American Doctors, TB and Europeans

[switchback]

I'm writing this as a response to the thread below but I feel that this is very important.

What I have read below alarms me for a number of reasons. We Americans are so willing to take our doctors at face value and do whatever they tell us, including taking whatever medicine they prescribe and we don't ever question it. You need to be aware that the treatment for TB is usually the drug Isoniazid, often in combination with Rifampicin. The course of treatment lasts for months on this medication and in some people it causes toxicity of the liver. This is a very dangerous side effect.

I bring this up because I fear that some of your family may be taking this medication needlessly. Let me explain. In the USA we rely on the Mantoux skin test for TB detection. I'm sure we're all familiar with the little blister injection on the forearm. The problem comes when that skin test needs to be read or "interpreted". If an American develops a large spot, a doctor can be relatively sure that they have been exposed to TB and treatment is appropriate. You can't apply those same standards to Europeans! American doctors are woefully ignorant of other countries medical practices. In most of the developed European countries, including Russia, people are given a TB vaccine. It's called the BCG vaccine. It works like other vaccines in that it stimulates the body's immune system into creating TB anti-bodies. My wife got this vaccine as a schoolgirl in Southern Russia. Today it is given to infants born in Russia. Now let's re-visit the Mantoux skin test. It's purpose is to detect TB anti-bodies. A person who has had the BCG vaccine will display a positive (by American standards) skin test! Treating someone with toxic medication who is already immune to the disease they are treating for is not a good idea. In countries where they use the BCG vaccine, the Mantoux skin test is used to be sure the vaccine worked!

Now, chances are that a person could take Isoniazid without serious side effects and it's done routinely. But why take it if you don't need to? When my wife came to the USA our doctor gave her the Mantoux skin test and said it was positive. He told us to contact our local health deprtment to arrange for treatment. They wanted both of us to take Isoniazid. At the time, my wife's English was not as excellent as it is now and she had serious doubts. I tried to reassure her and I wanted her to have faith in American medicine. She mentioned to me that she thought she had been vaccinated. I had never heard of a TB vaccination so I doubted her. That is until I decided to research the subject and found out about the BCG vaccine. When I explained to her what the vaccination entailed, she told me that it was indeed the same vaccination she received as a schoolgirl. She is immune from TB and her skin test will always give a "positive" indication.

I urge you to talk it over with your family members and see if they may have been immunized. I don't know anything about medicine in Ukraine but, I would have to assume that it would be similar to Russian medicine. If you family has immunization records, check for the BCG vaccine.

Check it out for yourself! I don't want to trivialize TB. It's a serious disease. Just be educated.

http://www.google.com/search?hl=en&q=bcg+vaccination&btnG=Google+Search

[Philb]

... in response to American Doctors, TB and Europeans, posted by switchback on Mar 14, 2005

Do not take a positive TB test lightly particularly when this occurs in a resident of the former FSU (among other countries).  While it is true that many physicians in the USA do not have a lot experience with TB, a positive test needs to be followed up.

Because of improper treatment drug resitant TB is a serious problem.  This a severe problem in much of the FSU.  This is a life threatening disease.  Do not take only my word for this.  Here is a link.  

http://www.who.int/features/2004/tb_ukraine/en/

I am sure there are many more resources available.

I am registered nurse.  If it was my wife from the FSU that tested positive I would immediately follow up with an infectious disease specialist or another physician who was familiar with the treatment of TB.  Above all, do not ignore a positive test or stop in the middle of being treated without consulting with an experienced specialist.

Yes, there are side effects with Rifampin and Isoniazid, but they may be the best alternative depending on the situation.

[switchback]

... in response to This is important!, posted by Philb on Mar 14, 2005

If you're a nurse then surely you realize that once you have been vaccinated with BCG you will have a positive Mantoux skin test for life. If you know you have been vaccinated then a skin test is a waste of time. My wife has been X-rayed and is fine.

My point is that people should find out if their loved ones have been vaccinated or not. American medicine, as you so deftly point out, has only one way of thinking. That is, a positive skin test REQUIRES medicine. Without regard as to why the test is positive.

I am well aware of the risks of TB and I know drug resistant TB is widespread in FSU countries. Don't think that Russians aren't also aware of it. That's why they vaccinate.

[Philb]

... in response to Re: This is important!, posted by switchback on Mar 15, 2005

BCG will cause a positive reading in TB skin tests following vaccination.  But, the BCG vaccine is at best effective about 2/3 of time and remains so for about 15 years (depends on the study being quoted).  So again,  my point is that a positive test needs to be followed up on by an "experienced" health care provider.  Here is a link with some info on the vaccine.

http://www.priory.com/cmol/bcg.htm

This link is from a British web site.  The vaccine is widely used in GB so the overall tone is more positive than what you would typically read on a USA based web site

[switchback]

... in response to True..., posted by Philb on Mar 15, 2005

Yes, follow up indeed but don't be a blind sheep and just do what the doctor orders.

There is a more accurate test for TB that is 95% effective. The trouble is that it's not widely known and you have to find a lab capable of doing the test. The blood sample can't be more than 30 minutes old! It's called QFT or Quantiferon test. It's effective for people who have been vaccinated. It's worth the effort to find a lab that can do the test versus taking Isoniazid.

The effectiveness of BCG is not ideal. It works best in young children and those who are exposed to populations with high TB rates. That's why we don't use it. TB is actually pretty rare here in the USA and that's one reason average doctors are not the authority on the subject.