Crohn's Disease Forum » General IBD Discussion » Latent tuberculosis while on aza


07-13-2018, 08:33 AM   #1
December's flower
 
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Latent tuberculosis while on aza

Prior to azathioprine exposure my Mantoux test was negative.
Today , two years after I am positive tested.
Has anyone experienced same situation and how has dealt with it ?
It's so overwhelming
07-13-2018, 10:05 AM   #2
my little penguin
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Latent tb
Needs to be treated by infectious disease doctor
They do a chest X-ray
Then isoniazid daily for 9 months
Simple as that
The isoniazid treats the latent tb
So at the end of 9 months no longer an issue
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07-13-2018, 10:53 AM   #3
December's flower
 
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Thank you so much for the reply.
Is it possible to stay on azathioprine for my Crohn's while taking isoniazid ?
I was just about to switch to biologics.
G.i. told me to continue aza , until next week and wait for the quantifieron results.
07-13-2018, 11:15 AM   #4
my little penguin
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You can have false positives
So that is why they are waiting on the blood test
Most start biolgics after 1-2 months on isoniazid
Woth 8 weeks off biolgics as optimum time frame per the literature

Not sure on Aza ...
07-13-2018, 11:29 AM   #5
December's flower
 
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Million thanks
07-30-2018, 09:14 AM   #6
December's flower
 
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Quantiferon came backnegative.
My g.i. suggests that the positive Mantoux is due to BCG vaccination.
Pneumonologists on the other hand are really thoughtful about if I'm really suffering from Crohn's or from intestinal paratuberculosis 🙄🙄🙄🙄🙄
This is so frustrating.
They want me on a nine month regimen of isoniazid instead of the 3 month scheme (combo of isoniazid plus 2 antibiotics.)
I ve already had a right hemicolectomy and been on azathioprine for almost 2 years.
This is like a nightmare 🤐🤐🤐
07-30-2018, 10:00 AM   #7
my little penguin
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9 months of isoniazid is standard protocol
Although woth bcg vaccine they should have never done a skin test
Only blood
Assume lung X-ray was negative
07-30-2018, 10:09 AM   #8
my little penguin
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One negative test does not negate a positive one
They should have explained that
If you treat them if or when you need a biologic they can treat you safely provide the isoniazid protocol was completed
07-30-2018, 03:51 PM   #9
December's flower
 
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That's right the lung x-ray was also negative.
I have some doubts because the day the nurse's assistant measured my Mantoux I didn't feel the enduration , just the redness which is still apparent on my arm.
Now they think that it is possible not to have Crohn's.
The pneumonologists want me to undergo a colonoscopy and take biopsies suspecting that I suffer from intestinal tuberculosis and not Crohn's.
They said that if I fail humira , as long as I failed also azathioprine this could be the answer.
I feel a little hope inside my heart that I might get cured , but I'm afraid that I am only going to be disappointed
08-01-2018, 11:13 PM   #10
my little penguin
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What???
Lots of folks who have Crohns
Eventually test postive for latent tb
Mainly due to the immunosuppressants/biologics
Required
Please get a second opinion
08-16-2018, 12:17 PM   #11
December's flower
 
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Oh gosh, I ve been to 4 different pneumonologists so far.
They aren't even capable of telling me with responsibility whether I got latent Tb or not.
So far I got a negative quantiferon , but they say that it's sensitivity of accuracy of the negative results falls down by about 50% for those who are immunosuppressed , so it's not much of a reliable testing for the docs.
I repeated the Mantoux test , no induration at all , just measured again a redness of 15 mm cause I'm a special case as I am immunosuppressed, otherwise they wouldn't pay attention to the redness.
And as I wrote the other time there were no findings in the x-ray.
Today I am still taking isoniazid and I'm waiting for two more weeks to eventually be on humira.
They also said that the 9 month isoniazid treatment doesn't mean that I'm going for sure to get rid of those damn mycobacteriums for sure :/
Such a mess ! 😜😜😜😜
08-16-2018, 01:52 PM   #12
my little penguin
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Please see infectious disease doc
Quantiferon gold
Has markers
It tells you if immunosuppressed patients
Give a response or not based on those markers
So you can have a negative quantiferon test
But as long as It shows your body would show a response of exposed then itís a valid test
If it shows your body wonít mount a response no matter what then an invalid test

So they can tell you if you have latent by or not
Good luck
08-16-2018, 03:19 PM   #13
Maya142
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I think the confusion may be because you can have TB in your GI tract...that may be what they are referring to. And on biopsies, I believe TB and Crohn's look similar but there are differences.

We have always used the blood test - Quantiferon gold - after consulting several infectious disease doctors. My daughters have positive skin tests because they had the BCG vaccination. They always have a negative Quantiferon Gold test and negative chest x-rays and have never been treated for latent TB.
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08-16-2018, 03:24 PM   #14
Jasonaldean
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Get well soon........
08-16-2018, 04:41 PM   #15
December's flower
 
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Thank all for the support. Unfortunately I'm going to wait two more weeks for my appointment with my gastroenterologist and probably I will try to reach an infectious disease doctor after all.
Meanwhile I kept googling about the quantiferon gold test and I came across to this https://www.ncbi.nlm.nih.gov/m/pubmed/26139305/
It was published by my gastroenterologist 3 years ago...
08-17-2018, 03:10 AM   #16
KarlB
 
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Good luck with your treatment. If you do have Crohn's, isoniazid has been shown in some studies to have a small benefit. So it may help with Crohn's as well as the TB.

