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    Why Should I Get A 2 Step PPD Test? 1000 667 Sandeep jain

    Why Should I Get A 2 Step PPD Test?

    Tuberculosis, or TB as it’s more commonly called, is a contagious infection that primarily affects the lungs. In the early 1900s, TB was the leading cause of death in the U.S. Thanks to advances in treatment and prevention, we’ve seen dramatic decreases in cases year after year. However, TB case counts were highest in California, Texas, New York (including New York City), and Florida – these four states accounting for almost half of the total cases in the United States. Unfortunately, this disease cannot be eliminated with people still contracting TB, so it’s important to take preventative measures to make sure you remain as healthy as possible.

    The best way to determine whether you have TB or not is by taking a 2 Step PPD Test. It uses a Purified Protein Derivative (PPD) injection to get a response from your body which is then measured by the doctor. Statcare can provide a safe, accurate and efficient 2 Step PPD Test any day of the week, including holidays, if you think you might have been exposed to someone with tuberculosis. If you’re not sure, keep reading. We’ll help you understand the test, what it covers and whether or not you need it.

    What Is A 2 Step PPD Test?

    A 2 Step PPD Test is designed for people who are at highest risk for getting TB. Many patients have reduced skin reactivity, so the second step of the test makes it possible to be more accurate with making a diagnosis. In a typical test, a doctor injects a small amount of purified protein derivative (PPD) into a patient. After a few days, the doctor will measure the size of the reaction your skin has to the injection in order to diagnose you. If you’ve had TB in the past, it’s likely that your skin won’t react at all, sometimes resulting in a false negative.

    A 2 Step PPD Test eliminates the risk of leaving TB undiagnosed because the added round of an additional skin test makes it harder for TB to go undetected. Getting a 2 Step PPD Test is the easiest, most accurate way to understand whether or not you’ve been infected with tuberculosis.

    The added step does add extra appointments to your schedule, which can be a concern for some people as many medical offices are closed on weekends and holidays. This becomes even more of an issue as the test may need to be redone if it could not be read in the 48-72 hour time frame. Statcare however makes it easy for you to make appointments on your terms. We are open every day of the week including holidays for extended hours. Our staff can accommodate your 2 Step PPD Test anytime and at any location so you can get your results as soon as possible.

    Required Tuberculosis Testing

    A few job industries require tuberculosis testing for all employees. Workplaces such as hospitals, schools, prisons and pharmacies are more vulnerable to the quick spread of TB through coughing, sneezing, and even talking.

    If your employer requires tuberculosis testing prior to your first day of work, it’s important to remember the nature of the test and that it requires several days to be completed. This isn’t a test that can be administered and read in a quick half-hour appointment. You’ll have to wait at least 48 hours between the injection and finding out your results. Make sure to plan for that timeline when you’re scheduling your 2 Step PPD Test before your first day of work. The test cannot be read after 72 hours so you may want to make sure that the medical office will be open 72 hours from the time of injection. Also, if you get the test done at one practice and then approach another practice to read the results, they may not be willing to read it without proper documentation of where and how the test was performed. At Statcare, this test can be read all 7 days a week.

    The Difference Between PPD Testing and 2 Step PPD Testing

    The main difference between PPD Testing and a 2 Step PPD Test is the accuracy of the test results. A negative 2 Step PPD Test is a more reliable screen that you have never been exposed to TB. This test is therefore recommended for all healthcare workers and people employed in daycare centers and prisons where they are exposed to large groups of people. Without it, there is a risk that your exposure to TB will go undiagnosed. And without the proper treatment, the infection can spread to other places in your body, like your brain and your spine. Avoid that danger by requesting a 2 Step PPD Test from your doctor.

    What to Expect During a 2 Step PPD Test

    The actual process of a 2 Step PPD Test is simple. First, your doctor will walk through your medical history. They will also be curious about the environments you’ve been exposed to lately. Obviously, people who’ve spent time in hospitals, in schools or any other area with large groups of people or have recently immigrated from other countries are at a higher risk of contracting TB, so your doctor will pay attention to those details.

    Next, your doctor will inject your forearm with the PPD. The liquid will stay right below the surface of your skin. The pain should be nothing more than the small pinch of the needle, so there’s no need to worry.

    You will then go about your normal daily activities. Your doctor will ask you to return either 48 or 72 hours later so that he or she can read the results of your test. When you return to the office, your doctor will take a look at the injection site. Generally speaking the doctor is looking for a skin reaction to the PPD, however, as we mentioned, some people’s skin may have reduced sensitivity during the test even if they have had an exposure to TB.

