Tuberculosis test

[griffon2011]

I was taking care of an individual who in addition to the initial illness was found to have pulmonary tuberculosis.  As I was in close contact with this individual I am concerned and would like to be tested.  In the event that I test positive is the Thai equivalent of the US Center for Disease Control (CDC) required to be informed and would this affect my retirement visa or stay in the country? 

[Sheryl]

There is no exact Thai equivalent to the CDC.

 

Statistics on numbers of cases of TB are reported to the Ministry of Public Health but nto names.

 

No effect on your visa.

 

 

[griffon2011]

3 hours ago, Sheryl said:

There is no exact Thai equivalent to the CDC.

 

Statistics on numbers of cases of TB are reported to the Ministry of Public Health but nto names.

 

No effect on your visa.

 

 

Thanks!  I was a bit concerned of what would happen if I tested positive.  

[MeePeeMai]

If you test positive you will get a chest x-ray and be put on oral antibiotics for an extended period of time.

 

I tested positive in Hawaii when I was just 18 y.o. (58 now) and had to do 6 months on a daily antibiotic.

 

I will always test positive for TB the rest of my life.  This does mean that I have T.B., only that I was exposed to it at some point in my life and have TB antibodies in my system.

[Peterw42]

OP, a positive test result would have an effect if you tried to get an OA visa from home country as it one of the medicial test required.

[MeePeeMai]

4 minutes ago, Peterw42 said:

OP, a positive test result would have an effect if you tried to get an OA visa from home country as it one of the medicial test required.

Not true.  A positive TB test result would have no effect at all UNLESS you actually have TB and it is duly noted on the doctor's report that you submitted for your O-A visa application.

 

Trust me, I have positive TB tests and I got an O-A visa in the USA from the Thai EMbassy in D.C.

 

Like I said above, if you have a positive TB test, you will be given a chest x-ray to determine whether you have TB or not.  An annual chest x-ray is no longer required (for those with positive skin tests) for employment in the US either, only the filling out of a medical questionnaire regarding TB signs and symptoms.... i.e.    Do you have night sweats? Coughing up bloody sputum?  Frequent fever?  Malaise? Difficulty breathing? etc.

[Sheryl]

I suspect when the OP said "prove positive" what he meant was "am diagnosed with TB/prove to have TB" not "have a positive skin test".

 

A positive tuberculin skin test  does NOT mean the person has TB, just that they have had some sort of exposure to the organism. People who received the BCG vaccine in childhood will test positive on this, for example.

 

This test is a useful screening tool to identify people who should then have a chest Xray to rule out active TB but does not in itself diagnose tuberculosis.

 

For someone with known close exposure to someone with active TB most physicians would start with a Chest Xray. If it showed no sign of active disease, they would then do a skin test and, if positive, follow that up with a special blood test to distinguish latent form active TB.

 

OP I suggest you see a specialist in infectious disease for appropriate work up. DIagnosing TB is not as simple as it may sound.

 

 

[Sealbash]

I had a chest x-ray showing an abnormality in my lung. I had not previously been ill or shown any signs of illness that I recall.

 

The doctor performed some blood analysis and determined a presence of TB anti-bodies. He was unable to determine if I had TB at the present time, but prescribed a 6 month series of antibiotics. 3 monthly x-rays performed over the next year did not show any change from to the size / density of the spot on my lung. The doctor concluded that at some time in the past I had most likely had TB, but the disease was no longer present. I am not a medical person, and do not claim to understand all the nuances of the doctor’s comments.

 

I was informed that it was the doctor’s opinion that the spot on my lung was most likely a scar from a previous TB infection. Just mentioning what was told to me.

 

A single chest x-ray will not determine the presence of active TB. It will take a series of x-rays over a period of time to determine “active”.

 

 

Sent from my iPad using Thaivisa Connect

 

[mike787]

44 minutes ago, Sheryl said:

I suspect when the OP said "prove positive" what he meant was "am diagnosed with TB/prove to have TB" not "have a positive skin test".

 

A positive tuberculin skin test  does NOT mean the person has TB, just that they have had some sort of exposure to the organism. People who received the BCG vaccine in childhood will test positive on this, for example.

 

This test is a useful screening tool to identify people who should then have a chest Xray to rule out active TB but does not in itself diagnose tuberculosis.

