money every year.

[ellorie]

I'm glad it didn't end up being prohibitively expensive - I got mine done in another province and had Alberta health insurance at the time where it was covered.

But I did have that fear of secretly having TB so it was nice to get the reassurance.

I get TSTs now and it actually remains swollen for a couple weeks and then leaves a visible mark/discolouration on my skin that lasts for months.  I got mine at the beginning of March and 2 months later the mark has just faded this week.  I actually wonder if I am allergic to some component, or maybe my skin just hates everything.

[ACHQ]

4 hours ago, sangria said:

But how it was taught even at my school was that it is presumed latent TB if TST is positive, and a history of the BCG vaccine can be ignored in the interpretation. That's what I learned in class, and also what has been told to me by multiple physicians over the years.

What I got was "yeah well you had 20mm+ so it's very positive" and "Sure if you really want, you can get the Quantiferon but it's not covered. But it's more likely that you picked it up somewhere." I was told that it was 500 bucks at one point, and I could not shell out that money every year.

So there are basically a few components to interpretation of a TST:

1. The size of the induration

2. The PPV of the test (any reason for a false positive as you have identified, and exposure history)

3. The risk of reactivation (immunocompromised/transplant, HIV, CKD, silicosis etc...)

They have nice calculators to help with the risk quantification: https://www.tstin3d.com/en/calc.html

you were identified as "very positive" but now we know it was a false positive via the Quantiferon test.

TST's should not be done unless one is going to treat for latent TB. The only reason we do it is because we are health care workers, and if it does turn out to be positive (a true positive) treatment for it should be strongly considered.

That being said I don't believe a positive TST ever goes away (i.e. will always test positive every year so most people will just get the yearly CXR)...

[sangria]

17 hours ago, ACHQ said:

That being said I don't believe a positive TST ever goes away (i.e. will always test positive every year so most people will just get the yearly CXR)...

It doesn't. But at least the negative Quantiferon will mean that the TST is a false positive and I'm not labelled as latent TB and scare the tech when they read the CXR requisition "hx of TB". 

My PGME doesn't recognize the Quantiferon and will only go by the TST results. So I'm getting yearly radiation because of a result that I know is a false positive? Makes no sense to me but I'll worry about that next year.

[sangria]

18 hours ago, ellorie said:

I get TSTs now and it actually remains swollen for a couple weeks and then leaves a visible mark/discolouration on my skin that lasts for months.  I got mine at the beginning of March and 2 months later the mark has just faded this week.  I actually wonder if I am allergic to some component, or maybe my skin just hates everything.

Did you find somebody else to read it?

My skin is the same way. It blows up when anything touches it. 

[ellorie]

3 hours ago, sangria said:

Did you find somebody else to read it?

My skin is the same way. It blows up when anything touches it. 

Occ Health read it as negative - all except that one nurse five years ago have, thankfully.

[ACHQ]

6 hours ago, sangria said:

My PGME doesn't recognize the Quantiferon and will only go by the TST results. So I'm getting yearly radiation because of a result that I know is a false positive? Makes no sense to me but I'll worry about that next year.

welcome to the nonsensical red-tape political BS that is rampant in medicine!