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Advice about TB Testing

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Positive but Latent TB test result

Feb 2013

My 21 year old daughter had a routine TB test for a job.I was shocked when she tested positive.She then had a chest X-ray which was clear.She was told she has latent TB and that over 90 percent of people will not go on to develop active TB.She is also not contagious as long as it remains latent.I read on line that one third of people world wide will test positive and have latent TB.It was recommended to her that she takes certain strong antibiotics for a nine month period and then she will no longer have latent TB in her system.While taking it one needs to be monitored for liver damage.What if she does this and then somehow gets exposed again and is latent again without even knowing?It seems like side effects of taking this medicine for 9 months makes it not a reasonable thing to do.We have no idea how she was exposed in the first place as she has never been out of the country or in any high risk situations.I would love to hear from others who had positive tests and what they did about it. Anon


I was in the same situation in my mid-20s (about 10 years ago) and decided to do the 9 months of antibiotics. I have mixed feelings about it. As a public health worker (ironically I was about to start grad school for my Masters in Public Health when I got the positive result) I understood the rationale for doing the antibiotics (INH). Basically, a healthy person can contain the bacteria and not develop active TB but if you become immunocompromised (chemo, HIV, another chronic debilitating illnes), the TB can become active and then you'd need to do 1 year of even more toxic drugs while you're dealing with whatever else is going on. I opted to take the meds and kill it while I was healthy. I have mixed feelings about that decision because I'm now dealing with fibromyalgia that I'm pretty sure is related (my symptoms started around the same time I started the drugs). I'm now doing some intensive alternative medicine to try and deal with this since Western medicine doesn't have crap to offer for fibromyalgia. My main recommendation would be for your daughter to work with an alternative medical providers (Ayurveda/Acupuncture) to support her liver through the process. All my symptoms now are consistent with liver issues (I've never been a drinkers, never had hepatitis, etc) and it's pretty clear to me it's from the INH. Happy to talk more offline. Jaime
The same thing happened with my daughter when she was about 9 years old. She did take the medication for 9 months - her doc was adamant that the 10% risk of getting TB was too much or a risk to take with her life long health - that having it erupt latter in life would have big consequences for her quality of life. It also becomes a public health issue - a public health nurse was notified that my daughter had tested positive and she called on a regular basis to make sure she was still taking the drug). My daughter did have to have some blood tests to monitor liver function - no problem there. She does have some funny immune-response reactions though - will never know if that's just the way she is or if the drugs could have caused this (it is a potential side effect).

We have paperwork to document that my daughter's chest x-ray was negative and that she took the med - we have to produce this for every new transition that requires proof of immunization etc. She will test positive for the rest of her life.

As far as where she picked it up - we will never know for certain, but I am sad to recall that one weekend we contacted a day labor organization for help with deep cleaning of the house - the woman who came was obviously very ill, coughing and coughing and coughing - we felt terrible, brought her beverages, asked her to rest, eventually told her we were fine, that she could go. Our health nurse reported that it could have been then (although normally, you need to be in tight quarters for a period of time, or, in any region where there's lots and lots of people from all over the world with different health protocols, there is more risk of exposure.

The one other thing, in retrospect, that I would have done is have her re-tested - sometimes there can be false positives with a TB test. committed to the health of the community


