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Pediatrics/Possible TB exposure in toddler

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Question
Dear Dr. Olson,

I am writing you with a few concerns about possible exposure to Tuberculosis or (hopefully) latent Tuberculosis. My 22 month old nephew who lived the first 7 months of his life in Ho Chi Minh City, Vietnam recently had a positive PPD. He had been tested upon first moving to the US 1 year ago and was negative, however his pediatrician tested him again as he had returned to Vietnam this summer with my brother and sister-in-law to visit family for 1 month. I am not sure what the size of the positive PPD was, however their pediatrician is placing him on 9 months of INH and is planning more tests for this week including blood work and a chest xray. They feel that most likely he has latent TB.

My concerns are this: I have a 19mth old boy who is regularly in contact with his cousin and being toddlers they exchange a lot of saliva (they have regularly shared cups and exchanged hugs and kisses) and although I understand that latent TB is not contagious- how can we be sure that what he has is in fact latent TB? As a toddler my nephew has regularly been ill with fevers, cough, runny nose, and is somewhat underweight but I never thought any of this was anything serious other then the regular string of toddler colds- now I am wondering if there was something more serious going on the whole time. Should I get my own son tested with a PPD? Second, if my nephew does in fact have the latent form of TB, and they start INH, how do we know if the medicine is working? If he develops illness in the next months how do we know this is just a cold and not the TB becoming active? I understand that not all forms of TB will respond to INH and I am not sure if there is a way to tell whether or not the form he has will respond to the treatment? I just want to keep my own son safe from possible infection as well as continue to allow the boys to play together as I care deeply about my nephew.

Thank you for your time!

Answer
Hi, Hannah,

Certainly have your son tested.  He has been closely exposed to someone with TB.  A test is easy and smart.

If it is negative, then it always could be repeated in a few months to be sure.  If it is positive, then he needs to be treated.  

If your nephew takes the full course of the INH, then he is treated.  If it is latent TB, thats about all you can do to treat.  If he develops symptoms of TB, then chest xrays could be done.

Good luck, Dr. Olson

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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