 

For someone with known close exposure to someone with active TB most physicians would start with a Chest Xray. If it showed no sign of active disease, they would then do a skin test and, if positive, follow that up with a special blood test to distinguish latent form active TB.

 

OP I suggest you see a specialist in infectious disease for appropriate work up. DIagnosing TB is not as simple as it may sound.

 

 

Sheryl is correct.  

Additionally, request an additional sputum analysis to confirm wether you have, or have NOT been exposed, and if you have been exposed - to which strain of TB.  Example. TB comes in several flavors.  Regular TB, MDR TB and XTR TB.  Depending on which TB  strain you are exposed to, will determine treatment based on the 2019 WHO guidelines.  The regular TB is a usually a 6 month treatment.  However, depending on the country and available drugs, that has been shortened based on evidence based research.  Best to do is get tested and speak to your MD, preferably a pulmonologist. If you are positive and placed on medication.  Remember 2 absolutes: NEVER miss a dose because you will have to start treatment all over again; and MUST NOT consume alcohol. ZERO.  Causes vomiting and renders drugs useless.  Plus destroys your liver.

[MeePeeMai]

1 minute ago, mike787 said:

Remember 2 absolutes: NEVER miss a dose because you will have to start treatment all over again; and MUST NOT consume alcohol. ZERO.  Causes vomiting and renders drugs useless.  Plus destroys your liver.

 

Yes this is correct.  I distinctly remember having to give up my beer drinking for six months while on the antibiotics. 

 

NOTE:  The legal age to buy liquor in Hawaii at that time was 18 y.o. so no, I was not a drunken criminal back then (so to speak). 5555

[Sheryl]

sputum test will show if there are TB organisms present (and can be used to determine what drugs they are sensitive to) but will be positive only in active infection, cannot show past exposure. Usually recommended only if Chest Xray shows something OR the person is symptomatic (cough for more than 2 weeks etc)

[tutsiwarrior]

I've discussed repatriating  back to the US and my sister who is a nurse has insisted that I get the quanteferon test for TB, she claims that it's the only way to tell if yer infectious 'and I work with doctors!!! and with TB specialists!!!'...sounds a bit hysterical to me but she believes that everyone in east asia is infected...don't know if this test is available in Thailand...

 

maybe better to stay in Thailand and die peacefully of TB if infection does indeed exist...doesn't matter that I have diabetes and high BP and more likely to die of a stroke...

 

 

[mike787]

1 hour ago, tutsiwarrior said:

I've discussed repatriating  back to the US and my sister who is a nurse has insisted that I get the quanteferon test for TB, she claims that it's the only way to tell if yer infectious 'and I work with doctors!!! and with TB specialists!!!'...sounds a bit hysterical to me but she believes that everyone in east asia is infected...don't know if this test is available in Thailand...

 

maybe better to stay in Thailand and die peacefully of TB if infection does indeed exist...doesn't matter that I have diabetes and high BP and more likely to die of a stroke...

 

 

I believe in "Informed consent".  If your mind is sound, then your decision is between you, and your God...whatever you decide.  If you choose death, know it is slow, painful when TB disseminates through out your body, also called "extra pulmonary".  It starts in the lungs, then it can migrate to your bones and can be painful.  It can feel like you can't breath because of poor oxygen to blood perfusion.  You may end up coughing up blood and vomiting blood as it advances.  TB will rob you of your energy, leaving short of breath and emaciated - if you live that long.  I can go on and on. My end point here is simple: to empower YOU with knowledge, so that your choice is the one that will bring you happiness, whatever that means for you.  

Do follow your sisters advice. Consult a pulmonologist, and YES Quanteferon is one gold standard, coupled with Chest Xray, sputum cultures x 3.  If you cannot generate sputum, they can assist with that.   

[mike787]

1 hour ago, tutsiwarrior said:

she believes that everyone in east asia is infected

She has a good point...she is making a factual statement based on statistical data.  Not everyone, but it is a serious "epidemic".

