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Tuberculosis

Confused about Positive TST and disclosure

01/14/2008

Question:

My husband tested postive today for his recent PPD test. We are both very scared. I tested in Oct 07 and was negative. However, we have both recently had bad respiratory "colds" and were treated with different antibiotics (me: 5 days Azythromycin. he: 10 days Ampicyllin and ear infection treatment)I have cleared up and his cough has returned yesterday after briefly clearing up for about a week.

In addition, he recently had a CT scan for a rib injury. He is also a heavy smoker. His scan showed what may be scarring on a portion of the lung, but this was more than 2 months ago now and during that time he did not exhibit any symptoms of TB or another illness. Our doctor did not seem overly concerned, although recommends that he quit smoking (I am accepting the fact that he will likely never stop but, this is another issue) He is now scheduled to follow up with a pulmonary specialist in a week thanks to his postive PPD.

I am concerned and scared about disclosure as well as protecting myself. Am I required to disclose to my own co-workers at this stage? what is appropriate and what is standard? when would we be expected to disclose? I don`t want to create unnecessary alarm nor do I want to expose others. The stigma is obviously a concern as is our ability to make a living. My doctor is not recommending another PPD test for me at this time. Also, and this may sound rediculous but, am I at increased risk when we have sexual contact (i.e. kissing)? Thanks for your time

Answer:

In answer to your questions, a positive PPD only means that the immune system recognizes tuberculosis. It does not indicate the presence of active tuberculosis.

In terms of disclosure, from what you have told me, you have nothing to disclose at this time. Your husband has not been diagnosed with any active infection. Even if he is found to have active tuberculosis, you cannot transmit it, only he can, and only by direct, prolonged contact. TB is spread only through the air, not on clothing or by touch. So unless he comes to your job site for hours at a time, he could not pass it on to your co workers. Also, it is not the job of individuals to inform the public of a TB exposure, that is the job of the public health authority and is only done if a diagnosis of tuberculosis is established.

Finally, in terms of kissing/other contact, this does not increase your risk of TB. If you live in the same household and he has active TB then you have a risk of exposure. I would not worry about changing normal household behavior at this time.

He should see his pulmonary physician and that person can help to evaluate whether there is any chance of an active tuberculosis infection

Thank you.

For more information:

Go to the Tuberculosis health topic, where you can:

Response by:

Catherine A Curley, MD, MS Catherine A Curley, MD, MS
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University