$Unique_ID{BRK01095}
$Pretitle{}
$Title{Isn't a Chest X-ray Necessary in a Tuberculosis Examination?}
$Subject{positive tuberculosis examination examinations chest x-ray Special
Procedures procedure infection infections respiratory lungs antituberculosis
prophylactic therapy therapies bacteria bacterium bacterial}
$Volume{P-5,A-5}
$Log{}

Copyright (c) 1991-92,1993   Tribune Media Services, Inc.


Isn't a Chest X-ray Necessary in a Tuberculosis Examination?


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QUESTION:  During a recent screening I had a tuberculosis skin test which
showed positive.  After a more thorough examination, during which I was found
to be in pretty good health, my doctor decided to put me on regular
medication, but then decided that a chest x-ray was unnecessary.  This doesn't
make a lot of sense to me, does it to you?

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ANSWER:  It took a bit of reflection and some reading, but I think I can make
a case for your doctor's position, and explain a few things to you while I am
at it.  To make it all come out right I am going to assume that you are under
the age of 35, which seems likely from the rest of your letter.  The purpose
of the skin test screening for tuberculosis is to find people who might obtain
some benefit from a course of therapy with an antituberculosis medication
which will prevent the disease from progressing beyond its first stages or, in
fact, ever developing at all.  Screening tests merely reveal that the patient
has been exposed to the disease and has generated antibodies to the bacteria.
The type of therapy recommended by your physician is called "prophylactic
therapy" and is used to prevent the bacteria from ever gaining a foothold in
your body.  Tuberculosis develops slowly, and wiping out the bacteria with
proper medications prevents damage to the lungs and other organs.
Prophylactic therapy with isoniazid is very effective, and presents little
risks for the young patient.  Since you fit the picture of a young patient in
apparent good health with a positive screening test, the decision to prescribe
prophylactic therapy to you was already made, and the results of a chest x-ray
probably would not alter that conclusion.  While the American Thoracic Society
does recommend a chest x-ray in cases such as yours, recent investigations
have shown that x-rays rarely show findings that reveal active disease, and
may be of little help in caring for the patient.  In these days when medical
costs are constantly under review, your physician may be practicing in a
system where costs are kept low by avoiding tests that are of questionable
value.  For sure, your therapy is correct; the question of a chest x-ray is
one that may be debated.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.