I've been exposed to tuberculosis

[Dr Strangelove]

Originally posted by Tiamat
Had the test done 12 hours ago and within the red circle is another circle appearing and it's discolored, a light brown the color of a light freckle. The bump isn't to high but it is hard like Dr. Strangelove said.

I think I"m within my rights to tell my supervisor that I don't feel comfortable continuing to care for this patient yes?

It's possible to have a false positive reaction. What you're describing may be the result of an allergic response to something in the test. Of course without actually seeing the reaction I can't be sure. Wait until 48 hours have passed to judge the reaction.

I'm not sure you can refuse to take care of this patient unless you have some special reason, like you're immune deficient. You're a healthcare worker, to refuse to care for him might be considered a form of discrimination. So long as you adhere to standard isolation protocols you're unlikely to catch it, and if you don't catch it you can't give it to your family.

[SpencerH]

Tia

If possible I'd suggest you try to see an infectious disease specialist. Given your immune and familial status, it may be better if this situation was monitored by someone with more than just "passing knowledge" of TB.

EDIT thats assuming the skin test is positive BTW and its someting that your family physician would suggest (I would think). I just wanted to mention it as an option you should be aware of.

[SpencerH]

Originally posted by *End Is Forever*
Don't they vaccinate against TB in the States?

The "vaccine" is virtually useless and not used in North America or Europe.

Research on TB virtually died out between the 70's and 90's (when it began to be re-funded with the realization that the drug resistant variants were emerging in cities such as New York). Of course by that time there were only a few fools still plodding along trying to make any research headway. After 9-11 there has been another huge upsurge in TB funding such that if you have any expertise with TB (unfortunately I dont) you can virtually write your own ticket.

[SpencerH]

Originally posted by Oerdin


.... or I'm one of the lucky 8% who are immune. ....

I'd be interested to know where you got that info from?

[self biased]

Originally posted by Dr Strangelove


It's possible to have a false positive reaction. What you're describing may be the result of an allergic response to something in the test. Of course without actually seeing the reaction I can't be sure. Wait until 48 hours have passed to judge the reaction.

yeah, i would always boggle my RN's mind when i came back with what amounted to was a half-positive reaction. turns out i was allergic to something else in the mix and it gave me a rash.

[Tiamat]

Went to work today and stoped by my office and let the nurse that gave me the test look at it. So I walked in all cheery and said so nursey worsey you think this is something to be concerned about? She looks at the red mark on my arm which is now the size of a quarter says YES!, jumps up from her desk grabs some measuring thingy that has circles on puts it on my arm. The biggest cirlce on her measuring thingy doesn't even cover the whole thing on my arm. At this point this isn't instilling a whole lot of confidence in me.

I tried the maybe I'm allergic to the serum, she says she opened up a new bottle for my test. Then she takes me into the human resources lady they set me up to go get an x-ray done (at their expense) and tell me I can't work until we get the results back. So here I sit on my ass waiting until Friday to see what's up. I looked at the x-ray, but I'm not a radiologist. Looked ok to me, but what to I know.

They tell me at the x-ray place that if I am positive that I have to let my local health department know and that they will provide me with the medication for free. So that's a plus but being off work for two days sucks. Good thing I have sick leave and vacation time.

So ok, still having a minor freek out today.

[lord of the mark]

Originally posted by Oerdin
If it matters some 8% of the European decended people are immune to TB. Our ancestors built up an impressive civilization then saw it go to hell in a hand basket after Rome fell so public services like city sewers fell apart and the population was exposed to massive outbreaks of disease.

I'm sure it was an unfortunate time to be alive but the legency is that the genes for immunity to various diseases became much more common.

IIUC being a carrier of Tay Sachs renders some immunity to TB which is why Tay Sachs is relatively prevalent among ashkenazic Jews - they lived in more dense, urban settings than other Europeans. IE Tay Sachs is to TB what Sickle Cell is to Malaria. Im a Tay Sachs carrier, BTW (thank goodness QOTM is not)

[SpencerH]

Originally posted by lord of the mark


IIUC being a carrier of Tay Sachs renders some immunity to TB which is why Tay Sachs is relatively prevalent among ashkenazic Jews - they lived in more dense, urban settings than other Europeans. IE Tay Sachs is to TB what Sickle Cell is to Malaria. Im a Tay Sachs carrier, BTW (thank goodness QOTM is not)

From my perspective as an expert in immune responses to bacterial diseases, I found a link between Tay Sachs and resistance to TB to be somewhat suspect (not impossible, but suspect). So I took a quick look and found that:

The possibility that heterozygote carriers of the Tay Sachs gene(s) are possibly protected from TB comes from an attempt to explain the unexpectedly high rates of heterozygosity in Ashkenazi Jews rather than from empirical evidence linking the two. In addition, the very first paper I found (abstract below) disputed the hypothesis so I looked no further. IMO its probably a scientific myth.

Am J Hum Genet. 1981 May;33(3):375-80. Related Articles, Links

Heterozygote advantage in Tay-Sachs carriers?

Spyropoulos B, Moens PB, Davidson J, Lowden JA.