I worked as a TB educator for years and my husband had a surprise positive TB test a few years ago so I know quite a bit. First for those out there who do not know a positve TB test means you have been exposed to TB, that your body walled off the infection and you DO NOT have active disease as ruled out by the chest x ray. You CANNOT spread it to others but you can at some later point develop TB disease. In your daughter's case, while it is true that she does not have TB there is substantial risk that when she is much older or if she develops any type of severe infection or chronic illness she could infact develop TB. While the drugs she would take to illiminate the TB infection are harsh, at 21 the risks are minimal and the drugs are MUCH less harsh than if she one day develops active TB. The monitoring is thorough and if any problems develop related to her liver function they can be discontinued and her liver will recover. The benefits of taking the medication to illiminate the infection at her current age and good health should not be underestimated. Her liver is young and healthy now and the drugs will prevent the possibility of TB later when she may not tolerate the drugs as well and her life and health may be compromised. When you have active TB you take multiple drugs for a minimum of 18 months. At this poiint she will only need 1 or 2 drugs for 9 months. Please encourage her to do them now. In my husband's case his positive test came at age 41. After age 35 the risks to the liver increase dramatically. He did try to do the drugs but his liver could not tolerate it. Now he will be TB positive for the rest of his life and there is always the possiblity of he will develop TB! If you want more information I highly recommend contacting the TB clinic at the City of Berkeley. They are extremely knowledgeable and will answer all of you questions. better safe than sorry
Hello. After living abroad (Spain), I came back to the States and had a positive TB test. That was 20 years ago when I was 18. I had a chest x-ray, which was clear. I was put on an INH treatment (pills). It was not a 9 month long treatment, but it was many weeks or maybe a few months. I do not remember it being threatening to my liver or being monitored for adverse side effects. I am wondering if alternate treatments are available to your daughter that have fewer side effects. Or, perhaps the science that treated me is old. I was told that I will always test positive for TB, so throughout my life since then, when a TB test was required, I have been required to get an updated chest x-ray. It's a hassle and expensive, but it's not rare. I hope there is an alternate treatment out there for your daughter. anon
I would get a second opinion on this, because that regimen of antibiotics seems too extreme, esp. since her chest x-ray is clear. My husband (a teacher) tested positive for latent TB over 18 years ago (he was probably exposed during an extended stay in eastern Europe). Once his chest x-ray came back clear, that was that-- no antibiotic treatment at all. If she has only had the Mantoux test (the skin prick) she should also give a blood sample and have an interferon gamma release assay (IGRA) run on it. This will rule out a possible false-positive result from the Mantoux. There are certain underlying conditions that can cause a false positive. Kristen
I would not worry about it too much. Many people turn positive in the course of their lifetime and most of them opt not to take the anibiotics course. As you said those are strong anitbiotics with harmful potential side effects. I would also make sure that whoever read the positive test is an experienced reader, ie somebody who routinely reads 100s of those tests, not your local primary care. A reddened area is usually not considered positive unless it is clearly swollen/raised. RN
When I was about 20 yrs old, I applied to volunteer at the Berkeley Free Clinic and tested positive on a TB skin test. My chest xray was negative and I took antibiotics for the prescribed amount of time. At the time, I was delivering meals to AIDs clients as a volunteer. It was possible that some of the clients had TB. Anyways, I'm in my mid-30s and work as a nurse now so I'm screened every year for TB. Since I tested positive in the past, I will always test positive in the future so I'm not required to do a skin test. Instead, I'm supposed to get chest xrays every few years. However, employee health told me if I'm not showing any signs/symptoms of TB, xrays aren't needed that often because of the risks from radiation exposure. Hope this helps
I had a positive TB skin test years ago. I also had an x-ray, which proved I did not have TB. A positive skin test just means that you were exposed to the bacterium, not necessarily that you had TB or are infectious. Taking meds for a positive test is routine in case the TB is latent, and in the rare chance that it will turn into full-blown TB. I did take 6 months of INH, and I had no side effects. The pills were kind of large, but other than that it wasn't a big deal for me.

My current boss, who is a physician, told me that the skin test result I had was likely a false positive. I don't know why he thinks that, but that is another possibility. I wouldn't worry about it. Your daughter should probably take the meds just in case, so that she can be done with it. Also, in case she ever wants to volunteer with kids, a negative TB test or treated positive with clear x-ray might be required (it is in my son's school district). They were not phased at all by my history of a positive test, since I did the routine x-ray and INH treatment. Not worried


I tested positive for TB several years ago during a required yearly TB test because I was a regular volunteer at a school. All of a sudden it went from ''normal'' one year to ''big raised bumps'' the next. I also had no idea where I had been exposed but my primary care physician said it was very common in the Bay Area (working with kids, riding BART, traveling on planes were all mentioned as possible exposure means). My chest x-rays have always been clear. My doctor recommended I complete the antibiotic course before I turned 50 (I first tested positive in my late 30s) because the chance of getting tb in my 70s would be much increased and harder to treat. I was also concerned about getting antibiotic resistant tb in the future.

