Expert: Prof. Dr. B.K. Singh - 8/23/2008

Question
QUESTION: Hello

I am healthy 31 years old man with very active life style, but few months ago I was surprised when I found that I have a positive TB skin test with 15mm swilling on my skin. After meeting with 3 different doctors specialized in lung, internal medicine, infections, and after several readings related to this topic, I found the following:  

• All the three doctors recommended that I start taking INH for 9 months.

• There is a 10 % chance that the latent TB germ will wake up in my body if I don’t take INH medication.

• Some people had positive TB test, but now they are very old and the germs never woke up in their whole life, and they never took INH or isoniazid.

• My BCG vaccine will not decrease the probability of getting the disease.

• INH can reduce the risk of getting the disease by 90 %.

• Quantiferon blood test or Mucus test can help to know about the infection, but doctors refused to do them for me.

• The skin test is of limited value in diagnosis of active TB because of its relatively low sensitivity and specificity. False positive reactions may be caused by infections with non TB mycobacterium.

• At present, the American Thoracic Society recommends restricting the use of isoniazid prophylaxis to tuberculin reactors (people with positive skin tests) younger than 35 and to those older than 35 who are at increased risk for activation of the infection. Factors that increase the risk of activation include diabetes, renal failure, alcoholism, immunosuppressant and abnormal chest x-rays suggesting previously active tuberculosis.

My question is:

1- Why my BCG vaccine that I took when I was a child, was not able to control infection, or is not able to control TB disease?
2- INH might cause hepatitis or effect the liver, or other body organs. With 10 % chance I may never get TB disease? Should I take INH or no?

Thank you for your helpful answers


ANSWER: At the time of vaccination it the duty of medical staff to confirm that it has been done successfully. Usually after a successful vaccination there occurs a thin discharge at the site of BCG vaccination lasting for few days which later heals leaving a raised nodule. This confirms that BCG vaccination is adequately done and it provides a life long immunity against TB.

INH no doubt is a drug of choice with one another anti-tubercular drug to be taken for at least nine months depending upon the state of disease. INH is prefer as it is bacteriocidal medicine and usually  resistance proof. In your case I would like to perform some more tests to confirm the diagnosis as there is always a possibility of false positive skin test. Kindly visit a specialist in your area for further line of action.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply, but I think you miss understood something on my last E-mail. I already have seen 3 different specialists. Internal medicine specialist, lung specialist, and infection specialist, and all of them refused to do more tests to confirm diagnosis.They said that BCG has nothing to do with my latent TB exposure to the germs. I took BCG when I was 1 year old, but now I am 31 years old,so BCG has no value or effect to prevent disease BCG is actually useless at this time it has now power or help for me. My lung x rays did not show any sign of TB, but all of the doctors recommended that I take INH for nine months. I am still skeptical and did not take medication yet.

Thank you

ANSWER: Please let me know that what made you to go for Mantoux test. Kindly send details if you had problems which may point to possible TB infection. Otherwise the person who has been successfully vaccinated for TB will show a positive Mantoux test. From a distance I'm not in a position to advice you as far as medication for TB is concerned. But as per your emails I feel that you may not need any medication for suspected TB, unless it is confirmed.

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. singh

Thanks for your reply from allexperts.com.

Few years ago I was working a nursing home for 3 weeks as a nurse aid her in Michigan, and over there I had exposure to some sick elderly people, who had Tuberculosis disease, so last June I decided to go for TB check up. After testing was over, they found 15 mm swilling in my skin. This is because I had the exposure of TB germs when I was working in that nursing home. Then I met with 3 specialists one for internal medicine, one for pulmonary, and one for infection disease. The doctors said that my positive skin test is not from vaccination. All the 3 doctors said that there will be about 10 percent chance that I will get TB disease because I was exposed to the germs at some point few years ago, so they recommended that I start taking INH for nine months. They said that the problem I am having now is not from vaccination, but is from exposure to germs. The only sign I have now is coughing; I have been coughing too much and too often for reason or without reason for the past few years. After taking x-rays for my lungs, they gave me this report:

There is blunting of the left costophrenic angle. Lungs are slightly hyperinflated. There are chronic appearing apical changes. The cardiomediastinal silhouette is within normal limits. Patient has mild scoliosis of his thoracic spine.  Impression:
Blunting of the left costophrenic angle that may represent a small pleural effusion versus scar

Please let me know if I can use acupuncture or alternative medicine to heal my latent TB, or to kill the sleeping TB germs in my body. I have a friend, who wants to go overseas to study acupuncture please let  me know what is the nearest location to Syria and Jordan to go study acupuncture. We might travel together, so I can get some healing for my inactive TB germs and he can get some training for his acupuncture course.

Thank you

Answer
As per your X-ray report it seems to be a tubercular infection. I will suggest aspiration of the pleural effusion and culture for the bacteria to confirm if there is still an active infection. In that case a course of INH should be advisable. I believe the doctor who is seeing you is in a better position to give a proper advice rather than me who is sitting so far. I have given acupuncture treatment to some tubercular patients especially with resistant to primary line of treatment with encouraging response as acupuncture certainly helps in improving body's natural defence system, but in your case probably a course of INH may be a better choice.I hope it satisfies your query.

If you want to come here,You may visit my Academy in Vancouver before October 30th with a proper appointment, as I will be on my regular lecture-cum-treatment tour to Japan, China, Hong-Kong, and India from November 1st, 2008 to January 12th, 2009.

www.bhupendratechniques.com