I am wondering if it makes sense to have the BCG vaccine before starting Aza. It seems logical to have it, since Aza increases your chance of getting TB, so you may as well get some extra protection.

I ask because I may be starting Aza soon for the first time, and I've never had the BCG.
08-17-2018, 07:07 AM   #17
December's flower
 
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Thank you
I had the BCG vaccination during my childhood.
Discuss about any required vaccination with your doctor and make sure to get the labs for hepatitis , hiv etc before starting azathioprine
08-17-2018, 10:19 AM   #18
my little penguin
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If you had Bch vaccine during childhood
They should have never done the skin test
Since it Bcg gives a false positives
Wow 😮
08-18-2018, 05:02 PM   #19
December's flower
 
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They are aware of my BCG and they didn't take it into consideration.
I'm just looking forward to be on the proper treatment for my Crohn's.
Azathioprine never put me in deep remission.
It's really important for me to achieve mucosal healing, I have already had a right hemicolectomy and a psoas abscess drained at 21.
Before this , I was suffering from pain alone in silence because no gastroenterologist ever mentioned the possibility of having ibd , until that emerged surgery who changed my life.
Now , I'm only 23 and I want to live a normal life.
Really hope that they will cure ibd in the future.
08-18-2018, 06:33 PM   #20
Maya142
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Hang in there December's flower. I'm sorry they have given you so much trouble over this. If you had the BCG vaccine, then the skin test is useless. It will give you a positive result.

So you have had a positive skin test and NOTHING else is positive? The blood test is negative, the chest x-rays are negative? And they're still treating you for latent TB?

My daughter had the same results because of the BCG vaccine - they did the skin test and of course it was positive. But nothing else was positive so we were sent to an infectious disease doctor. We saw about 3 infectious disease specialists, ALL of whom agreed she did not have TB and did not need treatment.

She started Humira a couple months later...no issues.

Hopefully, Humira will be your miracle!
08-19-2018, 04:44 PM   #21
December's flower
 
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Yes , I had the skin test twice in fact , because I wasn't persuaded about the latent tb story.
They said that because I'm immunosuppressed I can catch the Tb even in the metro.
They claimed that my vaccination was a really long time ago , 15 years approximately , so it wouldn't justify the positives.
Quantiferon gold is negative and so does the X ray , but they say that it might be false negative due to the immunosuppression.
I'm still taking 3 pills of isoniazid once a day.
I am planning to visit an infectious disease doctor when I ll come back home to Athens cause I'm on holiday at the moment and most good doctors have also closed for summer until September
08-19-2018, 05:00 PM   #22
my little penguin
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Definitely see Infectious Disease
Quantiferon has a three part test
One is for the latent tb
Ther other two whether you can mount any response on the test to rule out false negatives
Grrr

Hope it gets straightened out soon
09-07-2018, 09:45 AM   #23
December's flower
 
Join Date: Mar 2018
Hi again just a quick update...
I tried to reach an infectious disease doctor but I didn't have any good chance with it is there wasn't any available appointment for the next 3 months...
So, I am just staying on isoniazid...
Visited my gastroenterologist yesterday to start humira, as I am on isoniazid for more than 34 days...
He now says that I need in total two months on isoniazid 😮😮😮😮, because they are afraid of the tb.
The Tb incidents in my country are rising high due to the refugees.
He shocked me !
The medical care practice, even if it's about Crohn's is so different across the world...
I thought the guidelines are Same
for all the doctors.
I really can't understand as a patient the necessity of waiting two months instead of 3 weeks before taking anti tnf in my case.
I can't see the point.
09-07-2018, 10:33 AM   #24
KarlB
 
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It is important that all the TB is eradicated before you start anti-TNF agents.

The anti-TNF agents will make it harder for your immune system to fight off any remaining TB.
TB can quite easily kill you if you are on anti-TNF.

TB is a tough bacteria to kill and I am not surprised at all that your doctor wants you to wait two months after starting isoniazid. Some guidelines suggest 3 months.

Are you on any other antibiotics as well as the isoniazid? This is usually given in combination with rifampin and a quinolone or macrolide antibiotic.

Are you on Azathioprine or any other Crohn's medication?

How are your Crohn's type symptoms at the moment?

Are you having regular blood tests for isoniazid induced liver damage? This is sometimes but not always recommended. Isoniazid can be quite toxic to the liver.
09-07-2018, 11:11 AM   #25
December's flower
 
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I am currently on azathioprine 200mg along with only isoniazid , isoniazid prescribed for 9 months.
Last colonoscopy in June showed disease recurrence on the anastomosis side , 8 apthus ulcers.
I am having all the blood tests on a monthly basis.
At first they said I just needed three weeks of chemoprophylaxis that's why I'm upset.
09-07-2018, 11:43 AM   #26
my little penguin
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8 weeks of isoniazid unfortunately is the norm prior to starting a biologic .
And then completely the full 9 months .

I am sorry you have to go through this

But they are being cautious for a reason
Tb mixed with anti tnf can be deadly
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