anyone with a positive ppd? FYI

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TraciZ
Regular Member


Date Joined Aug 2007
Total Posts : 255
   Posted 6/24/2008 8:59 AM (GMT -6)   
Please be aware that prednisone and other immuno-suppressant drugs may activate the TB. My doc has me going to the health dept. for treatment. I got a positive ppd about 22 years ago and never took the meds, because my immune system had it under control. Anyway, my awesome new GI wants me to take the INH med to reduce my chances of developing active TB if/when I need Remicade in the future or prednisone (again).
Tressa 35 (F)
probably pancolitis
Colazal 3X3/day, Lialda upped to 4/day,Phosphatidylcholine 4 (420 mg capsules) once/day
Colazal 3X3/day (not generic)
Rowasa & Canasa as needed
Asacol 12/day


piper_chris
Regular Member


Date Joined Jun 2008
Total Posts : 73
   Posted 6/24/2008 11:33 AM (GMT -6)   
Have you had a TB test recently? Or does the positive 22 years ago mean you would always be positive? Please keep us updated about how it goes with the INH.

I was in the hospital in May for UC and the doctor there was encouraging Remicade but said if I had been exposed to TB that Remicade would activate the TB. So they gave me a TB skin test but it was unconclusive/unreactive, probably because I was taking high doses of steroids (intravenous solumedrol/oral prednisone). I didn't do the Remicade, partly because I was worried about the TB possibility (I have travelled extensively in pacific islands and asia statying in budget shared dorm room/hostel places). I think I have to wait until I'm totally off the prednisone to get a more accurate TB test.

I didn't realize that prednisone could activate dormant TB? Do you know if other immuno-suppressant drugs can activate it? (I just started 6-MP).
- diagnosed ulcerative colitis Feb 2005
- currently 25mg prednisone (tapering down), 75 mg 6-MP/mercaptopurine/purinethol (just started), asacol/mesalamine 4800mg (4 pills x 3 times day), 1 Canasa 1000 nightly, VSL#3, multivitamin, calcium, fish oil, sometimes digestive enzymes


jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 6/24/2008 1:38 PM (GMT -6)   
The protocol for Remicade requires a TB skin test (or chest x-ray if you've ever had a positive skin test) prior to starting the infusions and yearly thereafter. I hope all of our doctors are following that protocol. Traci, it sounds like your doctor is being proactive, and that's a great thing.

Note: if you were born in or lived for significant parts of your life in certain countries, you may have received the BCG vaccine against TB. If you did, your skin test will be positive even though you don't have dormant TB. In that case, a chest x-ray would be done.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from steroid therapy.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


TraciZ
Regular Member


Date Joined Aug 2007
Total Posts : 255
   Posted 6/24/2008 3:40 PM (GMT -6)   
Hi, Once you've been exposed to TB, you'll always be positive. They say that you should never get another PPD test again, but I've had 3-4 over my life.

Any immuno-suppressant drug may activate dormant TB. I'm no expert, but from what I understand, when you're healthy, you're immune system can isolate the TB and create a hard outer shell around it. Immuno-suppressant drugs can deteriorate that shell and the TB can get out, making it active.

My previous GI put me on prednisone knowing full well that I have a pos. ppd. In fact, she told me not to take the other drugs like remicade. Then when I switched GI's, the new one was surprised and said that I shouldn't have taken the pred and that it could have activated the TB. The new doc also specializes in immunology, so I definately trust her about this.

Not sure about the 6mmp, but it would make sense with my limited knowledge.

piper_chris, it sounds like your ppd was negative, since it was non-reactive. I hope so. Also, I'm not sure about whether pred messes up the accuracy of the ppd test.

I posted this not to cause anyone excess worry, but because I thought it may be important info for some of us. Knowledge is power.

piper_chris
Regular Member


Date Joined Jun 2008
Total Posts : 73
   Posted 6/24/2008 6:37 PM (GMT -6)   
No, my TB wasn't negative, it was ineffective. They put TB in skin of one arm and put yeast in skin of other arm as a control. They expected the yeast arm to react and get irritated, but it did not. Since the control arm had no reaction, the assumption is that the steroids suppressed any inflammation on the control arm and could also do that on the TB arm. They did do a chest xray when I was admitted to the hospital for UC on May 1st. I didn't take remicade but am on both prednisone and 6-mp. I'm hoping I wasn't exposed to TB but don't confidently know the answer to that question. I actually do have some kind of sinus/throat/lung thing going on. I go periodically to my general physician to have him listen to my lungs but haven't had anymore chest xrays or TB skin tests. Thanks for the info and hope you are feeling well.
- diagnosed ulcerative colitis Feb 2005
- currently 25mg prednisone (tapering down), 75 mg 6-MP/mercaptopurine/purinethol (just started), asacol/mesalamine 4800mg (4 pills x 3 times day), 1 Canasa 1000 nightly, VSL#3, multivitamin, calcium, fish oil, sometimes digestive enzymes


TraciZ
Regular Member


Date Joined Aug 2007
Total Posts : 255
   Posted 6/24/2008 9:18 PM (GMT -6)   
whoa! I hope that everything goes ok with you. That must be pretty scary. I wish you all the best. I wonder if it makes sense to take the INH med as a preventative even if you're TB neg? My doc wants me on it at least 6 weeks before putting me on immunosuppressants. You may want to talk to a doc who knows about these sorts of things. It's very complicated. I wish only the best for you.
Tressa 35 (F)
probably pancolitis
Colazal 3X3/day, Lialda upped to 4/day,Phosphatidylcholine 4 (420 mg capsules) once/day
Colazal 3X3/day (not generic)
Rowasa & Canasa as needed
Asacol 12/day


TraciZ
Regular Member


Date Joined Aug 2007
Total Posts : 255
   Posted 6/26/2008 10:36 AM (GMT -6)   
The chest Xray would indicate whether you were exposed to TB.

I went to the clinic today and was put on Rifampin for 4 months. It's an alternate to the INH and they say it's just as effective. This is supposed to reduce the risks of getting active TB. No one could tell me how reduced the risk is, though. If I don't take the med, my chance of developing active TB is 5-10%, but that's not considering if I take immuno-suppressant drugs. For me, it's worth it to take the treatment, even without knowing the odds.
Tressa 35 (F)
probably pancolitis
Colazal 3X3/day, Lialda upped to 4/day,Phosphatidylcholine 4 (420 mg capsules) once/day
Colazal 3X3/day (not generic)
Rowasa & Canasa as needed
Asacol 12/day

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