It took me a few years before I was ready to do the drug therapy but I completed it about a year and a half ago. My doctor felt that 6 months of antibiotic therapy (isonaizid in my case) was adequate (I believe there was some recent research that indicated most of the benefits were obtained with a six month course with only minimal gains for continuing on the drugs.

I did baseline liver testing before beginning the drugs, tested again a month into it and at completion. It is important to do the liver tests if you have certain conditions or drink alcohol (which you can't do at all on the drugs)

Once you have latent tb you will always test sero positive on the skin test. I get a chest x-ray when needed. My doctor has also provided me with a letter that indicates I completed the therapy course and had clear x-rays. While I was on the treatment at least five friends told me they'd also tested sero positive and completed the treatment.

Hope this helps. been there and did the abx


So sorry to hear that you and your daughter are grappling with this decision. If your daughter goes without preventive measures and does develop TB, her illness could well be very serious. She would also pose a serious risk to those around her (think your grandchildren in the future!). The preventive and treatment measures are better tolerated in younger people, so that should be taken into account. It is not nearly so likely that a 21-year old would be exposed in the US as in many other regions of the world, so if she has spent time in a region with endemic TB, that may be an explanation for her exposure. In most US populations the chance of reinfection is quite low. Please encourage your daughter to talk to her doctors. Also, do get multiple opinions if you are not convinced that a well-monitored preventive course is at least a reasonable course of action. There is risk either way, so keep asking questions.

Just a few resources that could provide information for you.

http://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm
http://www.acphd.org/tb.aspx

In general everyone should note that prevention of TB is a public health concern, and resources do exist to treat those who cannot pay. http://achealthcare.org/ -- Not a medical doctor, just concerned.


Did she get a blood test or a skin test? If she got the skin test, ask for a Quantiferon blood test. Some private practice doctors who don't see much of a high risk population for TB may not be using it as much as they should. It's newer and more expensive but more reliable than the skin test. If she has no known exposures and it was just a positive skin test, then most likely the Quantiferon will be fine. If she had a positive Quantiferon then she's best of taking the 9 months of medication. Yes, most people who have latent TB don't progress, but a 10% risk of progressing to active TB is substantial. The risk of dying or having permanent disability from letting latent TB potentially progress is worse than the risk from taking 9 months of INH -- particularly for a 21 year old, as the risks of INH are lower the younger you are. doctor at an immigrant clinic
Our son took TB test as part of college admission and also to our surprise tested positive but was also latent (rest of family got tested and no one else tested positive - he could have been coughed on anywhere!). The issue is that while healthy people are highly resistant to developing full blown TB, anyone with compromised immune systems (malnutrition, autoimmune illness, chemo/radiation) are HIGHLY susceptible. And you can have active TB and not know it (hence who knows where your daughter/my son was exposed). By the way, if he hadn't taken the drug protocol, he WOULD NOT HAVE BEEN ABLE TO RESIDE IN THE COLLEGE DORM! So its as much a public health issue as well as a personal health issue (your daughter's health status could change, lupus, mono, all kinds of autoimmune illnesses could activate the TB virus). For evermore, he will test ''positive'' and will have to have doctor's ''note'' that he successfully completed the drug regimen in order to negate the positive test. Many jobs require TB testing (especially food, teaching professions) and either a negative or a ''proof of regimen completed'' is required to have the job. In terms of the regimen's safety, one very important issue is NO ALCOHOL can be consumed during the 9 month regimen (and the drug must be taken regularly or the TB virus just becomes resistant). This was impressed upon our son - he successfully completed the regimen without any issues and just has to deal with always having to explain a positive TB test. anonymous
Hi, I didn't see the original post, but I want to second what one person suggested about the Quantiferon blood test. I tested positive in a TB skin test, and was told by a Kaiser doctor that I needed a chest x-ray and antibiotic treatment for months-- this was causing me all kinds of stress since I have a history or allergic reactions to antibiotics and am breastfeeding currently. Long story short, a simple blood test showed that the skin test was a false positive-- I had never been exposed to TB at all. I am SO GLAD that an alternative doctor suggested the blood test- saved me a lot of stress! been there
I missed the original message, so I'm not sure about the age of the child that tested positive for TB. If your child is 5 years old or younger, please understand that the risk for progression from latent TB to TB disease is significant.

