cbrsmurf Posted May 17, 2013 Share Posted May 17, 2013 So I have a 20 y/o M pt, currently going through CNA training, immigrated from the Phillipines a few years ago, hx of a bcg vaccine, had a positive PPD. Chest XR was obtained, which was negative. I wanted an interferon gamma test from the beginning - SP wants to give isoniazid for 6 months, of course I am overruled. I don't want to put the patient through 6 months of drug therapy without some proof of TB, am I in the wrong here? Link to comment Share on other sites More sharing options...
Guest Paula Posted May 17, 2013 Share Posted May 17, 2013 Can you get an infectious disease consult by phone without your SP overruling you on that? Link to comment Share on other sites More sharing options...
ccc0621 Posted May 17, 2013 Share Posted May 17, 2013 I agree with Paula. Did your SP give an explanation as to why they want to go straight to isoniazid? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 17, 2013 Administrator Share Posted May 17, 2013 Ask your SP to explain to you what a BCG is and does. Then, see what they come up with... Link to comment Share on other sites More sharing options...
cbrsmurf Posted May 17, 2013 Author Share Posted May 17, 2013 I agree with Paula. Did your SP give an explanation as to why they want to go straight to isoniazid? "because it would be good for him and he will be working in hospitals." Don't know if it is relevant, but the pt does have hypochromic microcytosis without anemia. Pt is completely asymptomatic and appears healthy. Link to comment Share on other sites More sharing options...
ljgiblin Posted May 17, 2013 Share Posted May 17, 2013 "because it would be good for him and he will be working in hospitals." Don't know if it is relevant, but the pt does have hypochromic microcytosis without anemia. Pt is completely asymptomatic and appears healthy. My husband always has a false positive for his ppd and when he went to paramedic school they made him take 6 months of isoniazid...his gp told him never to take the ppd again, go straight to the chest xray. So he just did that for his physical for PA school which starts in 2 weeks! Link to comment Share on other sites More sharing options...
SocialMedicine Posted May 17, 2013 Share Posted May 17, 2013 interferon gamma test is expensive and a bit labor intensive I can see still running the initial PPD in this guy since MOST people with that vaccine history do not test positive. if that guy wants to give him INH than I would document he wants to give it and have that patient follow up with him going forward. If he is the less than 1% of people with serious liver toxicity and it turns out he does not have a latent Infection that will not be a good situation. Link to comment Share on other sites More sharing options...
rcdavis Posted May 17, 2013 Share Posted May 17, 2013 Don't know if it is relevant, but the pt does have hypochromic microcytosis without anemia. Pt is completely asymptomatic and appears healthy. Especially with his origins, this most likely is the micro/hypo of an alpha-thalassemia. Link to comment Share on other sites More sharing options...
Guest Paula Posted May 17, 2013 Share Posted May 17, 2013 What was the size of the PPD reactivity? How old was he when he had the bcg vaccine? Has he had exposure to TB while living in the Phillipines? What is the rate of TB in the Phillipines? Did the answers to these questions impact the physicians decision to treat? Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.