Should I be worried about my TB test?

Take two deep breaths and call me in the morning.

Why do you need a second TB test?

Don’t worry until you have a doctor / medical professional read it as positive and then get antibiotics.

@gailcalled It’s required to have 2 TB tests done and come back negative.

Why? For what?

To be hired at a daycare. I have the job, just need this last test to come back negative to start working.

Do not worry.

Hmmm. I am not a doctor, but here is what I know. If you come back positive that is positive for exposure. You will be required to take a chest xray, and as long as it is clear, which I am sure it will be, you won’t be required to do anything else, and you will be allowed to work (why do you think you won’t be allowed to work? Did they say that?). You do have the option to take antibiotic if you are positive to exposure, a lot of doctors won’t even tell you about the option. It does reduce your risk of ever developing the disease, but the risk is rather small anyway. Two people I know opted to do the antibiotics, the other people I know never did.

Once you are positive for exposure, it is recommended to not get any more TB tests because the reaction can be very bad. Plus, once positive you are always positive, because it is positive for exposure. You will always come up positive, and always be required to get an xray. But, since you had the tests so close together it has me wondering if you are reacting more where they gave you the shot because you have a little of the first shot in you, but not positive for TB.

Following along with my thought process, maybe there is a good chance in 48 hours it will reduce and show as negative. But, I am just sort of guessing from the pieces of info I do know about the test.

I don’t think you should be worried.

If they didn’t call you in and start treatments right away, I would not worry about it. In some parts of the world they use TB vaccines which will give a positive result on the normal US test, in which case you will need the chest xray.

The vaccine isn’t used in the US or Canada much because the risk of exposure to TB is lower than the risk of side effects from the vaccine. That and it can mask the TB tests.

@WestRiverrat The test hasn’t been read yet.

The bump could be the sign of a false positive

How to read a TB test skin bump

If you think that worrying about it will help you pass the test, then by all means worry as much as you can. Otherwise…

@CWOTUS My thoughts exactly. What will worrying accomplish? Wait until your doctor tells you what it means.

Here’s what I know: you get a tb test, its negative. Then you get another, then another. This makes you come up positive, then you need a chest xray, then you need antibiotics for six months. Here’s the reality: You can have false positives from tb tests. Why are you even having them? I’ll tell you why I had them, I was incarcerated. You can only have one or two before you come up false positive, you should only have them every five years or so, so unless you are being forced to have them…why?
’

When someone is being hired for a job where TB screening is required you are given 2 tests, usually one to three weeks apart. The second test is done because the first could be a false negative, especially if you have never been tested before or not for a long time.

You can’t read the test until at least 48 hours after it was “planted” and if at that time there is still some redness and swelling you wait an additional 24 hours for the final reading. To be positive the raised area is usually required to be at least 10 cm, depending on your health. Positive means you have been exposed (have antibodies), not that you have active disease. I wouldn’t be concerned unless the raised area is getting bigger and more swollen.

I get tested every year at my job. When they first give you the test you have a raised area that gradually goes away after a few hours. Mine always turns purple because I tend to bleed, but by 48 hours when they read it by gently rubbing a finger over the spot there is no swelling.

Some people just aren’t very good at poking others with needles. I’d bet that your second “nurse” or whoever it was .. got a little punchy with the needle is all.. not to worry.

@bewailknot I have never heard of testing twice close together. I worked at a hospital and it was once a year. I realize working with children might have different parameters, but it sounds ridiculous to me. I certainly care about the spread of TB, but that seems like overkill. Especially if the person appears to be in good health with no cough. Luckily TB is not very contagious, not like Measles for instance, but of course all TB patients with active disease should be kept separate from the population if deemed contagious. We only check for active lung TB routinely, but it can be in other parts of the body. I don’t know how contagious it is when in other areas of the body.

@JLeslie I work at a hospital. Ongoing employees are tested once a year but the standard is for new employees to get a “two-step” tuberculin skin test (TST) if the first test is negative.

@bewailknot We didn’t do that at my hospital. Is that hospital policy or state law driven? Can the tests close together more likely produce a false positive?

It makes no sense to me. Why would a new employees negative test be any different than a person who has worked there 10 years negative test?

