Fiancee told to take Sputum test again

[maximus 0]

My fiancee went to SLEC to get her medical results after waiting the required 2 months for the culture test and it came back negative, but they detected a spot on her most recent X-Ray and told her she will need to retake the Sputum test and wait again 2 months for the results. I dont understand why cuz the negative culture should over ride the abnormal X-Ray spot.

The original X-Ray already showed the abnormal spot thats the reason she did the first Sputum test, now she has to do it again.

Has anyone else had this issue come up?

[Atencio 43]

Normally at the hospital I work at they will do sputum tests times 3 days because there is a chance that the specimen collected is not accurate due to poor technique. All I can guess is that based on the cxr they want to verify the results.

[Mariye & Ky 172]

My fiancee went to SLEC to get her medical results after waiting the required 2 months for the culture test and it came back negative, but they detected a spot on her most recent X-Ray and told her she will need to retake the Sputum test and wait again 2 months for the results. I dont understand why cuz the negative culture should over ride the abnormal X-Ray spot.

The original X-Ray already showed the abnormal spot thats the reason she did the first Sputum test, now she has to do it again.

Has anyone else had this issue come up?

Hi, they're looking for TB (Tuberculosis). Typically, it shows up as a few spots on an X-ray and even if so, one spot would require further diagnostics. It may be that she might have been exposed to it at some point, but not active. As well, you stated that her sputum testing was negative. Most probably they are looking for an objective finding that both sputum tests are negative for confirmation. Did they do the skin testing?

Here, is a simple [lay person] link that might help you with your question. http://www.livestrong.com/article/68685-sputum-test-tb-work/ If you would like a Medical Journal answer, you can also google that, however, be mindful of the terminology and complexity. I think what might be the frustration here, is the waiting period for you both. Take it easy, follow their instructions, and even with delay, and the Grace of God, she will be with you soon! I hope this helps ... Mari

[sjr09 155]

Hi, they're looking for TB (Tuberculosis). Typically, it shows up as a few spots on an X-ray and even if so, one spot would require further diagnostics. It may be that she might have been exposed to it at some point, but not active. As well, you stated that her sputum testing was negative. Most probably they are looking for an objective finding that both sputum tests are negative for confirmation. Did they do the skin testing?

Here, is a simple [lay person] link that might help you with your question. http://www.livestron...m-test-tb-work/ If you would like a Medical Journal answer, you can also google that, however, be mindful of the terminology and complexity. I think what might be the frustration here, is the waiting period for you both. Take it easy, follow their instructions, and even with delay, and the Grace of God, she will be with you soon! I hope this helps ... Mari

"But not active"

Mycobacterium tuberculosis. X-RAY will not show LTBI LATENT TB

Edited December 18, 2010 by sjr09

[Mariye & Ky 172]

"But not active"

Mycobacterium tuberculosis. X-RAY will not show LTBI LATENT TB

You're right, and let me clarify "Calcification, or lung scaring" --

Lung Scars

Scars in the lung, like scars on the skin, are permanent and usually cannot be removed. However, the lung is remarkably resilient and able to withstand small scars without any ill effects. Granulomas are scars that are caused by previous infection and can develop into calcified scars. Normally, these lesions are not treated and there is neither treatment nor necessity for their removal. Much like a scar on the skin, stable scars on the lung are generally not treated.

Calcified scars are usually caused by previous lung infections such as pneumonia. In the Ohio River Valley specifically, there is a fungus in the soil known as histoplasmosis that sometimes causes infection but rarely causes any health problems. Tuberculosis infections can also cause granulomas. Other factors that can cause calcified scars over time, include:

• Silicosis (from inhalation of silica dust)
• Asbestosis (from inhalation of asbestos)
• Sarcoidosis
• Cystic fibrosis
• Prior infections (such as pneumonia, tuberculosis infections, or fungal infections) ** This is what we typically read on Xray, the calcification from lung scaring**

I meant, from the OP's description, his fiance does not present as active and infectious, but the further object ive diagnostics are needed to Rule Out on a differential diagnosis. Thus, she can pass the medical examination and they can move forward. The whole point of this, isn't it?

[Atencio 43]

In regards to TB, a chest x-ray is really only useful to rule-out the disease. Since there is some kind of marking that may or may not be from TB a sputum/smear specimen becomes more important. Now like I said most hospitals I have been at will do three specimens on three consecutive days to rule out TB in cases described here. Now maybe St. Lukes wants a second specimen for the same reason or maybe the first specimen had too many traces of normal oral flora in it to ensure it was a good specimen. I read a report where half of their TB+ patients had negative AFB sputum smears. The reason? Poor technique in collecting the sample.

Whatever the reason, I wish your fiancee the best of luck on the second sample.

[happyme 0]

hi. i know of a vj member who had to take a follow-up x-ray 2 weeks after her 2-month culture result waiting time. she was eventually cleared after finding her x-ray result had improved. it may not be exactly like your case but you may find some info about her experience through this thread:

http://www.visajourney.com/forums/topic/277273-sputum-test-in-st-lukes-walkthrough/page__st__45__p__4358564#entry4358564

good luck and your fiancée will surely pass her medical soon.