[tutsiwarrior]

5 minutes ago, mike787 said:

I believe in "Informed consent".  If your mind is sound, then your decision is between you, and your God...whatever you decide.  If yo choose death, it is slow, painful when TB migrates, or called "extra pulmonary".  TB can effect every part of your body.  It starts in the lungs, then it can migrate to your bones and be painful.  It can feel luck you can't breath because of poor oxygen to blood perfusion.  You may end up coughing up blood and vomiting blood as it advances.  TB will rob you of your energy, you will lose weight.  I can go on and on. My end point here is to simply to empower YOU with knowledge, so that your choice is the one that will bring you happiness whatever that means for you.  Do follow your sisters advice. Consult a pulmonologist, and YES Quanteferon is one gold standard, coupled with Chest Xray, sputum cultures x 3.  If you cannot generate sputum, they can assist with that.   

whoa...settle down there pardner...my post was to inform about quanteferon for TB testing with a bit of entertaining banter on the side...certainly not to discuss exit arrangements between me 'and my god', etc...and I'm sure that if most westerners were concerned about the rate of TB infection in east asia most of us wouldn't be here...

 

a harsh life with poor nutrition and a weakened immune system can happen anywhere...

 

 

[mike787]

25 minutes ago, mike787 said:

 maybe better to stay in Thailand and die peacefully of TB if infection does indeed exist...doesn't matter that I have diabetes and high BP and more likely to die of a stroke...

Apologies.  There is a misunderstanding.  I am only providing information regarding TB disease processes as a result of  the above statement regarding end of life matters.  Disregard.  Wish you much peace in all your endeavors.  

[Sheryl]

10 hours ago, tutsiwarrior said:

I've discussed repatriating  back to the US and my sister who is a nurse has insisted that I get the quanteferon test for TB, she claims that it's the only way to tell if yer infectious 'and I work with doctors!!! and with TB specialists!!!'...sounds a bit hysterical to me but she believes that everyone in east asia is infected...don't know if this test is available in Thailand...

 

 

it is available in a few places but expensive.

 

i think you have misunderstood what your sister is saying.

 

QuantiFERON test does nto determine whether one is infectious. It is an indirect measure of whether or not you have had contact with the TB organism but does nto distinguish between latent and active infections. Only people with active infections are infectious.

 

A high proportion of the population is East Asia are tuberculin positive i.e. at some point in their lives had exposure to the organism that causes TB. Most of these people do nto have and never will have active tuberculosis.

 

Unless you have been in close contact with someone with active TB the likelihood of your now being positive is very, very small.

[tutsiwarrior]

1 hour ago, Sheryl said:

 

it is available in a few places but expensive.

 

i think you have misunderstood what your sister is saying.

 

QuantiFERON test does nto determine whether one is infectious. It is an indirect measure of whether or not you have had contact with the TB organism but does nto distinguish between latent and active infections. Only people with active infections are infectious.

 

A high proportion of the population is East Asia are tuberculin positive i.e. at some point in their lives had exposure to the organism that causes TB. Most of these people do nto have and never will have active tuberculosis.

 

Unless you have been in close contact with someone with active TB the likelihood of your now being positive is very, very small.

 

I tested tuberculin positive in Bolivia in 1965 and I presume that hasn't changed so that nothing further would be revealed by the quantiferon test...something that my sister doesn't understand apparently...most indigenous areas in latin america have got a TB problem...

 

a brother in law here in Suphanburi died of the infection about 4 years ago and most of the family had been to the local district hosp TB ward to see him...I got all the family that lives in my house to get tested but not sure what test was used, was at work in the ME and wasn't able to supervise...

 

 

[griffon2011]

18 hours ago, Sheryl said:

I suspect when the OP said "prove positive" what he meant was "am diagnosed with TB/prove to have TB" not "have a positive skin test".

 

A positive tuberculin skin test  does NOT mean the person has TB, just that they have had some sort of exposure to the organism. People who received the BCG vaccine in childhood will test positive on this, for example.

 

This test is a useful screening tool to identify people who should then have a chest Xray to rule out active TB but does not in itself diagnose tuberculosis.

 

For someone with known close exposure to someone with active TB most physicians would start with a Chest Xray. If it showed no sign of active disease, they would then do a skin test and, if positive, follow that up with a special blood test to distinguish latent form active TB.

 

OP I suggest you see a specialist in infectious disease for appropriate work up. DIagnosing TB is not as simple as it may sound.