From the CDC: ''Because of their age, infants and young children with a positive TST reaction are known to have been infected recently and are at high risk of rapidly developing TB disease. Infants and young children are also more likely than older children and adults to develop life-threatening forms of TB disease.''

The advice of previous posters suggests that a decision to treat your child for latent TB is made on the basis of protecting him/her from disease in adulthood. It is true that latent TB can progress to TB disease many years after infection (especially during periods of stress or other illness), but children can and do develop TB disease! Get advice about whether to treat your child from his/her physician and the health department. A Public Health Professional


Positive TB test for very healthy 10 year old

Oct 2007

Looking for recent experience with a positive TB test in a very healthy child (age 10). Our doctor wants to treat with antibiotics ( a 9 month course) even though a chest x-ray shows no sign of active TB. The rest of the family is in the process of getting checked out. I have a consult set up with an infectious disease doc, but was looking for any other parental views on this. Just not comfortable yet moving ahead on the treatment. ANy thoughts/good resources to consult with on this issue? I am told it is not that uncommon but the news really threw me. Sign me..cautious about treatment


Hi. The same thing happened when my very healthy daughter was 9 years old. A positive TB test just means that she was exposed to someone who had an active case of TB. In the bay area, sadly, this is not that unusual. We traced her exposure to a woman who cleaned our house.

The x-ray is to rule out that your daughter has TB. If she does not take the medication, there is a 10% chance that she will develop TB at some point in her life. Often, the disease will surface when the body is placed under extreme stress, the person is immuno-suppressed, or when the person is elderly. TB is a life changing, potentially life threatening disease.

Even though we weren't thrilled about putting our daughter on the meds, we decided that the disease risk was unacceptable. Also, we were surprised by how worked up people get about the fact that your child had a positive TB test. A lot of people did not believe that she did not have TB. It's nice to have a letter from your doctor saying that they do not have TB, have been x-rayed and undergone preventative treatment to put school officials at ease.

Now it's ancient history and we've moved on. Good luck with your decision. It's always something, isn't it?


Hi. I was also told by doctors at L. Packard that the chest x-ray would not show anything. So, they opted not to do one and just have the TB test redone for confirmation. To be honest, I would prefer to have the treatments rather than complications later on. anon
I have knowledge about TB, although I am not a physician so you will have to talk with them to make the final decision. This is standard for a positive TB test. Most people who pick up TB don't show active symptoms right away (fever, coughs, etc.). Instead, the TB goes dormant and sits in the body until the person is really stressed out and the immune system is compromised in some way. Then the person gets full-blown TB. This could take two, five, ten or more years. If it is not a drug resistant strain (most US strains are NOT drug-resistant), it can be easily treated, but it can be a dangerous disease for an unlucky few who get a worse version of the disease (very rare) and it is highly infectious to others. So, when a person has a positive test, they most likely have dormant TB (also called latent TB) so the standard procedure is to go on the anti-biotics for nine months. (I did this too about 13 years ago. Never had any side-effects from the medicine, which is the same drug they still use now.) Children do better with the drug than adults. It's the older adults that need to watch their livers, etc. but kids do great. Just don't use tylenol during the treatment (use motrin instead which affects the liver much less). This is standard procedure and safe. You really don't want your kid developing TB later. TB is initially scary to most people because it is a weird and complex disease, but the CDC guidelines for this disease are smart and safe. To tell you the truth, my 3 year-old is on the same drug now and I have a PhD and have researched this and I'm OK with it. (He was exposed at daycare.) Should you decide to go with the treatment, make sure your son takes the drugs for the entire nine-months or else drug-resistant TB could result. health depts are on top of TB because there are drug-resistant strains outside the US. The strains in the US respond to drugs and the CDC wants to keep it that way and protect our population. TB is weird but we are OK in the US
I don't want to give you medical advice so please don't take it that way, I am just sharing my experience. When my son was younger, the clinic we took him to did a TB skin test every year at his checkup (even though he has no risk factors for TB). When he was four, they said that the skin test was positive (didn't look positive to me, but what do I know). The chest x-ray was negative, but the doctor wanted to put him on INH (the antibiotics)anyway as a preventative measure. I was very wary to put him on those antibiotics because they PERMANENTLY impair your liver function - a fair price to pay ONLY if you really have TB. So I made a fuss and had them redo the TB skin test. They didn't want to do it because they said every time you repeat the test, you increase the chance of getting a false positive, but I insisted (A question I didn't think to ask until later - If repeating the test increases the chances of a false positive, why are you testing todlers EVERY YEAR?). The repeat test came out negative, and I had them write a note on his immunization card to STOP doing the TB skin tests. I have since found out that it is not standard practice to test a child with NO risk factors for TB, and that TB skin tests are notorious for giving false positives. I think I have heard that there is a more reliable test for TB, but I don't know what it is called or how to get it. My advice is to be very cautious, my experience in general is that doctors are liable to overtreat. No more TB tests for us
I was in the same position about 7 years ago. My healthy 10 year old had a positive TB test and negative chest x-ray. I agree with previous posters, please have your child take the treatment, don't let this become an active case of TB. 9 months feels like a long time but it's a blip over the course of a lifetime, and worth it to avoid a preventable disease. Permanent impairment of liver function is NOT a normal side effect of the medication. It's true it MIGHT affect the liver, but part of the treatment protocol is to have a blood test part way through the treatment to make sure the liver is functioning normally. If there are problems the course is discontinued. My child did not have problems with the treatment, and I hope your child will be fine too. Good luck. Been There

