Tuberculosis and diving

[Ber Rabbit]

Under what conditions could a person who tests positive on a TB test dive? I understand there's a difference between having TB and testing positive but I don't know why. What kind of doctor's evaluation should a student be asked to provide to prove they aren't going to infect other students with TB if they just test positive but don't have TB. What medications are used to treat TB, should a person dive at all if they need these medications?
Ber

 

[rmediver2002]

We had several positive tests after Somalia, I do not remember the specific medication they were on but the series lasted five weeks if I remember correctly...

No one was removed from diving status permanently though.

After completion of the series they were diving again but I think they will always test positive for the anti-bodies...

Sorry this is not an absolute answer for your situation.

Jeff Lane

 

[Adrian Kelland]

I remember having a chest x-ray to spot TB scars on the lungs (or any scar i suppose). AIUI any scar could be a weakness in the lungs, and thus lead to inceased risk of pneumothorax.

Having a tuberculosis infection is not the same as having tuberculosis, strange as it sounds. A skin test will normally confirm the infection, but it can read false, both positive and negative. There is a 5% risk of developing the full disease during the next year. Treatment is used to prevent the further development.

I doubt that anyone should dive while taking the kinds of medication I guess must be involved. Would you dive while taking even a common cold rememdy? Some side effect of Izonaid, a common treatment are

Change in vision
Clumsiness or unsteadiness
Nausea and vomiting
Pain in upper abdomen
Tingling and numbness of hands/feet
Weakness and fatigue

These sound familiar Can you imagine getting thse while diving. Is it a side effect or DCI???

With a bit of luck, one of the doctors will pop in soon with a much more suitable reply.

 

[Ber Rabbit]

Thanks for the info!

rmediver
Actually the person had been exposed on the job several years ago I believe and from what I understand he went through exactly what you described. I just need to be sure the TB can't be passed to others.

Adrian
Thanks for the info and drug name, as far as I know no medication is being taken at this time but I needed a name in case his Dr. report says otherwise. I'll let him know that a chest x-ray would be a good idea.

Hopefully the docs will chime in with more info but this is enough to help me help a student. THANKS!
Ber

 

[Adrian Kelland]

Ber

I think an x-ray would only be required if the person had developed the full blown disease.

Adrian

 

[KBeck]

For what it's worth, I can describe my own experience.

I had a TB test came back positive when I was in college......and it was quite obvious, where the test area swelled up to a very large red lump.
This was @ 7 years ago now, but the explanation from the doctor was that because TB (active) is so easily transmitted, you can pick up the infection from just being near someone, being coughed on, etc.
However, in many cases (as was for me), you never show any outward symptoms, etc., and with proper treatment, will never develop the actual disease. You're simply a "carrier", and cannot further transmit the infection. (Again, with proper treatment).
The treatment was an antibiotic every day for six months, and a blood test every month. I do not remember if the purpose of the blood test was to check out the status of the infection or to be certain that the antibiotics were not causing other problems. They did take an x-ray of my lungs at the very beginning, to be certain there were no signs of active infection in the lungs, and at the end of the series for the same reason.
The only activity I was barred from was drinking alcohol, due to the contraindications from the antibiotics (of course, that didn't necessarily stop me.......).

I think the key is the difference between having a positive test (being "infected"), and actually developing the disease itself, at which time you develop the ability to infect others.

Now, obviously, I am not a medical professional and it's been years since this happened, so if anyone sees any incorrect information in my post, please do correct me. However, given my memories of the doctor's explanation, I don't think there should be any fear of infecting other divers. However, someone else may have better input as to whether diving during treatment should be avoided or not.

I just figured a "first-hand" account might be of interest.

 

[Lloyd]

Depending on the size of the reaction it can indicate whether you have an active disease or have have been exposed. A small area of induration(swelling) usually indicates exposure. About 10% of exposed people develope active tuberculosis. The other 90% fight the disease off. About 10% of this group have inactive bacteria which can develope into an active disease later in life. The other 90% are cured by their bodies own immune system.

If you received treatment after exposure, your chances of developing active TB approach zero. You are not even a carrier. You are cured. The purpose of the chest x-ray is to see if you are contagious. If you have active TB in your lungs, you are contagious. It does not show for sure if you have the active disease since you can have TB in any part of your body. I have had several patients with TB in their eyes.

Please excuse any typos since I had an emergency appendectomy yesterday and am still a little fuzzy. The above is factually accurate.:doctorM me for more specific advise if needed

 

[The Iceni]

KBeck once bubbled...
For what it's worth, . . . I think the key is the difference between having a positive test (being "infected"), and actually developing the disease itself, at which time you develop the ability to infect others.

good one Lloyd. Not much to add, really.

TB was a scourge in the 19th century. Far worse than AIDS is today and there is re-emergence of TB in the UK particularly in those from the Indian subcontinent.

Transmission of Mycobacterium Tuberculosis is very easy and the organism can lie dormant for many years with no symtoms whatsover. The disease becomes active when the "carrier" becomes immunocompromised, whether is is due to malnutrition, intercurrent illness (particularly cancer) or old age (often affecting the hip).

Some individuals are genetically susceptible to the disease whom it rapidly "consumes" (hence the term consumption). H G Wells and D H Lawrence immediately spring to mind as two of its most famous British victims but of couse there were thousands upon thousands who succumbed. (Of interest, it increases the libido. That could explain Lawrence's obsession with sex - The white peacock (1911), Sons and lovers (1913), Women in love (1920), Lady Chatterley's lover (1928), The virgin and the gipsy (1930) - to name but a few)

TB was largely irradicated following the introduction of BCG vaccination (Bacillus Calmet-Guérin) and aggresive use of multiple drug regimes for those with active disease (Isoniazid was commonly used but now ethambutol, pyrazinamide and streptomycin are more often employed here.) There are considerable problems with compliance because of the awful side effects with all anti-TB medication, which adds to the public health problems.

As with all bacteria multiple resistance is becoming widespread.

In the past I offered BCG, to provide life-long immunity, as a part of the work-up on babies but we are no longer able to get the vaccine in UK practice.

Active pulmonary TB is an absolute contraindication to scuba diving because of the cavities it forms in the lungs, with the associated risks of barotrauma.

I hope you non-medics find this interesting.

 

[Ber Rabbit]

Thank you SO MUCH for the information. The student will be pleased that he'll be able to take the class as soon as I get confirmation of the TB situation he described (similar to rmedivers post). Hopefully he understands that it's my duty to protect the health and welfare of my students as well as myself and that's why I insisted he contact his doctor.

Again, thanks so much for the information!
Ber