Guest FrenchyMed Posted June 24, 2004 Report Share Posted June 24, 2004 So, I was getting all my shots in order to get ready for September. Got the standard Mantoux TB test. I've just been told that it's positive... I had it done 4 yrs ago and it was negative. What does this mean??? Can they stop me from starting Med school because of this?? I'm getting a chest X-ray done today and my GP wants to start me on TB meds for 9 months! My mom tells me that both she and my dad have tested positive for TB in the past, but have never been prescribed meds. Any insight??? Link to comment Share on other sites More sharing options...
Guest therealcrackers Posted June 24, 2004 Report Share Posted June 24, 2004 It's prophylaxis meds, unless they find something on the CXR that you're having done. If you're put on rifampin, prepare for all of your secretions (tears, sweat, etc.) to turn orange... Having TB is a very big deal, if you get a reactivation. People who are already sick are somewhat immunocompromised, and picking up an extra infection like TB can really put them in a bad state. (This will include your overtired classmates when you approach exams.) Check with the public health people if you are still concerned: but most medical schools will have in their instructions to incoming students or general information their rules about the varying degrees of TB positivity. Did you get BCG? Were you born in Europe? Then the negative CXR may be all you need in that circumstance... Link to comment Share on other sites More sharing options...
Guest FrenchyMed Posted June 24, 2004 Report Share Posted June 24, 2004 I'm not sure about BCG... I was born in Ottawa and previously tested negative for TB. I have lived in Europe (Paris) since my last TB test. Damn those baguettes!!! Ottawa U's documentation on immunization reqs says that if a student test positive, the GP needs to report results, indicate prescribed treatment, attach chest x-ray and advise student to omit future skin testing and inform him/her of symptoms of active TB. From the looks of it, they will probably still admit me to Med school. Clearly, I've never had active TB (I think I would have noticed). I doubt that the staff at the clinic would have let me walk out of there if they suspected active TB. :b So crackers, are you telling me that wearing a white t-shirt and sweating a lot may turn some heads? I can see it now, I'll be the girl with the orange armpits, crying orange tears because everyone is laughing... Link to comment Share on other sites More sharing options...
Guest therealcrackers Posted June 24, 2004 Report Share Posted June 24, 2004 The T-shirt problem is only if they give you rifampin. If they're considering it, ask them... but you might want to change your wardrobe if it's on the list. If you're a "fall" for skin and clothing colours... you'll be fine. Yes, they will admit you to medicine, and you might have to take the drugs for 9 months. But better to eradicate it now than have TB rear its ugly (and it is butt-ugly) head during your exams next winter. Good luck! Link to comment Share on other sites More sharing options...
Guest westerngirl2004 Posted June 24, 2004 Report Share Posted June 24, 2004 FrenchyMed, I was tested positive for TB a year or two ago too. I had to get my chest xray done. Then I was on meds for 9 months too (the doc was unsure whether the positive test was from me living in asia and getting the shot when I was young). I didn't have orange secretions though, don't remember what i was prescribed (probably not rifampin). so try not to worry too much about it, unless they find something. westerngirl Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted June 24, 2004 Report Share Posted June 24, 2004 Hi there, I think there's probably a couple of big things on your mind; 1) will the med school still take me, and 2) what does this mean for my personal health? Obviously, it sucks to have any medical test come back as anything other than completely normal. Still, a positive PPD doesn't mean that you are actively infected with Tb; it just means that at some point in the past, your immune system was exposed to it enough that your T-cells have now reacted to being injected with Tb antigens (the active ingredient in the PPD/Mantoux injection). As crackers mentioned, that might be because you've received a BCG vaccination at some point, or, perhaps either in Canada or abroad, you've been exposed to enough Tb to cause an immunologic reaction. In some rare cases, having a prior PPD is enough to sensitize your immune system into reacting to future PPD's! As far as med schools go, I'm 99.9% positive that they can't keep you out of med school for this. I know of at least one instance where a medical student had a PPD go positive after some clinical experiences exposed this individual to Tb; as far as I'm aware, there were no med school repercussions to this. I also know of any number of classmates who were vaccinated to BCG, and their PPD's obviously were positive, if they even got them done (vaccination to BCG doesn't guarantee 100% that they still couldn't have contracted Tb at some random time from their home country). ie. You get vaccinated at birth for BCG, still manage to pick up Tb at age 15 from a relative, and have a positive PPD on entry to med school. That person despite having a perfectly reasonable explanation for a positive PPD test might still have Tb regardless! They all started on time as well. As far as your own health goes, in the rather unlikely event that the chest x-ray turns up evidence of prior infection, they will start you on a big cocktail of medications designed to eradicate the Tb; unfortunately, this might constitute up to 4 different antibiotics over a lengthy period of time, depending on the prevalence of drug-resistant Tb in your city. If the chest x-ray does not turn up evidence of prior infection, then like crackers mentioned, you would likely, (and in my opinion, definitely should) go on prophylactic antibiotics. This is because although the chest x-ray is pretty good at picking up pulmonary infections, it's never 100%, and on the off-chance that you do have Tb (and I stress again, for the average med student, who is immuno-competant, hasn't been spending lots of time travelling in areas with a high Tb prevalence, or a lot of time around sick people with Tb, etc, your chances of having an actual Tb infection are pretty low) the prophylactic antibiotics will help take care of that, as well as give you that peace of mind that you are actively doing something. Here's a couple of articles from eMedicine that might be worth browsing. The first is an article about Tb from an Infectious Diseases doc, and the second is a Tb article written by an Emerg doc. Both discuss the diagnosis, tests, and treatments for Tb. www.emedicine.com/MED/topic2324.htm www.emedicine.com/EMERG/topic618.htm All the best. You're not alone in this; lot's of other med students and doctors have had positive PPD's as well, and they all get through the system just fine. Ian Link to comment Share on other sites More sharing options...
