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2-step ppd test done. Had back injury, fracture, yeast infection and lack of sleep. Any thoughts?

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Posted on Mon, 27 Aug 2012
Question: I am quite sure that my PPD skin test will be read as positive when I return this afternoon to the HD for my reading. I am in my last leg of nursing school and have received yearly 2-step ppd's, all of which have been negative. The injection site measures 22 mm, swollen, but without induration. I was wondering if spinal corticosteroid injections have the same potential to cause false +'s as oral steroids such as prednisone? I had a back injury on 12/31/10 with balloon kyphoplasty over a yr after the injury, when the T12 compression fracture hadn't healed and further compressed. My pre surgery labs came back with some abnormalities which were attributed to a skin rash that had recently and seemingly out of no where developed and a yeast infection. I have felt malaised, but wrote it off to stress, diet, lack of sleep with my late night studying and school stress. I recently found out that my bf of 3.5 yrs has regularly took weekend hiatuses to the red light district of Amsterdam while travelling for work. He recently spent 2 months in Kuwait where tb is not overly uncommon. The combination of learning of the multiple netherland prostitutes and incidence of tb where he regularly travels, etc, has me concerned. I would love to know if my series of spinal corticosteroids for my spine could possibly have any correlation to a positive ppd? I have found ample resources that indicate oral steroids.
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Answered by Dr. Pravin Banodkar (2 hours later)
Hello     
Welcome and thanks for your question
I would be pleased to help you with your Question

The skin test should be read by a trained health professional 48 to 72 hours after administration ppd. Sensitivity is indicated by induration only; redness should not be measured.
High dose steroids in any form with induration more than 10 mm is a risk factor.

One more important point:Patients with a second tuberculin test (booster) response of 10 mm or more is considered due to having experienced past or old infection.

Persons who do not boost when given repeat tests at one week, but whose tuberculin reactions change to positive after one year,
should be considered to have newly acquired tuberculosis infection and managed accordingly.
Since tuberculin reactivity may not necessarily indicate the presence of active tuberculous disease, and you have a reaction you should be further evaluated with other diagnostic procedures.

Steroids give rise to false negatives more commonly.
Thanks and take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Pravin Banodkar

Dermatologist

Practicing since :2005

Answered : 474 Questions

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2-step ppd test done. Had back injury, fracture, yeast infection and lack of sleep. Any thoughts?

Hello     
Welcome and thanks for your question
I would be pleased to help you with your Question

The skin test should be read by a trained health professional 48 to 72 hours after administration ppd. Sensitivity is indicated by induration only; redness should not be measured.
High dose steroids in any form with induration more than 10 mm is a risk factor.

One more important point:Patients with a second tuberculin test (booster) response of 10 mm or more is considered due to having experienced past or old infection.

Persons who do not boost when given repeat tests at one week, but whose tuberculin reactions change to positive after one year,
should be considered to have newly acquired tuberculosis infection and managed accordingly.
Since tuberculin reactivity may not necessarily indicate the presence of active tuberculous disease, and you have a reaction you should be further evaluated with other diagnostic procedures.

Steroids give rise to false negatives more commonly.
Thanks and take care