+PPD and 9 months of Isoniazid, Woo Hoo!!!

Well, after working as a phleb. for the past seven months and despite having been VERY careful to take appropriate personal precautions, I have converted my annual employee PPD. My CXR is negative, I am asymptomatic <sp?>, and now get to take prophylactic INH for 9 months. mad.gif
I know that medical schools require a physical with a PPD. If I have a conversion, will they still extend an acceptance? My gut says that many health care professionals convert, and it is a non-issue. However, I am a nervous sort and look forward to any opportunity to worry. rolleyes.gif Maybe I just have to show other proof, such as a clear CXR and record of the prophylactic drug therapy.
Ah, I’m just mad that my FP said I can’t have any beer for the next 9 months. laugh.gif Seriously though, it was kind of distubing to find out I had been exposed. It is sobering to think that health care workers run very real risks of contracting disease in the course of serving their fellow humans. Has it dampened my desire to become a physician? No way !!!

No, your conversion will not preclude admission to medical school. In fact, such a policy might even violate some Fed statute or something…they cannot discriminate against people w/ HIV, hepatitis and such. However, do let this conversion highlight to you that being a healthcare professional can be hazardous to not only your health. Furthermore, converting your PPD does not mean that you have TB; only that at some point you were exposed to it.
Once you have tested positive, I believe this is the most current recommendations, you will no longer have annual PPDs. From now on, they will shoot a 2-view CXR.
I vividly recall my first dirty needle stick. I was involved in coding a young man who was executed in crack house for allegedly jippin one of his “clients”. The “client” took a 9mm pistol to the back of the 14y/o drug dealers head and shot him…point blank. Long story made short, I was stuck in the middle of coding this young man. This occured less than a month after my getting married, the first time. I was terrified not only for my own health; but also for the health of my then, new bride.
Of course, with such a greivous wound, the young man died. We drew blood from both he & I for extensive labs work to ascertain the presence of anything communicable that we could think of. I was retested for HIV & several of the hepatitis variants quite frequently over the next several years. The first few times waiting for those test results to come back was extremely nerve wracking!!! It got easier with each testing. Now, I rarely even think about it.
In 11 years as an RT, I only had 2 other dirty sticks and they were both very low risk. None of the three of them were truly my fault and really could not have been prevented by the standard protection equipment.

Hey, Ian, that sucks! To show you that great minds think alike, my very first thought was, “Man, no beer for nine months.” tongue.gif
It will absolutely NOT have any effect on your application. You’ll be noted on your physical as having “+PPD, completed 9mos INH,” and that will be the end of the story - well, as Dave notes, you’ll have the regular follow-up CXRs.
Speaking of unnecessary, you know that strictly speaking your birthdate in 1966 puts you just outside the age range for required treatment? According to the CDC, if you’re >35 the decision to go to INH is not automatic. Here’s what the CDC says, the key stuff is the final paragraph (in blue) but to get the appropriate context I had to include a lot of preliminary stuff (I’m not putting it in a quote box, it’s too long for that much teeny print):
"The largest and most comprehensive study of isoniazid hepatitis was conducted by PHS during 1971–1972 (11). In this survey, nearly 14,000 persons who received isoniazid were monitored for the development of hepatitis. The overall rate of probable isoniazid hepatitis was 1%, but it was age related, with no cases occurring among persons younger than 20 yr of age and the highest rate (2.3%) occurring among persons older than 50 yr of age. An association of hepatitis also was found with alcohol consumption, with rates being fourfold higher among persons consuming alcohol daily than among those who did not drink alcohol. Rates among males and females were equivalent and were lower among black males and higher among Asian males compared with rates among white males. Hepatitis rates were lower among participants in the IUAT trial, although the same positive association with age was observed (32). In the PHS surveillance study, eight deaths from hepatitis occurred among the participants, seven of which were among persons living in Baltimore. Several years after completion of the study, a review of death certificates showed a marked increase in deaths from cirrhosis during 1972 in Baltimore and surrounding counties, suggesting that another cofactor may have been associated with the cluster of deaths observed in the study (90).
"A comprehensive analysis of deaths from isoniazid-associated hepatitis in the United States found that women may be at increased risk of death (91). Other reports have suggested that the risk for isoniazid-associated hepatitis may be increased by the administration of the drug to pregnant women in the third trimester and the immediate postpartum period (92) or by the concomitant administration of acetaminophen (93). Although experimental evidence suggests that acetaminophen hepatotoxicity is potentiated by isoniazid (94), a more detailed study of deaths from isoniazid-associated hepatitis did not implicate acetaminophen as a factor (95).
"Isoniazid-related deaths continue to be reported. However, the likelihood of this occurrence can be greatly reduced by careful monthly monitoring and stopping of medication if symptoms occur (96). In a recent study, seven of eight patients receiving a liver transplant following the development of fulminant, isoniazid-related hepatitis continued to take the drug for a least 10 d after onset of symptoms of hepatotoxicity (97).
"Following the PHS surveillance study, guidelines on the use of isoniazid for the treatment of LTBI [latent TB infection] were revised to recommend that low-risk persons older than 35 year of age with reactive tuberculin skin tests not be treated, that no more than 1 mo drug supply be issued at a time, and that monthly questioning and education about signs and symptoms of hepatitis should be routine (12). The guidelines were further revised to recommend baseline and periodic liver-function tests for persons at risk for hepatotoxicity, including persons aged 35 yr of age or older (15). "
Here’s the link for the whole document:
TB info from the CDC
It doesn’t sound like you’re beating yourself up too much, and that’s a good thing - TB is a tough one. When I was on my medicine rotation, one of my student colleagues did the ER workup for a patient who came in with pneumonia symptoms… it was only after they got a lot more history (HIV+, past IV drug use, close contact with TB) that the risk of TB was recognized - by then the team had been up close and personal, examining her without the special masks, etc. Yup, she had TB. Fortunately for the team (NOT the patient!) she actually had miliary TB which is considerably less communicative. I haven’t heard an update about how many folks converted over that one.
Oh, another TB story: during my second year, one of our “discussion cases” was a patient with TB. At the conclusion of these cases we always had a guest speaker, often it’d be someone with the disease we’d been dealing with. Imagine our surprise to find one of the deans sitting in the hot seat, telling the story of getting TB (not latent, he was SICK) while a resident. It’s an occupational hazard, as you observed.

Thanks for the replies guys! As always, great info!
Although INH therapy isn't automatic at my age (36), I figured for my family's sake, if no other reason, I should go on it. I'd feel really bad if it did become active and then my family got TB.
The beer ban does irk me a bit. From what my FP told me, it is a double whammy because the alcohol AND tyramine present both can affect the liver's function. Regardless, I now get LFT's done monthly, checking the ALT and AST numbers.
Thanks again!

No beer for 9 months blink.gif That risk might take me out of medicine! biggrin.gif