    For the 2 Step PPD Test, your doctor will ask you to return for a second round of testing anywhere from 7 to 10 days later. You’ll go through the same testing procedure as before. One appointment will be the injection itself and a second appointment 48-72 hours later will be for reviewing the results. The second round of testing ensures that no one is given a false negative diagnosis.

    After the results of the second round are read, your doctor will be able to diagnose you accurately and give you a treatment plan if your testing was positive. If it’s negative, you won’t be required to take any further action. Although, it is a good idea to get regular 2 Step PPD Tests, most healthcare workers need to be screened for TB testing annually as they are at high risk of being infected. There are typically no harmful side effects of PPD tests, so you can take as many as you like.

    Do I Need a 2 Step PPD Test?

    Thankfully, advances in treatment and testing have greatly reduced the number of people diagnosed with tuberculosis in the United States. However, as recently as 2014, the World Health Organization estimated that 1 in 4 people with TB go undiagnosed. That means, to keep yourself healthy, you should routinely get tested for TB. You definitely need a 2 Step PPD Test if you’ve been diagnosed before and suspect that you’ve been exposed to TB again. But even if you’ve never had tuberculosis, you can request a 2 Step PPD Test to avoid a false negative read.

    See your doctor immediately if you’ve been exposed to someone with TB or you start exhibiting symptoms. Some common signs include fever, unexplained weight loss, coughing, and night sweats.

    Statcare is open every day, including holidays, for extended hours. If you think you need a 2 Step PPD Test, come in to one of our five convenient locations to start your test. Our trained staff will be able to walk you through the test, accurately read the results, and help you through any necessary treatment plan.

    If you’re curious about any other services we offer, we have a convenient list for you. We even offer online doctor visits for those times when you just can’t get out of bed. Take a look or come visit us anytime.

    What Is a PPD Test? 750 499 Sandeep jain

    What Is a PPD Test?

    Tuberculosis is a potentially serious infection that usually occurs in the lungs. The bacteria that causes TB is spread through the air from common things like sneezing and coughing. Unfortunately, that means you are more susceptible to TB in the winter months. We’re all traveling more, attending more festive holiday parties and spending more time around people we don’t normally spend time with. A bunch of people in close quarters is sometimes a good breeding ground for infectious diseases.

    The good news is there’s a specific test that can tell you whether or not you’ve contracted tuberculosis. A purified protein derivative (PPD) test or a TST (Tuberculin Skin Test, is a simple test your doctors can use to diagnose you with TB). Read more to learn about the PPD test and whether you need to take it.

    What Is a PPD Test?

    A PPD test is a skin test that can give you clear answers on your TB status. It helps determine if you have been exposed to Tuberculosis. It does not diagnose disease, just that you have been exposed. Think of a PPD Test as being an allergy test. A PPD protein (called Tuberculin) is injected into your skin and left there for 2-3 days. If your body identifies and reacts to it in 2-3 days, it means you must have been exposed to Tuberculosis bacteria. The test cannot be read earlier than 2 days from the time of injection.

    What Is the Fastest Way to Get a PPD Test?

    A PPD test involves two visits with your doctor – the first visit is to get the PPD (Tuberculin) injected into your skin and the second visit is to get the area of skin checked and examined to see the intensity of your body’s response the tuberculin protein. As you probably guessed, you will have to wait 2-3 days before the response can be measured.

    The fastest way to get this testing done is therefore 48 hours. The response to the test can be checked at a maximum of 72 hours, after which you need to wait before the test can be re-done on a different part of the skin.

    What should I be careful about When I Get a PPD Test?

    First, you always want to make sure that your doctors’ office will be open at 48 hours from the injection time so that the test result can be read. Or before 72 hours. If you miss that window between 48-72 hours, the test result becomes void.

    When you have the first test voided, you have to wait at least 7-10 days before the next PPD test can be injected. And this can become an issue if you have a job or a college form that needs filled. So, our recommendation is that you don’t miss getting the test read between 48-72 hours.

    Secondly, many doctors’ offices will not read the test if someone else has done it. They may perhaps agree to read it if you have a letter from a licensed practitioner stating that a PPD was injected in that area (right or left forearm) with a date, time specified to the hour; along with Name of Manufacturer, Lot Number of the PPD vial and Expiration Date of the vial from which the PPD was injected. This is to maintain the integrity of the testing results.