The hospital I work for also does a two step skin test (PPD) for new hires and then a yearly test for everyone else. This is the first place I’ve worked at that has done the two step skin test, but it seems to be a lot more common these days. The recommendations for routine TB screening has changed a bit over the years.

@Mtrencher For some people, it’s common to have an initial reaction to the injection. Usually that goes down by the time they actually read the site for the result. If it does come up positive, you should be sent for a chest x-ray (as other’s have mentioned). I hope you can find a way not to stress about this too much. You’ll have your results soon. I personally wouldn’t be worried by what you have described.

@JLeslie recommended by department of health and CDC.

The difference is – has the person been tested regularly? Take the example of someone who had only been tested when he started a healthcare related college program – it was negative. When he started his second year the new test was positive. The only known exposure had been as a small child to a relative with active TB. His conversion was reported to the health department, and the doctor decided he did not have active disease.

@bewailknot That makes no sense to me. Very few people know when they were exposed. If I have a negative PPD it can be a false negative or actual negative each time I do the PPD. I don’t see why statistically it would change the second time. If someone is negative the first time, and then positive a year later, most likely he was exposed during that year. So? Is it possible the first was a false negative PPD? Sure. Not likely, but possible. So? Why would it matter where it was contracted? Even if he had known he might have been exposed years before, he also might have been exposed in that one year between tests. No way to really know.

If a relative had active TB then all relatives who come into contact with that relative would have been routinely tested for exposure. People all over America are positive for exposure, we only worry about the active disease. Most people do not treat when there is a positive PPD and negative chest xray.

TB is always reported. Active disease within 24 hours of diagnosis. I think Latent is within 72 hours, but check me.

@JLeslie The CDC says “Two-step testing is useful for the initial skin testing of adults who are going to be retested periodically, such as health care workers or nursing home residents. This two-step approach can reduce the likelihood that a boosted reaction to a subsequent TST will be misinterpreted as a recent infection.”

@bewailknot Do you have the link? Why is it important to know if the infection is recent or not? So, you either caught it in the last three months, the last year, or 20 years ago, but the first PPD we gave you was a false negative. So? Most people I know who are positive are addicts or hospital workers. I know one person who never worked in a hospital, never worked with children. None of these people know where exactly they contracted the bacteria. We can assume the hospital workers got it working in the hospital. So? If they had a wave of multiple positives, especially in one wing of the hospital they might investigate, that would be useful. But, the one new employee being retested would not tell you a bunch of employees working on that wing are also suddenly positive.

From your quote it does not say it is required to do this two step testing, but maybe it is recommended? Honestly, just because the CDC recommends something doesn’t mean it is a great idea. I had tetanus shots 5 years apart that should be ok, but I had a bad reaction, which I had never had in the past and my tetanus titer is extremely high, and I wonder if some of my chronic health problems are related. My mom who used to work in vaccinations for the FDA is horrified by my titer number. Thank goodness I was alert on my ER admission a few months ago and could refuse the shot, I really need to get a bracelet. But, the protocol is my vaccination should have been just fine.

Don’t get me wrong, if I were convinced it truly is much better for the greater popuation to do this two step testing I would agree we should do it. But, I am not convinced it is better. I also think possibly it might increase sensitivity to the test with more likelihood of false positive, that is unclear to me, and what I hate about that is once positive the person os destined to a chest xray every year for the rest of their life, or at least their career in that field. I’m pretty negative about unnecessary xrays.

@JLeslie http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm It is way down the page. Sorry I haven’t learned to link otherwise.

Ok, so it seems like a recommendation not a requirement. It also seems like they are talking out of both sides of their mouth. Two tests will likely stimulate the immune system, but two tests are not contraindicated in any way. What if the immune system is stimulated to give a false positive? It says a persin with exposure many years ago might deliver a false negative. Well, if they infection was active I would think it would register very postive, and that is the main heath concern, active infection. I really really think the CDC would come down on the side of not giving a shit if people need to get an xray every year as long as it is more likely to prevent infection overall in the population. I like the idea of protecting society from TB and any ID, but not to the extent of creating false positives. I don’t know for sure it does create false positives, but it seems like it would.

@JLeslie The hospital where I work used to give everyone a chest x-ray every year. I am not sure when that stopped (never really), but we have several employees who have worked there more than 30 years (one more than 50) and their health folders are full of old x-ray reports.

@bewailknot That makes me sick.