A chest x-ray showed a client’s lungs to be clear. His Mantoux test is positive, with a 10mm of induration. His previous test was negative. These test results are possible because:
A. He had TB in the past and no longer has it.
B. He was successfully treated for TB, but skin tests always stay positive.
C. He’s a “seroconverter”, meaning the TB has gotten to his bloodstream.
D. He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test.
Correct Answer: D. He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test.
A tuberculin converter’s skin test will be positive, meaning he has been exposed to an infection with TB and now has a cell-mediated immune response to the skin test. Induration of 10 mm or greater indicates positivity in persons with above baseline risk of reactivation.
Option A: The client’s blood and x-ray results may stay negative. It doesn’t mean the infection has advanced to the active stage. If the chest radiograph or clinical evaluation are suggestive of tuberculosis, then active infection needs to be excluded with further testing.
Option B: Because his x-ray is negative, he should be monitored every 6 months to see if he develops changes in his x-ray or pulmonary examination. If there is no evidence of active disease is noted by history, physical or radiograph, the patient is deemed to have LTBI and should be treated.
Option C: Being a seroconverter doesn’t mean the TB has gotten into his bloodstream; it means it can be detected by a blood test. If there is a high risk of infection and progression, the test should not be repeated.
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