    Thirdly, many doctors’ offices will read it as positive or negative because traditionally that is how it was meant to be read. However, the science has progressed and now you need to know the size of the reaction in millimeters. At Statcare, PPD Testing is done all week long and our providers always measure and note the millimeters. If you don’t get the reaction size recorded, it can become an issue with Federal and State requirements such as for purposes of Immigration. Also, all subsequent medical decisions for PPD will be based on the size in millimeters and your medical and demographic history.

    What Happens When You Get a PPD Test?

    To take the test, a doctor will swab the inside of your forearm with an alcohol solution. You’ll then get a shot administered under the top layer of your skin. It should be quick and relatively painless (for a shot). Your doctor will likely give you a bandage for the injection site but be sure to remove this after a few minutes. Allergy to band-aid glue is common and you want to be sure that nothing interferes with your PPD test. After that, you go home and wait for 48-72 hours.

    The second part of a PPD test (NOT to be confused with a 2 step PPD test) happens 48 to 72 hours later. You’ll return to your doctor to get the results. The doctor or nurse will examine the injection point, consider your age, country of travel or birth, medical history including prior PPD results and give you your results. If you experience any redness or irritation during those 48 – 72 hours, it may not be directly related to your PPD test. Don’t panic, just wait until you can see your doctor or nurse to get an accurate reading on your reaction.

    Reading the Results of a PPD Test – Common Mistakes

    When you arrive for the second part of your PPD test, your doctor will look at the skin around the injection. The standard guidelines are to measure the area that looks reddish or pinkish (called Erythema) and record its size in millimeters. Then, the area has to be felt by the examiner’s fingers to detect any raised, thickened and firm skin inside the red or pink area. This hardened skin is called induration and its size also needs to be recorded in millimeters.

    Induration is often raised and has an edge. To the untrained eye, this can easily be confused with redness or bruising that is normal with any shot. You can see that it takes a skilled, trained doctor to administer an accurate reading, which is why it’s important to be selective when choosing a doctor for your PPD test. Always choose a medical provider that does this test routinely.

    Although retail pharmacies might offer a PPD test, their staff may not have the same kind of nuanced understanding of the test results to ensure the most accurate reading possible. Pharmacists aren’t trained during their schooling to read a PPD test, but it is a regular part of a doctor’s medical school training. TB is too serious of an infection not to choose the most highly skilled medical professional to help you through a PPD test.

    Getting a Positive PPD Test – What It Means

    There are a few things to keep in mind if you get a positive PPD test. First, tuberculosis progresses in two stages: latent and active. And all latent TB does not always convert into an active TB.

    It is good to think of Latent TB as being a sleeper cell of a terrorist bacteria called Mycobacterium Tuberculosis.  The tuberculosis bacteria get inside your body and immediately go into hiding, living inside the very cells that are supposed to fight infections – the white cells. The TB bacteria can thus go undetected for years. Tuberculosis bacteria also multiplies ever so slowly, thus evading detection by your bodies’ troops.

    This latent TB phase can last days, weeks, months or years. Latent TB means that you have a TB infection, but the bacteria is in not active yet and isn’t causing symptoms. According to the Mayo Clinic, about 2 billion people in the world have latent TB. It also isn’t contagious, but it can turn into active TB at any time, so it’s still important to keep an eye on.

    On the other hand, active TB means that the bacteria started dividing and growing inside your tissues. Typically, the TB bacteria need a lot of oxygen, so they prefer living inside lung tissue where fresh oxygen is always available. Active Tb means you are contagious, and you will experience symptoms. Some symptoms of active TB include:

    • Coughing that brings up phlegm
    • Cough that lasts three or more weeks
    • Coughing up blood or blood tinged sputum
    • Chest pain, especially while breathing or coughing
    • Unintentional weight loss
    • Fatigue
    • Fever, esp. towards the evening
    • Night sweats
    • Chills
    • Loss of appetite

    Unchecked, TB can also affect other parts of your body including kidneys, spine, and brain. It is important to talk to your doctor immediately after a positive PPD test to get a treatment plan in place.


    What Does a Positive PPD Test Look Like – Common Mistakes

    Indurations that indicate a positive PPD test look different for different kinds of people. Your previous health-related issues, plus your lifestyle can both affect your positive reading. For a healthy person who has a normal immune system, an induration greater than or equal to 10 mm is considered a positive.

    A common mistake is to measure it along one dimension. The induration needs to be felt by rolling the fingers all around its edges. Then the maximal edges should be marked with a pen. Finally, the distance between any of the two furthest points has to be measured using a straight metric ruler – one that that has markings in millimeters.

