$Unique_ID{BRK01095}
$Pretitle{Special Procedures and Laboratory Tests, Infections or Parasites}
$Title{Isn't a Chest X-ray Necessary in a Tuberculosis Examination?}
$Subject{tuberculosis test x-ray}
$Volume{P-5, A-5}
$Log{}

Copyright (c) 1991   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 anti-tuberculosis 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.
ÿ
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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.