One-year-old tested positive, then negative

May 2007

My 12 mo. old recently had a TB skin test. Twice I was told that the results were positive at 10mm. The third person said it seems to be 8mm- which would be a negative result.So, they went with the 8mm and advised that there would be a retest at some point. Now, I am uncomfortable and wondering if this has happened to anyone else? Any advice would be appreciated. anon


Not sure if this answers your question directly but... You might want to check with a doctor from Infectious Disease (at Children's or elsewhare). A positive PPD is measured by the size of the ''bump'' (not what is simply visibly red) and there is a range of what is considered positive. ''TB Tests'' are really PPDs that test for a reaction to a variety micobacterial infections- not just Tuberculosis. My son is recovering from a non-tuberculosis micobacterial infection characterized by swollen cervical lymph glands. The infectious disease group at Children's Oakland figured this out by placing a PPD which came back positive, and we had pretty much ruled out the real TB. Your regular pediatrician should also know all about this, however. I'm curious to know why he had the PPD in the first place?

Toddler with positive TB test

July 2004

Our 2.5 year old son was born in Mexico and routinely given a TB test the day after he was born. As he prepares to enter a California pre-school, he has tested positive for tuberculosis, though his chest x-ray shows a negative result for the disease. A doctor prescribed a nine-month course of isoniazid taken daily, to satisfy state education authorities that the boy's condition was under treatment. However, after reading the catalog of side effects (including liver damage and hepatitis)we are concerned that the ''cure'' may be worse than the ''disease.'' Does anyone know if alternative therapies exist for inactive TB, and/or whether a physician's statement that the treatment is excessive and unnecessary would satisfy the authorities? Finally, does anyone know a good pediatrician who is willing to consider alternatives to standard overkill treatments? Many thanks... concerned parent


