What are the TB testing requirements at St. Mary's University?

All international students must have a TB skin test or IGRA blood test.:

• TB skin test or IGRA blood test must be performed within the last 12 months before starting at St. Mary's University
• TB skin test must be performed in the United States
• It must be read in millimeters of "induration"
• All students with a positive TB skin test or IGRA blood test must have a CXR performed.

What is tuberculosis?

Tuberculosis, also called TB, is an infection caused by a bacterium that usually affects the lungs, but it can spread to the kidneys, bones, spine, brain and other parts of the body.

How does my doctor check for tuberculosis?

The most commonly used method to screen for tuberculosis is the TB skin test or "PPD" skin test. If you have a positive TB skin test, it means you have been exposed to tuberculosis and you are infected with the bacterium that causes the disease. A "newer" method of screening for Tuberculosis is the IGRA blood test. It is mainly reserved for individuals who have had a BCG vaccine in their home countries, since the BCG vaccine can result in false positive TB skin tests.

If you have a positive TB skin test or positive IGRA blood test, you must have a chest x-ray and a physical exam to find whether you have active TB disease or are able to spread the disease to others.

It usually takes only a few days to tell whether you are contagious. Most people with a positive skin test are not contagious.

How do you perform a TB skin test?

The TB skin test is performed by injecting 0.1mL of 5 TU (tuberculin units) PPD underneath the top layer of the skin of the forearm (see picture below). The injection is typically made using a very small needle and syringe. A pale elevation of the skin or wheal should be produced when the injection is done correctly. Generally the wheal will be quickly absorbed.

When do I need to return to have my TB skin test read?

You will need to return to have your TB skin test read by a medical assistant in 48-72 hours.

What is the cost of a TB skin test at St. Mary's University?

The cost for a TB skin test is FREE at the Student Health Center. The IGRA blood test costs ~$100.00 and is billed to your student account. There are additional charges that are the responisibility of the student if the TB skin test or IGRA blood tesdt if found to be positive. These might include, but are not limited to, Chest x-rays, medication, and referrals.

I received the BCG vaccine when I was younger. Do I still need to receive the TB skin test?

YES.

St. Mary's University requires all international students to have a TB skin test or IGRA blood test REGARDLESS of prior BCG vaccination. The IGRA blood test is a better screening test for a student who has received a BCG vaccine, however the TB skin testing is NOT CONTRADICTED for BCG-vaccinated persons. In fact, a 10 mm reaction to the TB skin test is considered positive in a BCG vaccinated adult. A chest x-ray should be performed if the TB skin test is greater than 10 mm or if the IGRA is positive. If the chest x-ray is normal, then a previously BCG vaccinated adult should be counseled on treatment for latent TB infection with isoniazid or INH.

If I have a positive TB test or positive IGRA blood test, do I have tuberculosis?

Not necessarily. A person can be infected with the bacteria that causes tuberculosis but not actually have the disease. For example, a person with positive TB skin test or IGRA blood test, no symptoms, and a normal chest X-ray has "latent TB" and is not contagious to others. This person is said to have latent TB and has a 10% risk of developing TB DISEASE or ACTIVE TUBERCULOSIS if prophylactic treatment with INH or isoniazid is not taken. People who have "active" TB have a positive TB skin test or IGRA blood test, have symptoms of TB, and also have abnormal chest X-rays. People with "active" tuberculosis are infectious or contagious to others. This is the reason it is so important to be tested so that treatment can be initiated promptly. Review below:

• There are 2 "Types" of TB:
  • Latent Tuberculosis Infection:
    • No signs and symptoms of TB
    • TB skin test or IGRA blood test is positive
    • Normal Chest x-ray
    • NOT INFECTIOUS
    • Latent TB treatment is recommended in order to decrease chances of converting to active TB during one's lifetime.
  • Active Tuberculosis Disease:
    • Signs/symptoms of TB usually present
    • TB skin test or IGRA blood test is positive
    • Abnormal Chest x-ray
    • Sputum smear/Culture Positive
    • CONTAGIOUS before Rx

How will my doctor treat the tuberculosis infection, also known as "latent TB"?

To be sure that you remain healthy, your doctor may recommend that you take medicine for 6 months to kill the tuberculosis infection. If you don't take the medicine, the bacteria will remain in your lungs, and you will always be in danger of getting active tuberculosis. The medicine used to treat tuberculosis infection is isoniazid or INH. You need to take 1 pill every day for 6 months.

INH may have side effects, but not very often. Typical side effects include a skin rash, an upset stomach or liver disease. Ask your doctor about other side effects that might happen.

Can I still get active tuberculosis after I take medication for latent TB infection?

Even after you take the medicine every day for 6 months there is a small chance that you could develop active tuberculosis disease, because some bacteria are resistant to the medicine. Staying healthy depends on having sensible living habits. You need enough sleep and exercise and a healthy diet to keep up your health and resistance to the tuberculosis bacteria.

What are the symptoms of "Active" Tuberculosis?

You might not know that you have active tuberculosis. Tuberculosis bacteria can grow in your body without making you feel sick. However, most people with active tuberculosis don't feel well. Symptoms of active TB include:

• Cough productive and prolonged (duration of 3 weeks)
• Hemoptysis or bloody sputum
• Fever and chills
• Night sweats
• Weight loss or lack of appetite
• Fatigue or lack of energy
• Chest pain

If you have any of these symptoms, you must contact your doctor as soon as possible. If you are found to have active tuberculosis, you will have to get regular checkups and chest x-rays for the rest of your life to make sure you stay free of disease, even after you have taken tuberculosis medicine.

How is Active Tuberculosis spread to others?

Tuberculosis is a respiratory infection and can spread to others when a person with "active" tuberculosis coughs, sneezes, speaks, or sings which allows the bacteria to spread to the respiratory system of another person. Those living with the person with active TB are at the highest risk of being exposed.

A person with a positive TB skin test or positive IGRA blood test, and a negative chest x-ray is said to have "latent TB" which is NOT infectious to others. A person with latent TB, however, has a 10% chance of developing "active TB" in their lifetimes, which is why prophylactic treatment with isoniazid or INH is so important.

What is the treatment for active tuberculosis?

If you have active TB, your doctor may recommend that you take several medications.

It's very important that you take all the medicine given to you. For the medicines to work at curing your tuberculosis, you must not skip a single dose.

Your doctor may also order several sputum and blood tests to be done while you are being treated for tuberculosis. (Sputum is phlegm coughed up from deep inside the lungs.) These tests can be done by the nurse or at a clinic.