Male1: He used to go, he used to get this three or four-point thing called the TB time and they do not do it anymore. It was such an easy thing to do. How come they stopped doing it?
Male2: It is unfortunate because it truly was a quick and easy and pretty much painless test especially for children. The problem was, it was not reliable. When we took a look at the data, we found out that the time test missed many cases of tuberculosis and the test that does not pick up the disease that we are looking for is not a test that is worthwhile. Nowadays, we use a test called a PPD. The PPD is a test where the serum is actually injected with a very small needle directly under the skin, raising a bubble. That bubble gets smaller over the first 24 hours and if the patient actually has been infected with the bacteria, you will then get a raised red mark at the area where the bubble had previously been. That raised red mark is seen between 48 and 72 hours after the test is applied.
Male1: If you have a test that tends to be positive and the doctor does a chest x-ray, he would have to say, you have TB, it says, you are at risk and he might give you some treatment just to prevent you from getting the disease, is that true?
Male2: There are two different types of disease from TB. There is tuberculosis infection and tuberculosis disease. The first stage of the process is tuberculosis infection. Once the bacteria enter the body, the body is infected and that is when the test first becomes positive. The body fights the infection and many times the body can fight the infection effectively so that the tuberculosis never spreads to the lungs or the other organs. If the tuberculosis spreads to the lungs and the other organs, that is tuberculosis disease and that is when the chest x-ray shows the changes of tuberculosis that we commonly expect. The difference is that if a person has tuberculosis infection, the treatment is different than if the person has tuberculosis disease. The antibiotics that we use are somewhat different and the length of treatment is also different, and so we need to differentiate with these two types of infection in order to know how to properly treat the patient. The other thing to realize is that a person with tuberculosis infection is not contagious. The only person who is contagious is the person with the full blown disease, not the infection itself.
Male1: Some doctors use the term recent converter which implies, you just have to give a little bit of protection, but does not have the disease, is that true?
Male2: Yes, recent converter is the same as a person with tuberculosis infection. A recent converter or a person with tuberculosis infection has a positive test, has a normal chest x-ray. That person needs only one medication for a period of nine months.
Male1: And that medicine is what?
Male2: The medicine we commonly use is called Isoniazid. The abbreviation is INH and most of us use the abbreviation. It is a whole lot easier to say.
Male1: If for some reason they are treated with INH, you still have got to watch the child for a period of time afterwards.
Male2: Well, we certainly trust the child care for like—he used INH for a period of nine months, you supervise the child to make sure that they are getting the medication properly. You do a physical examination on the child monthly at least for the first few months to make sure no side effects are occurring and to make sure that the patient is responding well to the treatment.
Male1: And a doctor would probably check all close contacts in a kid who converted to see where the source is?
Male2: Absolutely. Since the child has gotten the tuberculosis from somebody else, it would be important to try to find out who gave the child the infection and who else may have developed the infection in that same circle of individuals.
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