You may want to talk with Dr. Salzburg, of Kiwi pediatrics. We talked to her about TB and she told us about how US guidelines (specially re: school policies) are not up to date with research and about the cons of treating TB in children when the X-rays do not show sings of TB. Their practice phone number is (510) 652-1720 (Alcatraz office, they also have an office in Albany). E.
I go to Pediatric Alternatives in MIll VAlley 415-380-8448, run by two western trained women pediatricians. One is also an herbalist, the other a homeopath. I would give them a call to find out what they can do for you. best of luck. kim
Please, please reconsider doing the course of treatment with Isoniazid for your son's positive TB test. The positive test means that he has been infected with tuberculosis bacteria and they are living in his lungs. A 9 month course of isoniazid (once daily) will eliminate the bacteria and prevent him from ever getting tuberculosis. If you do not do the treatment, there is a chance he will develop active tuberculosis, which requires FIVE medications for an extended period of time, and the risk that he could develop disseminated disease and have long term complications. This is not something you can treat in other ways...I wish it were. I am speaking as a physician who has taken care of many, many children with positive TB tests and I can say that the complications/side effects from the medication are very rare...children actually tolerate the medication much, much better than adults do, and most have no problems at all with it. Please do your child this favor. Anon
I sympathize with you. Our daughter also tested positive, when she was just about to turn 4, and had a negative chest X-ray. I really agonized about putting her on the INH treatment regimen, and did a fair amount of reading on the subject. Our group of pediatricians were not very helpful or knowledgeable on the subject, and gave some conflicting opinions and advice. In the end, we went ahead and did the INH treatment, although only for 6 months (which was fine according to our new pediatrician). Currently the standard protocol is 9 months. The side effects you mention are really an issue only for adults; young children rarely experience them. And you can ask for periodic blood tests to be sure. I guess what persuaded me was the risk of developing full-blown TB as an adult, which would be so very much more serious than taking the medication now. Our daughter did have some problems with the liquid medicine--which at first caused explosive diarrhea. Web readings suggest that it is the sorbitol in the liquid that causes such problems. Many people preferred to use the pill form for this reason, and break it up and put it in food or juice. Good luck with this unpleasant situation. If you do decide to go ahead with the INH treatment, just know that the 9 months will pass much quicker than you think it will! Lori
My child also tested positive and was prescribed a full dose of INH. I felt that it was a false positive since he was given a TB ''vaccination'' at birth- dead cow antibodies to TB - required by the WHO in the country he was born in. I was totally panicked after reading the INH side effects too. After talking with several doctors (and friends who specialise in public health and community health issues) I decided to give the full course of INH to my child. The information that made me feel this was the best choice for me was:

1) The medicine-induced Hepatitis is an effect that is not mistakable and is remedied immediately by not giving more INH. The symptoms are immistakable and not vague: extreme fatigue (like lying down and refusing to get up), dramatic yellowing of the skin. These symptoms will go away within 24-72 hours of stopping the medication. 2) Impact to liver -- the most dramatic being the hepatitis -- can be mitigated by alternative treatments. I recommend seeing an herbalist.

3) Once the INH course is completed, he will have a super immunity to TB given that he has produced his own antibodies to having the virus present (ie the positive test) and the INH has killed the actual virus. This is important since most likely he will travel to areas with high risk of active TB exposure.

4) If for some reason his immune system becomes surpressed in the future, we will not have to worry about the TB choosing to activate itself at that time. Fighting the TB virus now when he is young and strong is the optimum situation for eliminating the TB virus in his system.

5) The medical community has to assume that a positive test equals a real exposure to active TB - which was a possibility in our environment. If there was a real exposure, then our child was in fact producing antibodies in reaction to the TB virus in his system.

If you refuse to fill the prescription, you will be hounded by the public health officials whose job it is it follow-up and make sure you are complying...I was called repeatedly and felt like I was treated in a very patronizing way when I made it perfectly clear that I was under a doctors supervision and was complying with treatment plans.

TB is a growing concern in the Bay Area and they are on high alert. One issue of concern is that if a kid tests positive, they assume it is from exposure to active TB in an adult. It is their job to find that adult. In our case I was sure that if there was an exposure, it was from people in another country (the entire immediate family and siblings tested negative). This did not placate them.

I would recommend doing something to address the negative impact of taking such a strong antibiotic for a prolonged period. Read The Yeast Connection.

Make sure it is noted in your childs yellow vacination booklet that they received INH treatment - since this may come up again in the future.

We did fine and had no noticable impact with the INH. I learned that several other kids in the class were taking it too. Unfortunately, the thing I want to know the most I cannot verify, which is, if there was TB virus is it now eliminated. Good luck making your choices! Been there too!


