[MCOH-EH] [External] Re: Quantiferon gold TB test - preplacement question

[Swift, Melanie]

Michael, what was the quantitative value of TB-nil? While the lab will call anything over 0.34 positive, there is definitely a grey zone between 0.34 and 1.11 where repeating the test is recommended. If the level is over 1.11 it's likely a true positive. Wendy Thanassi has published a great article on this, attached.

As a teaser, the topic of latent TB infection is one of our MCOH-sponsored sessions at the next AOHP in Baltimore. Wendy will be speaking on interpretation of IGRAs. Allen Kraut, also of this listserv, will add his perspective from the frozen north (aka "Canada") as well :). Plan to attend!

Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
http://occupationalhealth.vanderbilt.edu

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Band, Michael DO
Sent: Wednesday, July 30, 2014 1:10 PM
To: 'MCOH/EH'
Subject: [External] Re: [MCOH-EH] Quantiferon gold TB test - preplacement question

Sorry

Trying to type between patients.

Yes her quantiferon gold TB test was positive, neg ppd.   I am worried this is a false positive.

Michael Band DO, MS

From: MCOH-EH [mailto:mcoh-eh-bounces+mband=watsonclinic.com at mylist.net] On Behalf Of Morelli, Karen J
Sent: Wednesday, July 30, 2014 2:07 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] Quantiferon gold TB test - preplacement question

I assume you meant to type that the Quantiferon is positive now after a negative ppd one month ago.  I have been monitoring the Quantiferon issue since we had a cluster of false positives last fall (presumably due to tube/process issues).  The research I have done states that Quantiferon could be run within a 3 day window of receiving a ppd, after that there is a chance of getting a false positive reading on the Quantiferon (from the ppd plant).  There is no concrete "cut off" time frame that I have seen to know when it would be okay to run a Quantiferon after a ppd.  The TB expert in my area stated that false positive Quantiferon tests have been noted up to 6 weeks after a ppd.  Due to the uncertainty of when it would be okay to run a Quantiferon after a ppd, our department has adopted a 6 months cut off time.

Thank you,
Karen Morelli RN, BSN
Eastern Maine Healthcare Systems

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Band, Michael DO
Sent: Wednesday, July 30, 2014 1:41 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [MCOH-EH] Quantiferon gold TB test - preplacement question

Currently we are using the quantiferon gold TB test for use after a positive ppd for preplacement.

Every once in a while a new doctor or employee are not available for a 48-72 hour ppd read so we do quantiferon instead.

Had a new doctor with a negative ppd one month ago at another facility and her quantiferon gold is negative.

NO symptoms of active TB and no known exposures.  She is in a low risk specialty for TB exposure.

Chest xay normal

Question:


1.        I read somewhere that a recent ppd can interfere with the quantiferon gold test.  Not sure if this is true?


2.       What is the next step?  Do we call this latent Tb?  Is it worth repeating the quantiferon gold test?  Could this be a false positive?


Thanks for any help.

Michael Band DO, MS
Watson Clinic

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