 

 

I made the initial inquiry on post #1.  Basically, my GF was diagnosed with lupus (SLE) in February and the initial chest X-ray was clear.  Treatment began with steroids which compromised her immune system and she gradually became weaker and developed a persistent dry cough with a dramatic weight loss (48 to 37 kilos) for about 7-10 days before being admitted to a private hospital in Bangkok in April.  A chest X-ray now indicated a problem.  After four days in the BKK hospital she was moved to a government hospital in her home town who reported that she had pulmonary tuberculosis.  So I think that would place me in the category of one with close exposure possibly for 3 weeks to a month since she started coughing.  I have no symptoms and feel good. I am 70 and remember a TB test when I was a child but no vaccinations if there were any. Not sure what to do from this point. 

[MeePeeMai]

12 minutes ago, griffon2011 said:

 Not sure what to do from this point. 

I would go to a clinic or Dr's office and explain your story and get a TB skin test first.  As you have seen first hand what the signs and symptoms are, watch for them yourself (google TB for a complete list).

 

The Doctor may want to put you on a course of antibiotics (just to be safe) since you have obviously been exposed but he/she will have to make that determination at that time.  He may just tell you to watch for any signs or symptoms and return immediately should you suddenly have any.

 

An annual skin test from now on would be a good idea also (unless you have tested positive prior). 

[MeePeeMai]

It might help your doctor if you knew for sure what strain of TB your GF had.  

[uhuh]

2 hours ago, griffon2011 said:

Not sure what to do from this point. 

Find out when was your last TB skin test (as recent as possible) and whether it was negative. 

If it was negative at the time get a new skin test.

 

Find out if your gf's sputum was ever tested and whether acid fast bacilli (AFB) were found in her sputum (if they found AFB it means she was infectious).

 

Find a doctor,  and under his supervision follow the steps outlined here:

https://www.cdc.gov/tb/publications/faqs/qa_latenttbinf.htm

 

Do not do all this on your own.  Go to see a TB specialist doctor,  easy to find in Thailand and not expensive. Follow his advice. 

TB is not something you can handle by yourself or with help from TVF.

[Sheryl]

 

@griffon2011GF will have had a positive sputum test, govt hospital would not be treating her for pulmonary TB otherwise. You should indeed have her find out if the TB she has is drug resistant or not - it probably isn't, but if it is this has implications for you so need to know. If she is reluctant to ask her doctors then just find out the names of the drugs she is on and post here  this will indicate it.

 

Agree that first step is for you to confirm that  prior TB skin test was negative and, if so, repeat it.

 

If still negative then I would no nothing for now assuming you remain asymptomatic....can repeat the skin test in 3-6 months if it really worries you.

 

If positive then see an infectious disease specialist for further work-up (but don't panic, quite likely your body has contained the bacterium.... that is what usually happens in people with healthy immune systems.)

 

No responsible doctor is going to start someone who is tuberculin skin test negative and asymptomatic on anti-TB drugs just because they were exposed to TB.  However if skin test positive and further work up shows no active disease, an abbreviated treatment regimen for "latent TB" is indicated to reduce the risk of it becoming active at a later time unless you have some contraindication to the drugs (e.g. liver disease).

 

@tutsiwarrior if you converted to TB skin test positive in 1965 you may have what is called "Latent TB Infection". This means you contacted the TB bacterium but your body was able to contain it and prevent development of active TB disease -- as noted above this is what usually happens in people with healthy immune systems. However,  it can flare into active TB disease later one at any time when your immune system is weakened - for example, if for other reasons you have to take drugs that suppress the immune system (as happened with OP's GF) or else simply in old age, as the immune system weakens in the very elderly. you might therefore want to consider being treated for LTBI now.

@tutsiwarrior

[griffon2011]

32 minutes ago, Sheryl said:

 

@griffon2011GF will have had a positive sputum test, govt hospital would not be treating her for pulmonary TB otherwise. You should indeed have her find out if the TB she has is drug resistant or not - it probably isn't, but if it is this has implications for you so need to know. If she is reluctant to ask her doctors then just find out the names of the drugs she is on and post here  this will indicate it.

 

Agree that first step is for you to confirm that  prior TB skin test was negative and, if so, repeat it.

 

If still negative then I would no nothing for now assuming you remain asymptomatic....can repeat the skin test in 3-6 months if it really worries you.

 

If positive then see an infectious disease specialist for further work-up (but don't panic, quite likely your body has contained the bacterium.... that is what usually happens in people with healthy immune systems.)