My mother was exposed to TB as a girl (in another country) and it was inactive most of her life. How I wish she had received the ''overkill'' treatment at some point! Her inactive TB was never treated until it was too late. She was put on prednisone for another condition in her sixties, and it apparently lowered her immune system so that her inactive TB became active. She developed tuberculous meningitis and went into a coma rather suddenly. She was put on all the medications, but it was too late. She died without ever waking up, before I had a chance to say goodbye.

TB is a really virulent disease that can strike at any time if it is inactive. For the sake of your child's future, please go through with the isoniazid treatment. I can't tell you how agonizing it is to watch your mother die and to know that the proper treatment existed, and that my wonderful mother would have been alive today if it had only been given sooner. Still missing her...


My husband tests positive for TB because he was exposed to Valley Fever while working as an archaeologist. In Arizona this is commonly known as a reason for a positive, symptom-free TB test. Maybe your child has been exposed to Valley Fever instead?

I'd get a second and third opinion before I did medication for a disease your child may not have. Stefani


Gosh, I just had to respond. I felt I needed to make a number of points.

First, You say you believe the TB is inactive. TB is very slow growing. Just because there is no X-Ray evidence does not mean that it is inactive. It has been active enough to cause his skin test to react. It is fortunate that it has not caused active disease in his lungs yet. If you wait long enough without treatment, it will appear in his lungs or some other organ.

Second, In my opinion, TB is much worse than the treatment. It can cause permanent lung damage, it can infect many organs in the body and it can and does cause death. Even today, people die from TB. And there are new and drug resistant strains of TB. (The resistance has been caused by people ending their treatment early and allowing the most resistant bacteria which are still alive in their bodies to multiply and spread.)

Third, I understand that the list of side affects from the medication is frightening. However, it is important to understand that the vast majority of people who take this medication never experience these side effects. Discuss with your child's doctor the incidence of each side effect, or the ones you are most concerned about. This may provide some perspective.

Finally, I would ask for information about the kinds of side effects that are most common in 2-3 year old children. Children react differently to medications compared to adults and the side effects listed for a medication usually refer to adult side effects.

I don't discourage your looking into alternative treatments, but I encourage you to thoroughly consider the advice of your physician. Be aware that the medical community has extensive experience treating this disease and there has been a lot more recent work on treatments, since the drug resistant strains have appeared. If a treatment fails (whether traditional or alternative), the only way you will know is if your son has X-Ray evidence of a TB infection. You have to be willing to take that risk. Anonymous and Concerned


I am an Rn, although I haven't worked for 15 years. Unless I am mistaken, a positive tb skin test only means that a person has been exposed to tb. ie the body has had enough exposure to mount a response to the antigen(the tb) but not necessarily enough exposure to result in the disease. Once exposed, the body reacts by developing antibodies. The presence of the antibodies result in positive tb test--the antibodies attack the killed mycobacterium given in a tb test, resulting in the redness and swelling at the site of the injection.

Unless your son has a positive chest xray, or sputum test-- (which I'm not sure they still do) or is sympotomatic in some way--chronic coughing? I can't understand why anyone would recommend treatment. There is nothing to treat unless he has the disease. Tons of people have positive tb tests, and no disease.


are you sure your child got a TB test in Mexico? or maybe got a vaccination? - these ARE routinely given in mexico though I don't know what age. if he or she just got the test right after birth - how would the exposure have happened? in utero? - doesn't make sense to me a test needs to be read by a medical person 48 to 72 hours after it is given - do you know if this was done?

on the other hand, if a vaccination was given, he or she will always test positive and will need the chest xray instead for all the activities in this country that require a test. ilona


Drop-in clinic for TB test

April 2003

Can anyone recommend a drop-in clinic for the Mantoux (using a needle under the skin) TB test in Berkeley ? I need to get tested but getting to my doc's office in the city is a hassle. Thanks, RK


