A patient had a previous negative PPD as a requirement for work. She then went oversees for a time and receieved the BCG vaccine. She is now back in this country and as part of work requirements gets another PPD which is now positive. She is asymptomatic and the chest xray is negative.
How would you handle this?
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QuantiFeron gold may help if available in your area. It is unlikely affected by BCG.
How old is she? Most countries that give BCG regularly do it in childhood to decrease the incidence of invasive (especially meningeal) disease.
T-SPOT.TB, an interferon gamma blood test from Oxford Immunotec does not cross react with BCG but will pick up true TB infection.
Well, the concern is this. She is at higher risk for active TB and for multidrug resistant TB. We know the incidence of MDR TB is still on the rise here (and usually occurs in foreign born or recent immigrants) and the incidence of TB among foreign born or recent immigrants from endemic areas is proprortionately on the rise. We also know that the chance for active TB conversion with a newly positive PPD (recent converter) is up to 5% in the first two years. If this woman has a positive PPD, I would treat her for latent TB to be on teh safe side. The current statement from CDC is to disregard the BCG status anyway, right?
Quantiferon looks like the way to go.Using it makes CDC advice re: disregarding BCG in interpretation of PPD outdated.Also you have to consdier the age of the patient if you tend to believe in the value of the age and risk of INH hepatitis consideration.
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