From the Coal Face.

These are some interesting comments from "reify99" who is an ex TB Nurse in the USA. I think it very clearly shows why there is "bottom up" pressure to use Quantiferon-TB in addition to the "top down" pressure that we are seeing expressed in trials and scientific papers.

"Understand also that I no longer work as a TB nurse so I don't feel I should expound too much since I don't have my finger on the pulse of TB diagnosis and treatment in the same way as before.

I agree wholeheartedly that it is shortsighted to use the TST and treat people based on it's 35% specificity to TB. In fact, it's ridiculous. In fact, given the liver toxicity associated with INH , rifampin, and other treatments for latent illness, I think it's only a matter of time before someone gets sued for treatment that was not needed but was recommended because of unreliable TST results. And caused liver damage. That will be a wake up call.

The other way I see Quantiferon TB Gold getting traction is with antibiotic resistant TB. If that gets a foothold here TB will be front and center because everyone will want results NOW. Forgive me if I've posted this before but when I worked with Hispanic immigrants it was very difficult to get the two stage test completed with undocumented folks. I would be administering the 13 antibiotic pills (4 drugs) to my spanish speaking patient in his rented home, hear faint snoring which was not coming from him, change my position slightly and see toesbehind the sofa. Ah, a friend from Mexico City who needed a bed for the night.

I would pull out my refrigerated bag, draw up a Mantoux TST dose and administer it. But that gentleman would have to show up at my clinic in 48 to 72 hours or be at my patient's house during the same time window when I visited. But he was probably out looking for a job. Many, many times the reading of the TST did not happen with these transient individuals who were part of the formal contact investigation. My patient had active illness in all four lobes and had positive sputum cultures for four months. He was still infectious for all of that time. If drug resistant TB gets a foothold, this incomplete test result will simply not be acceptable and I think the CDC will insist on Quantiferon TB Gold."

http://www.sharesguru.com/forum/cellestis-cst-2013-1260.html#p54197

"reify99" goes on to say

"I worked as a TB nurse in Indiana. I live in Wisconsin now. The patient I spoke of worked as a dishwasher in a Chinese restaurant. Think clouds of steam, helping to keep TB traveling thoughout the room. It can stay airborne for several hours anyway. One of the contacts was, I surmised, an illegal immigrant from China.

He disappeared after I gave him his TST but before I could read it, and I was told he'd moved to New York. 

Actually, I have great sympathy for the mexican people immigrating here. My ancestors came over from Ireland in the holds of ships, many of them infected with TB. I think of these people as dealing now with what my great-grandparents dealt with then. They work hard, take the jobs no one wants, live 5 to a house, ride bicycles or walk. If you are in any restaurant in the USA, take a peek into the kitchen and you will likely see a recent immigrant, working hard.

The problem is that latent TB is carried by one third of all the people in the world. So, just like my ancestors, they are bringing it with them, usually in latent form, when they come looking, and willing to work for, a better life. 

We have a product which is a significant part of the solution to the TB cycle. But Governments have also to commit the resources to finding the carriers and treating them. That is coming."

http://www.sharesguru.com/forum/cellestis-cst-2013-1260.html#p54204

Thanks "reify99"

P.S. I am working furiously on "The Cellestis Story. Part Two". Hopefully, I will be able to post it this weekend.

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