 

No responsible doctor is going to start someone who is tuberculin skin test negative and asymptomatic on anti-TB drugs just because they were exposed to TB.  However if skin test positive and further work up shows no active disease, an abbreviated treatment regimen for "latent TB" is indicated to reduce the risk of it becoming active at a later time unless you have some contraindication to the drugs (e.g. liver disease).

 

@tutsiwarrior if you converted to TB skin test positive in 1965 you may have what is called "Latent TB Infection". This means you contacted the TB bacterium but your body was able to contain it and prevent development of active TB disease -- as noted above this is what usually happens in people with healthy immune systems. However,  it can flare into active TB disease later one at any time when your immune system is weakened - for example, if for other reasons you have to take drugs that suppress the immune system (as happened with OP's GF) or else simply in old age, as the immune system weakens in the very elderly. you might therefore want to consider being treated for LTBI now.

@tutsiwarrior

I thank all you kind people for the advice.  I will start the testing tomorrow and see what happens.  I was aware that her immune system was compromised by the steroids and while caring for her was careful to wash my hands frequently, make her wear a mask and keep my distance just to prevent her from picking up something from me.  Maybe that will work in my favor.   

[WyrldTraveler]

I was diagnosed with active TB at age 21.  I was put on Isoniazid for 6 months.  (It made me hallucinate for 6 months also, but that is another story.)  I will also always test positive for TB with the skin test, just like people who had the vaccine.

 

As a health care professional, this is what happened from both sides of the interaction:

• Exposed to TB
• first 'tine test' antibody test showed exposure to TB 
• second test to rule out sensitivity to chemical used in initial TB  'tine test' chemical
• chest x-ray (baseline for comparison)
• IMPORTANT: productive cough (coughing up blood, frothy sputum, etc.) tested for active infection
• medication regime 6 months
• follow up chest x-ray in 6 months  to determine if disease progressed or was suppressed

 

If you are otherwise healthy and not symptomatic (fever, chills, night sweats (this is abnormal sweating - not soaking the sheets because it is 38 degrees and the AC is broken!) and a few others - you are generally considered OK.  If you feel sick, then you probably are.  TB hides in the bones, spinal column, spleen and anywhere else it can hide.

 

[Sheryl]

If you were treated with INH only you did nto have active TB but rather latent TB.

 

People with latent TB wil be asymptomatic.

 

 

[higgy88]

I'd like to jump in with my experience with the TB test. 

I first tested positive with the skin test when I was about 5 years old, along with the rest of my family; father, mother, sister and brother.  The health services had come into our neighborhood and tested everyone because apparently someone living in our neighborhood had TB.   We were all then taken to a health center for X-rays.  For the next 10 years or so, each and every year we were given the skin test, tested positive, and went for the X rays.  Finally they decided we did not have to do this any more.  That was the last time I was tested for TB, and if I have my way, I will never be tested again. 

Fast forward about 50 years.  My father had been having reoccurring bouts with pneumonia so his doctor decided for him to go to the hospital and run a bunch of tests to see why this was happening, and one of the tests was the TB test.  He tested positive and was given  penicillin, which he was allergic to, but the hospital was not informed of this, and he died within a few hours.  We requested an autopsy which showed no signs of TB.

A few years after that, my sister got cancer and again, the TB test was given as part of the routine tests, again she tested positive, and she had a big fight with the doctors about refusing treatment, which she only half won.   This is one area of medical science where I am really dumbfounded at their refusal to consider the possibility that not all tests are 100% accurate and there may be things that are not completely understood.

And then there is my brother, who also died from an allergic reaction to medicine, this time it was Warafin, which he was being treated with for Hepatitis C. 

Since this fatal interaction with medicine seems to run in my family, I know I have to be very, very careful. 

[Sheryl]

Penicillin is not used to treat TB. His getting it was unrelated to the positive TB test.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[uhuh]

And Warfarin is not a treatment for Hepatitis C. 

 

[GroupA]

TB can be found in many different  organ systems in the body. It is infectious to others only if in the lungs. That's why in health care and other professions with positive skin test (PPD) are required to have a chest X-Ray to work. This doesn't mean that the patient is free of TB, but does not present a risk to others. US CDC recommends treating all positive skin tests in US.  Treatment in Thailand is probably not recommended because risk of re-exposure to too high. If you doubt this check out the CDC USA web site. 

Non respiratory TB can show up later in life especially in joints or kidneys, but also other organs. After treatment positive PPD usually are negative. 

I am a licensed Microbiologist.