I'm not sure if ''Mantoux'' is different from the regular TB skin tests that one normally receives, but the Berkeley Free Clinic does them in the evenings from about 6-8pm on a drop-in basis. You just call at 5:45pm and ask if they can take you. Call ahead to double check because it's been awhile since I've known anyone who's been there. paula
University Health Service (Tang) did this for me for free a couple of years ago. I tried to pay, but since I worked on campus they considered it a covered expense even though we didn't have them as our primary care doctors. Anon
The Berkeley Free Clinic does same-eve TB tests for anyone; you need to call them [510-548-4811] at 5:45pm [no earlier] on any weeknight [except Thursday] that you'd like to be seen and the Medical Appt. Taker will sign you up for an appointment after 7:00 pm. The appt. lasts about 20 minutes and you need to come back 2-3 nights later for the results and the verification slip. It's free, it's great, and although your test will be done by a [very well-trained] medic, not a professional, it's a totally acceptable and excellent service. Oh, did I mention FREE? Although donations are welcome! If you have questions you can e-mail me directly. Jean

Daughter tested positive for TB - false positive?

April 1999

Our daughter has tested positive (14mm) to a TB skin test. We are both negative and can't figure out where she could have been exposed. She does not have TB and a chest X-Ray was normal. We are even wondering if this is a false positive, which are not uncommon. It has been recommended that she take the 6 month course of Isoniazid. Has anyone had this experience or treated active TB with this drug? How did your child fare? Any tips on getting two large pills down a 5 year old everyday? Thanks.


About ten years ago I also tested positive for TB (skin test) but my chest x-ray was fine. I did not have TB, but my doctor at that time (a new grad from medical school I think) prescribed some pills for me which I was told would have some side effects with the liver. I never took those pills. My pediatrician who had worked in Asia told me that many people from Asia had (chicken pox? I don't remember ) immunization shots when when they were young -- which is exactly my case-- and would test positive on the skin test even though they do not have TB. I wonder if your daughter's situation is the same. If you like, I would be happy to give you the name of my pediatrican -- just email me through this list).
I know nothing about TB, but I have LOTS of experience with giving medincine over a prolonged period to my daughter (unfortunately). I'd be glad to give suggestions about giving your child the medication if you chose to go that route. Also, it is possible to get any medication flavored to make it tolerable to kids. A pharmacist on the East Coast developed very strong syrups that mask the flavor of practically any medicine after struggling to get lots of bad tasting medicine down his kid, who has epilepsy. There are pharmacies in California that will mix up your kid's medicine in this syrup and fedex them to you. I can find the number for one of them, if you'd like it. (I think these syrups are used at the pharmacy at Fresno Valley Children's Hospital.)
False positives can certainly happen with TB. But if you don't know where your child was exposed, it would be good to double check her possible sources, such as day care providers, other sitters, etc. I would get another opinion before starting on a course of isoniazide, because many TB strains are resistant to that drug. You can contact Children's Hospital in Oakland, where they have a specialist in pediatric TB, Dr. Ann McLaughlin. She is well known for her expertise and has access to other professionals who work in the area of TB, so could get others' input if necessary.
Which kind of TB test did your daughter take, the one we all had as kids (quick scratch on the surface) or the mantoux (needle under the skin, a more expensive test)? Dr. Ralph Berberich, my son's pediatrician, says that recent studies have shown that the old test has so many false positives and false negatives that it is worthless and shouldn't be used. The only reliable test, he says, is the mantoux. He cited medical organizations/agencies that shared his view. If your child had the discredited test, perhaps you don't need to be worrying how to get pills down a 5 year old's throat.
To the parent concerned with his or her child's positive TB test. Has your child ever traveled out of the country, and received an immunization shot? The reason I'm asking is because, coming from Peru as a child I was administered a shot that always counteracts with the antibody found in the TB shot. I have always shown to be positive, and after about 5-6 tests, chest X-Rays, and taking those nasty pills, my doctor decided it was not necessary for me to be exposed to such things. My body was purposely exposed to the causing agent, but never had the reaction. From this day on I will always test positive in my TB shots, but I was warned by my present doctor not to allow anyone to administer the TB shot because it was doing me more harm than good. I don't remember the name of the immunization that I was given, but I am sure that your pediatrician is aware of it. A doctor once told me that most native Filipinos and Latin Americans will show a positive TB result, only because of the immunization given to them at an early age. This in no way shows that they have ever had the infection.
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