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Retest PPD?


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I tested positive for a PPD tb test a few years ago. The PA school I'll be starting at this May is asking I get a physical done so I contacted my family doctor and informed her that I tested positive a few years back for my PPD (I took the INH and all that and my x-rays were clear). She insists that I take another PPD test... but from my knowledge, if you test positive for the PPD test you'll ALWAYS test positive... correct me if I'm wrong.

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You are correct, but you could have had a false-positive and you may test negative now. Its up to you, but sounds like there is no active disease. With your history you may want to see what the PA programs policy for a history of positive PPD is.

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Chances are that you test positive again are more likely than not, ask to get the quantaferon gold blood test. It is far more specific and sensitive than a PPD. Which by the way you shouldnt really need again, especially if you have had a neg. CXR within the past 5 years, and documentation of 9 mos INH.

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Should is the operative word, there. Every new position (and PA school is a "position") seems to want to run PPD+ folks through the gamut from square 1: PPD, repeat PPD, CXR, without reference to whether a past PPD has been positive or a CXR has been taken.

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There is a protocol for questionably positive ppds ( and of course you have to exclude anyone who has had bcg vaccination).

 

1. Give 1/5th standard dosage ( eg 1 tuberculin unit versus 5) intradermally

2. Have an anergy panel planted on the right forearm ( to prove adequate imunnicity)

3. If the test dose is positive ( greater than 5mm) STOP. Are proven to be either a convector or reactor.. Depending on your ppd status before the first positive.

3a. If anergy panel is negative STOP, no antigen test can be reliably interpreted

4. If the test is negative, go ahead with the full standard dosage of 5 tuberculin units and read in 48-72 hrs

5. If anergy was positive ( normal) and the full dosage was negative, then you are now ppd negative.

 

However, you are right, by the book, once positive, should be assumed always positive and placed into annual screening ( cxr and questionnaire)program.

You could cite this is you do not want to question the initial result.

 

Vr

 

davis

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