Just a quickie:
Saw a patient today who is from mainland China. He's a researcher. He wants to stay in the US, so he is applying for a green card.
A great deal of the non-US world gets a vaccine as kids. It's called BCG (Bacillus-Calmet-Guerin, approximately). Bacillus CG is another word for Mycobacterium tuberculosis. If you receive this vaccine, your tb skin test (ppd--standing for Purified Protein Derivative) is always positive.
He produced a document from the US State Department saying that, even if you have proof that you had a BCG vaccine, and that you have a chest x-ray that shows no evidence of tb, you WILL NOT receive a green card unless you take INH (Isoniazid) for nine months.
INH can be hepatotoxic. And if you don't take it with supplements of Vitamin B6, you can develop a nasty peripheral neuropathy.
If I have a patient that used to have a negative ppd, and it changes to a positive one, you OFFER a patient six months of INH to lower the possibility of 'late reactive' tuberculosis as they approach old age. You OFFER it to them, and get their informed consent before they take it.
But, thank God, this guy left a totalitarian state and came to the US. Let freedom ring.
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