[Mariye & Ky 172]

In regards to TB, a chest x-ray is really only useful to rule-out the disease. Since there is some kind of marking that may or may not be from TB a sputum/smear specimen becomes more important. Now like I said most hospitals I have been at will do three specimens on three consecutive days to rule out TB in cases described here. Now maybe St. Lukes wants a second specimen for the same reason or maybe the first specimen had too many traces of normal oral flora in it to ensure it was a good specimen. I read a report where half of their TB+ patients had negative AFB sputum smears. The reason? Poor technique in collecting the sample.

Whatever the reason, I wish your fiancee the best of luck on the second sample.

Typically, a skin test (Mantoux) is done before the X Ray or CT Scan. I did not read anything on OP's original post stating that test in her history. When Xrays are read, If opaque or white calcifications are noted, then we order further diagnostics/labs such as sputum-- and yes, the handling is very important. But, X-ray alone does NOT rule out TB: The patient hx, CT Scan if done, blood tests, skin and sputum tests, all together rule out or confirm a differential diagnosis. Note that pulmonary /lung calcifications can be from pneumonia, fungus, or a number of lung diseases which is why TB cannot be diagnosed simply by reading a 2D film. As I said earlier, a second, even a third sputum test is objective (can be done over and over with same outcome), so I am in great hopes for this couple's sake that his fiance's sputum tests are ALL NEGATIVE (-) and that one spot on her Xray was from nothing more than pneumonia a very long time ago.

[Atencio 43]

If the patient has no history, no risk factors, no s/s of TB, and has a history of having gotten BCG vaccine then a chest x-ray is done to clear a person of TB. I think we are basically saying the same thing though you are probably more accurate in saying all of the above are needed to clear a patient. Presently where I work all employees are given PPD except for those with history of BCG vaccine who have to have a chest x-ray.

[elena aguilera 0]

If the patient has no history, no risk factors, no s/s of TB, and has a history of having gotten BCG vaccine then a chest x-ray is done to clear a person of TB. I think we are basically saying the same thing though you are probably more accurate in saying all of the above are needed to clear a patient. Presently where I work all employees are given PPD except for those with history of BCG vaccine who have to have a chest x-ray.

hi, im waiting for my interview to be sched.. since you're working in a medical field just wanna ask if i am considered exposed to TB cause i am a student nurse around 2006-2008.. but since 2008 i was never involved in health care again.. and then this november i just had my cxr-cause i got so sick and the result is ok.. and i can show saint lukes that plate when my medical exam will be shed.. (again just wanna know if i am considered exposed to tb? im afraid im gonna wait 2months too like the others here if i will tell them that i was a stud nurse before, cause if yes i will try to have an early medical test in St lukes.) THANKS!

[Atencio 43]

Elena, working in a hospital only increases your risk of being exposed to TB. It doesn't mean you will get TB. There are so many Filipino nurses here in the US and none with TB. If you just had a clear chest x-ray I wouldn't worry too much other then the St. Luke errors mentioned now and then that all of us face.

I don't think St. Lukes will care about previous films however I am not an expert on what they do and it doesn't hurt to bring it.

[Mariye & Ky 172]

If the patient has no history, no risk factors, no s/s of TB, and has a history of having gotten BCG vaccine then a chest x-ray is done to clear a person of TB. I think we are basically saying the same thing though you are probably more accurate in saying all of the above are needed to clear a patient. Presently where I work all employees are given PPD except for those with history of BCG vaccine who have to have a chest x-ray.

I said that when I told you that the patient's entire case file must be taken into account. However, if I am not mistaken, the OP specifically SAID THERE WAS A SPOT [or UNKNOWN calicification] ON THE PATIENT (fiance's) 2D film. Physicians are under strict guidelines IN THIS COUNTRY anyways, to confirm and re-affirm there are absolutely NO INFECTIOUS DISEASES that can be spread via an immigrant or foreigner, or any patient for that matter. Therefore, there is no way any Doctor that I know of, can assume or presume this case as a clear (pass), without further testing. I most certainly would not give this a pass without several negative indicators as such, and I don't care if it took till Kingdome Come. This includes the test(s) is/are done objectively with negative results and if necessary a CT Scan if still in doubt. EVEN WITH a vaccine, they are not 100% guaranteed to function as protective. See Ref. Med Journals* Remember, the OP did not give light to her med hx. aside from the xray and one negative sputum test in his post, so your text book (from nursing school perhaps?), is redundant here. You say you work in the medical field, as a Doctor? Would you pass this patient if you read the X-ray with an unknown, and only one negative sputum test, when you posted earlier that bad handling in the lab could have resulted as a negative? I hope not!

Read between the lines from the OP's statement when he adds the 2nd test results will come in 2 more months. Is it possible its not just another sputum test he's worried about; but the time they have to wait for the results so they can be together?