Chi-square analyses of new data as well as data previously reported by Myrianthopoulos have shown that grandparents of Tay-Sachs carriers die from proportionally the same causes as grandparents of noncarriers. It is unlikely that there is any advantage to being a Tay-Sachs carrier insofar as resistance to tuberculosis is concerned. Our results are further evidence to support Fraikor's claim that the high carrier frequency of the allele in Ashkenazi Jews is probably caused by a combination of founder effect, genetic drift, and differential immigration patterns.

[lord of the mark]

"Chi-square analyses of new data as well as data previously reported by Myrianthopoulos have shown that grandparents of Tay-Sachs carriers die from proportionally the same causes as grandparents of noncarriers"

what was the age range of the sample population? Im a carrier, and my grandparents all died in the US between 1960 and 1990, all in middle class circumstances. Not much exposure to TB there.

[lord of the mark]

Yokoyama (1979) concluded that it is unlikely that drift alone was responsible for the high frequency of Tay-Sachs disease in Ashkenazim. Heterozygote advantage was considered a likely additional factor. Spyropoulos et al. (1981) showed that proportionally the grandparents of Tay-Sachs disease carriers died from the same causes as grandparents of noncarriers. They suggested that the finding indirectly supports the notion that the high frequency of the TSD gene in Ashkenazim is 'caused by a combination of founder effect, genetic drift, and differential immigration patterns.'

Diamond (1988) defended selective advantage as the cause of the high frequency of the TS gene in Ashkenazi Jews.

[SpencerH]

Originally posted by lord of the mark
Yokoyama (1979) concluded that it is unlikely that drift alone was responsible for the high frequency of Tay-Sachs disease in Ashkenazim. Heterozygote advantage was considered a likely additional factor. Spyropoulos et al. (1981) showed that proportionally the grandparents of Tay-Sachs disease carriers died from the same causes as grandparents of noncarriers. They suggested that the finding indirectly supports the notion that the high frequency of the TSD gene in Ashkenazim is 'caused by a combination of founder effect, genetic drift, and differential immigration patterns.'

Diamond (1988) defended selective advantage as the cause of the high frequency of the TS gene in Ashkenazi Jews.

It's possible that a selective advantage may or may not explain the high frequency of the TS gene in Ashkenazi Jews (its also more frequent in other specific populations as well). However, there is no empirical data to link Tay Sachs to TB resistance.

While it is interesting that the mutation effects a lysosomal enzyme (from which one could hypothesize altered monocyte function and CMI in some way), I find it strange that the mutation is not prevalent in populations where TB continues to be endemic.

At this point, linking Tay Sachs to TB has no more scientific validity than linking Tay Sachs to eating Matzo balls.

[lord of the mark]

Originally posted by SpencerH


It's possible that a selective advantage may or may not explain the high frequency of the TS gene in Ashkenazi Jews (its also more frequent in other specific populations as well). However, there is no empirical data to link Tay Sachs to TB resistance.

While it is interesting that the mutation effects a lysosomal enzyme (from which one could hypothesize altered monocyte function and CMI in some way), I find it strange that the mutation is not prevalent in populations where TB continues to be endemic.

At this point, linking Tay Sachs to TB has no more scientific validity than linking Tay Sachs to eating Matzo balls.

Question: Is sickle cell prevelant in every area where malaria is endemic, or just West Africa? I honestly have no idea.

But yeah, there does seem to have been a really tight genetic-bottleneck/founder effect for Ashkenazim, so it could just have been bad luck.

[SpencerH]

"The sickle cell gene is now known to be widespread, reaching its highest incidence in equatorial Africa, but occurring also in parts of Sicily and Southern Italy, Northern Greece, Southern Turkey, the Middle East, Saudi Arabia, especially the Eastern Province, and much of Central India (Figure 1). This distribution is determined by the occurrence of the sickle cell mutation and its selection by falciparum malaria. "

from http://www.kfshrc.edu.sa/annals/143/rev9239.html

[Dr Strangelove]

Originally posted by Tiamat
Went to work today and stoped by my office and let the nurse that gave me the test look at it. So I walked in all cheery and said so nursey worsey you think this is something to be concerned about? She looks at the red mark on my arm which is now the size of a quarter says YES!, jumps up from her desk grabs some measuring thingy that has circles on puts it on my arm. The biggest cirlce on her measuring thingy doesn't even cover the whole thing on my arm. At this point this isn't instilling a whole lot of confidence in me.

I tried the maybe I'm allergic to the serum, she says she opened up a new bottle for my test. Then she takes me into the human resources lady they set me up to go get an x-ray done (at their expense) and tell me I can't work until we get the results back. So here I sit on my ass waiting until Friday to see what's up. I looked at the x-ray, but I'm not a radiologist. Looked ok to me, but what to I know.

They tell me at the x-ray place that if I am positive that I have to let my local health department know and that they will provide me with the medication for free. So that's a plus but being off work for two days sucks. Good thing I have sick leave and vacation time.

So ok, still having a minor freek out today.

You need to have your TB test read by someone who knows what they're talking about.

[Tiamat]

Which would be exactly why I'm keeping my appointment with my primary care doctor tomorrow. Tomorrow is when it's supposed to be read. I even asked her if it was given in the same arm 3 months apart couldn't that have some effect. Of course she said no, no in anything I've read and I've read alot. I'm thinking....somehow I'm not feeling it lady. So am keeping my appointment.