Guest FrenchyMed Posted June 24, 2004 Report Share Posted June 24, 2004 Thanks guys! I feel less stressed out now that I've read all this info. I was wondering if my chest x-ray could pick up something that may look like a TB lesion but was in fact due to a lung infection I contracted about 15 years ago. At the time, my physician ordered a chest x-ray and prescribed oral cortisone. I will definitely be taking the TB drug (can't remember which one) for the next nine months. :x As the saying goes: "mieux vaut prévenir que guérir!". :lol Link to comment Share on other sites More sharing options...
Guest codloghorn Posted June 24, 2004 Report Share Posted June 24, 2004 it's all over. make up your will fast. :rollin Link to comment Share on other sites More sharing options...
Guest FrenchyMed Posted June 24, 2004 Report Share Posted June 24, 2004 :b :lol Man I love this forum!!! If I survive this disease, maybe I should sign up as a moderator... Link to comment Share on other sites More sharing options...
Guest strider2004 Posted June 24, 2004 Report Share Posted June 24, 2004 Remember you can't have any alcohol while you are on INH. Link to comment Share on other sites More sharing options...
Guest noncestvrai Posted June 24, 2004 Report Share Posted June 24, 2004 How do you get TB? noncestvrai P.S. Good luck Frenchymed...c'est un mal necessaire, en effet. Link to comment Share on other sites More sharing options...
Guest CaesarCornelius Posted June 24, 2004 Report Share Posted June 24, 2004 Hey My PPD test was positive too.. The worst thing was that the induration and erythema were HUGE on my arm. So everyone in my class knew (short sleeves) that I had a positive test. The other thing was that it hurt! I had remnents of that damn test 6 months after! I had to get a chest xray, even though i told them that i lived in france for a while (as a kid) and I got the BCG vaccination. They said "don't care, get cxray." At least I didn't have to take meds. If I were you, I would refuse to pay for them. Some places REQUIRE a negative tb test.. DoH! I don't know how it will affect me (and now you) down the line. I guess some hospitals you go might go to during 4th year for electives require an updated ppd test.. The doc told me just to come and get a chest xray. No sense in putting my poor arm thought that. On another note, i asked my immunology prof about the possibility of becomming sensitized to the ppd by repeated testing. He said it was highly unlikely due to the delivery method (under the skin). I was looking into going back to france this summer and doing an elective. but one of the criteria for being 'accepted' was a negative TB test.. I nearly fell out of my seat! Imagine that, they make me positive and then say I can't go back there! Serenity now! CC Link to comment Share on other sites More sharing options...
Guest noncestvrai Posted June 24, 2004 Report Share Posted June 24, 2004 Wait I'm going to Europe in like 5 days should I get my second PPD done before leaving? The first was negative 10 days ago. noncestvrai Link to comment Share on other sites More sharing options...
Guest FrenchyMed Posted June 24, 2004 Report Share Posted June 24, 2004 No alcohol??? This is crazy!!! Maybe I should wait until after orientation to start the meds... noncestvrai, where are you heading? I'm going to Paris in August. I wonder if they'll let me into the country with a +ve PPD. :rolleyes In Canada, is the BCG given systematically to kids? I'm looking at my immunization record and I don't see it mentioned. It does state that I've been tested several times for TB (all -ve until today). Link to comment Share on other sites More sharing options...
Guest therealcrackers Posted June 25, 2004 Report Share Posted June 25, 2004 BCG is NOT given in this country. A lot of people who emigrated from Europe (central or east) did get it, so they can't use the Mantoux test on them. Link to comment Share on other sites More sharing options...