[Atencio 43]

I said that when I told you that the patient's entire case file must be taken into account. However, if I am not mistaken, the OP specifically SAID THERE WAS A SPOT [or UNKNOWN calicification] ON THE PATIENT (fiance's) 2D film. Physicians are under strict guidelines IN THIS COUNTRY anyways, to confirm and re-affirm there are absolutely NO INFECTIOUS DISEASES that can be spread via an immigrant or foreigner, or any patient for that matter. Therefore, there is no way any Doctor that I know of, can assume or presume this case as a clear (pass), without further testing. I most certainly would not give this a pass without several negative indicators as such, and I don't care if it took till Kingdome Come. This includes the test(s) is/are done objectively with negative results and if necessary a CT Scan if still in doubt. EVEN WITH a vaccine, they are not 100% guaranteed to function as protective. See Ref. Med Journals* Remember, the OP did not give light to her med hx. aside from the xray and one negative sputum test in his post, so your text book (from nursing school perhaps?), is redundant here. You say you work in the medical field, as a Doctor? Would you pass this patient if you read the X-ray with an unknown, and only one negative sputum test, when you posted earlier that bad handling in the lab could have resulted as a negative? I hope not!

Read between the lines from the OP's statement when he adds the 2nd test results will come in 2 more months. Is it possible its not just another sputum test he's worried about; but the time they have to wait for the results so they can be together?

Why don't you read my very first post.

[Mariye & Ky 172]

Why don't you read my very first post.

I did. And did you pay attention to why Doctors do what they're required to do, especially if there is a mishandling in the lab? I see that your'e still carrying on about a chest X-ray being the end all of a differential... lol.... not. Redundant, but you are right about not being an expert.

[sjr09 155]

If the patient has no history, no risk factors, no s/s of TB, and has a history of having gotten BCG vaccine then a chest x-ray is done to clear a person of TB. I think we are basically saying the same thing though you are probably more accurate in saying all of the above are needed to clear a patient. Presently where I work all employees are given PPD except for those with history of BCG vaccine who have to have a chest x-ray.

Different workplaces have different policies with regard to needing to take meds/how often to have CXRs etc. One should go by the CDC Guidelines! Not your work place

I said that when I told you that the patient's entire case file must be taken into account. However, if I am not mistaken, the OP specifically SAID THERE WAS A SPOT [or UNKNOWN calicification] ON THE PATIENT (fiance's) 2D film. Physicians are under strict guidelines IN THIS COUNTRY anyways, to confirm and re-affirm there are absolutely NO INFECTIOUS DISEASES that can be spread via an immigrant or foreigner, or any patient for that matter. Therefore, there is no way any Doctor that I know of, can assume or presume this case as a clear (pass), without further testing. I most certainly would not give this a pass without several negative indicators as such, and I don't care if it took till Kingdome Come. This includes the test(s) is/are done objectively with negative results and if necessary a CT Scan if still in doubt. EVEN WITH a vaccine, they are not 100% guaranteed to function as protective. See Ref. Med Journals* Remember, the OP did not give light to her med hx. aside from the xray and one negative sputum test in his post, so your text book (from nursing school perhaps?), is redundant here. TRUE You say you work in the medical field, as a Doctor? Would you pass this patient if you read the X-ray with an unknown, and only one negative sputum test, when you posted earlier that bad handling in the lab could have resulted as a negative? I hope not!

Read between the lines from the OP's statement when he adds the 2nd test results will come in 2 more months. Is it possible its not just another sputum test he's worried about; but the time they have to wait for the results so they can be together?

CDC

TB infection, and a chest x-ray that shows noncalcified fibrotic lesions suggestive of old,

healed TB, treatment decision is based on several factors. These include clinical

suspicion, prior TB treatment history, sputum results and repeat x-ray. All such patients

should be evaluated for active tuberculosis, with a physical exam, chest x-ray and sputa.

If sputa are smear negative and there is no evidence of adequate prior treatment for TB,

treatment should be started with isoniazid, rifampin, pyrazinamide, and ethambutol for 2

months. This regimen has several advantages: it can be used to treat patients who may

have isoniazid-resistant organisms; it may promote better adherence than the 9-month

treatment regimen for LTBI; and it allows patients to start treatment at the first medical

visit, rather than waiting until sputum cultures are shown to be negative for M. tb.

If a culture comes back positive, then treat as active tuberculosis with an appropriate

regimen. If all cultures are negative by two months, repeat a CXR:

a) If the x-ray shows no change, the lesions presumably were inactive. Classify the

patient as having old TB:

i. If the patient has no prior TB treatment history, continue with 2 additional

months of isoniazid and rifampin only.

ii. If there is a history of same prior TB treatment, continue all four drugs for an

additional 2 months.

iii. Other diagnoses should also be pursued as warranted.

b) If the x-ray shows improvement, the lesions presumably were active. Classify the

person as having culture negative active TB:

i. If the patient has no prior TB treatment history, continue with 2 additional

months of isoniazid and rifampin only.

ii. If there is a history of same prior TB treatment, continue all four drugs for an

additional 2 months.

At the end of 4 months of therapy, the patient should receive an end-of-treatment x-ray to

serve as a baseline for future reference. Some patients classified as old TB may show

improvement on the 4-month x-ray; they should be reclassified as having culture negative

active TB.