    Another mistake that gets made is when the skin is inflamed and the PPD is read as a positive. If blisters are present on that person’s arm, the medical professional needs to determine if it was an allergic reaction to the protein (hypersensitivity) or truly a positive result.  It is quite common to have an allergic reaction to the glue in the tape. This glue upon the skin causes an inflammation of the skin (contact dermatitis) which may have nothing to do with the underlying PPD injection.  Again, pharmacists are not trained medically to be able to read such test results at It needs a background medical knowledge about these medical conditions and clinical experience for it to be diagnosed properly.

    Also, not everyone has a typical immune system. For those, the test gets a little more specific. For example, if an induration measures 4 mm or more, the USCIS considers it a positive test for purposes of the i693 Form that is filled out by a USCIS Certified Civil Surgeon for purposes of Immigration to the US.

    An induration of 5 mm can be indicative of TB for people who:

    • Have suppressed immune systems
    • Are HIV positive
    • Have seen changes on chest x-rays that are consistent with previous TB
    • Are recipients of organ transplants or on steroids, chemotherapy drugs or TNF-Alpha-blockers

    If an induration measures 10 mm or more, it is considered a positive test if that person qualifies as one or more of the following:

    • A recent immigrant (within 5 years) from a place with a high prevalence of TB
    • A recent travel of more than a month in areas with a high prevalence of TB
    • A resident or an employee working in a high-risk area (including hospital and urgent care staff)
    • IV drug abusers
    • Children under 5 years of age
    • People with higher risk of converting from latent TB to active TB – those with kidney disease, diabetes, stomach surgery, certain cancers, Body Mass Index of less than 18.5%, silicosis etc.

    An induration of 15 mm or more is considered a positive test if that person qualifies as being low risk and who would otherwise not have needed PPD testing for screening for TB.
    As you can see, there is a lot of personal medical history that goes into reading a positive PPD test. If you want to talk to your doctor and ask questions about your PPD test, you should seek out a testing center that you can trust, with doctors who are prepared to give you accurate and complete answers. Statcare doctors can help you through treatment options and offer all the resources you need right at your appointment. No need to follow up or see additional doctors. You’ll get everything you need during your visit.

    An important note on positive PPD tests: your induration will likely not go away for 3-4 weeks. That is normal. If it becomes red and starts creating ulcers, talk to your doctors.

    What to Do After a Negative PPD Test

    If there is no induration present at the site of the test, you most likely do not have TB. However, there are instances such as viral infections, vaccinations and certain disease states and medicines that you might be consuming where you can get a false negative for a PPD test. People who have had their immune system compromised, by chemotherapy treatments, AIDS virus or steroid usage can experience a false negative PPD test. Be sure to answer all your doctor’s questions honestly when giving your medical history so they can determine whether your PPD test is negative or may be presenting a false negative.

    What is a 2 Step PPD Test

    So far, we discussed a regular PPD Test and how the negative results could be falsely negative. Studies have shown that repeating the PPD Test after a 7 to10 day interval, boosts the response and increases the likelihood of eliminating the false negative test results. In other words, a re-exposure to the tuberculin protein is more likely to enhance the ability of detecting the exposure to TB. This is called a 2 Step PPD Test or a 2 Step Tuberculin Test. It is typically done for all healthcare related job physicals and needs about 2 weeks to complete. This is another reason why getting a regular or a 2 step PPD test done at a trusted medical facility rather than a pharmacy or other location is so important.

    Follow Up PPD Tests

    Your care does not stop once you are read your PPD test results. If you test positive, there is no need to take the test again. Once you have been exposed to Tuberculosis, that test will always come back positive for the rest of your lifetime. The follow-up conversations you’ll have with your doctor will include medication and symptoms management. TB responds to different medication in a unique way, so getting treatment as soon as possible will help you maintain a healthy lifestyle. You’ll want to schedule 2 chest x-rays, one year apart, to monitor your lung function after your initial diagnosis. Women who are pregnant will also need special care, so keep in touch with your doctor as you manage your TB.

    On the other hand, a negative result doesn’t mean that you will remain negative forever. Everyone should consider taking an annual PPD test, but especially if you fall into one of the more vulnerable categories listed above. At all Statcare locations, you can get an accurate PPD test administered and read by a doctor you trust, for only $40.

    So, Should You Get a PPD Test?

    If you live in NYC, the answer is simple: yes. Exposure to Tuberculosis is common in NYC. If you think you may have been infected, been around someone who has TB or recently traveled to high-risk areas, definitely ask for a PPD test as soon as possible. Come to Statcare for your 2 step PPD test as well as all the answers and treatment options you need. We are here to help.

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