Guest CaesarCornelius Posted June 25, 2004 Report Share Posted June 25, 2004 Hey Sorry if I have caused confusion. I was looking at going to a hospital to work in france, they said you needed a -ve ppd... I wasn't talking about going to france in general. They don't care about your ppd status, or at least, they don't ask about it. CC Link to comment Share on other sites More sharing options...
Guest T dawg 2004 Posted June 25, 2004 Report Share Posted June 25, 2004 i've had numerous tb skin tests (almost one a year, every year)... and this year(i.e. i just completed a 2 step) it's flared up a bit more than normal (i.e. it's pretty borderline - sitting at 8mm in diameter... with a big itchy spot...) so i think that i'm developing a reaction from having been exposed to the tb antigens (my first step was worst than my second in terms of flare up). Does anyone know if at Western they make you do ANOTHER round in August, if you've just had one done this summer? Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted June 25, 2004 Report Share Posted June 25, 2004 Hi there: Strange thing. A dear friend of mine was recently diagnosed with active TB and she lives in Paris! The stats on this France thing I'll have to check out.. Link to comment Share on other sites More sharing options...
Guest noncestvrai Posted June 25, 2004 Report Share Posted June 25, 2004 Yay, I will be in France in august...this soooo reassuring. What about England, Holland, Sweden and Germany...also some of my destinations? noncestvrai Link to comment Share on other sites More sharing options...
Guest gucio93 Posted June 27, 2004 Report Share Posted June 27, 2004 Hello! You may want to check out if the +ppd prevents you from doing an elective in France ... as it is only a screening test its positive results should theoretically be used only to promote further, more specific testing (like a CXR) ... I know that medical schools in Canada only require the ppd originally because most people will have a negative one and will not require further testing. For those who have a positive ppd (like me - most likely do to BCG) a CXR is all that is required. The medication, in the face of no symptoms and a negative CXR, is recommended by most articles; hover as public health legislation stands right now it is not required, nor can it be required by the school to insist that you take it. The theory behind the medication is that, once exposed to tb, you have a lifetime risk of developing active TB of 10%; taking the medication reduced this risk by half, but does not eliminate it. The medication also is not free of side effects, one of the most serious being the potential to develop drug-induced hepatitis (hence no drinking - don't want to add other insults to your liver) ... and the older you are (notably past the magic age of 30) the higher this risk is. Personally, I have decided not to take the medication ... my reasoning is that I will have regular follow-up and will be able to get on top of things quickly if disease develops (still a remote possibility). The other reason being that taking this medication for nine months still does not eradicate the possibly of developing active disease and, being as I work in the hospitals, I am still at a high risk of re-exposure - the medication will not safegard against that future possibility either ... It is a tough decision and must be an individual one, but I would encourage you to make an informed decision Link to comment Share on other sites More sharing options...
Guest mydream88 Posted June 28, 2004 Report Share Posted June 28, 2004 I was born in South Africa and was therefore vaccinated for TB. I know this sounds like a stupid question but: 1)is the Mantoux test the same as the test where they prick your skin then check for flair up after 2 days? If so, then i have been negative for that test 2) if not, then what is the Mantoux test? thanks, mydream88:) Link to comment Share on other sites More sharing options...
Guest FrenchyMed Posted June 28, 2004 Report Share Posted June 28, 2004 The Mantoux test consists in injecting a small amount of tuberculin under the skin and checking for a reaction. Link to comment Share on other sites More sharing options...
Guest mydream88 Posted June 28, 2004 Report Share Posted June 28, 2004 thanks FrenchyMed, I think that is the test I had before. Argh, that must be so frustrating for you, I am really sorry that you have to deal with all this.:rolleyes good luck, mydream88:) Link to comment Share on other sites More sharing options...
Guest blinknoodle Posted June 29, 2004 Report Share Posted June 29, 2004 hey mydream, I'm just curious.... I wonder what it means if you are not reactive to the Mantoux test but have had a previous BCG immunization..... I know many people who had BCG immunizations and they had huge Mantoux reactions. hmm, indeed. Does that mean the vaccination didn't work? But then again, I knew BCG was a fairly shoddy immunization for adult TB anyhow. Cheers, -bn Link to comment Share on other sites More sharing options...
Guest cradlecrotch Posted June 30, 2004 Report Share Posted June 30, 2004 Guys, the meds would be isoniazid + vit B6 for 9 months likely with monthly liver function tests, not rifampin so dont worry about not being able to drink alcohol and orange urine... I went through this myself. Link to comment Share on other sites More sharing options...
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