Filipina Fiancee just got positive TB skin test results

[TeddyHoney 42]

Being in the medical industry I say to you that she needs to start the TB treatment ASAP! At this time the VIsa/medical can wait your fiancee's health is in question now and TB is nothing to take light.

Yes I just chatted wtih her a few minutes ago and she already have her first medicine for treatment and first day of Sputum smear so her treatments is started. And when its time for her K-1 medical exam they will instruct her from that point based on wht they find in her x-ray at that time and we will just follow that whatever it may be even it is another sputum and 2 months wait for that and then 6 moths treatment if sputum is positive at that point regardless of any previous treatment she had and sputum results. I undertsand that now and was what I was asking. Thanks you for your response and information. It helped a lot!

[Tahoma 2,292]

They start the treatment for two months on the presumption that she has TB, based on the test results so far. The results of the sputum culture will either confirm or deny that presumption. If it confirms, then she continues treatment for a further four months. If the sputum culture is negative then she can stop taking the antibiotics.

There is no earthly reason to postpone treatment. TB is serious and often deadly. The longer you wait to treat it, the higher the chances that the treatment will fail. The visa is secondary to your fiancee's life. Do the right thing.

As Tahoma has indicated, TB skins tests are not reliable in that part of the world. The skin test only checks for the presence of antibodies, and a large portion of the population there has been exposed to the bacteria that causes TB. In your fiancee's case, they did a chest x-ray first and that obviously showed something to be concerned about. That, combined with the positive skin test, is a sufficient reason for concern. The doctors are right to proceed under the assumption that she's infected with TB.

I agree that the clinic is starting the treatment now based upon the presumption that she has TB.

However, it is my understanding that a chest x-ray which shows an abnormality, combined with a positive skin test, is not a sufficient reason to assume a Filipino has TB and to start the TB medication regime.

The reasoning behind this is that a vast majority of Filipinos have been administered the BCG vaccine. Those who have received the BCG vaccine will nearly always test positive for TB on the skin test. St. Lukes does not administer skin tests for this reason. St. Lukes performs sputum analyses which include three smear tests (PPD) and an eight-week culture. The results of the culture will confirm whether or not she has TB. A medication regime is begun if the culture is positive.

Also, many chest x-rays show abnormalities. Few turn out to be TB. Even if it did turn out to be TB, chances are that it's latent TB rather than active TB.

The doctors at her clinic should complete the sputum analyses before making a diagnosis.

[Tahoma 2,292]

My fiancee was having cough and cold for a few weeks and it got bad and she went to a clinic and got chest x-ray. They could not determine if she had pneumonia or TB.

She should complete the treatment for pneumonia, then get another chest x-ray to determine if the abnormality on her first x-ray was caused by pneumonia.

Also, please note that many "clinics" (as well as some hospitals) in the Philippines do not have modern x-ray machines. If she has not done so, she should go to a modern facility and consult with a pulmonologist.

As a side note, my wife was an RN in the Philippines and she is now an RN here in the States. She tells me that St. Lukes Medical Extension Clinic (where your fiancée will undergo her K-1 medical exam) has a very modern x-ray machine. They also have pulmonoligists on staff.

[TeddyHoney 42]

She should complete the treatment for pneumonia, then get another chest x-ray to determine if the abnormality on her first x-ray was caused by pneumonia.

Also, please note that many "clinics" (as well as some hospitals) in the Philippines do not have modern x-ray machines. If she has not done so, she should go to a modern facility and consult with a pulmonologist.

As a side note, my wife was an RN in the Philippines and she is now an RN here in the States. She tells me that St. Lukes Medical Extension Clinic (where your fiancée will undergo her K-1 medical exam) has a very modern x-ray machine. They also have pulmonoligists on staff.

You are the first to comment on that part of my op. Yes she is currently on day 6 of pneumonia treatment so she will complete that first and also continue the ptb treatment. Then she wants to go to SLEC (I think it is - she live near in Pasay City)and get another x-ray mostly for our own purposes but also to take to her medical exam for K-1 to possibly compare with St. Luke's x-ray. We know thier own will prevail but she will take anyway.

Thanks!

[Tahoma 2,292]

Okay thanks for your response. So then she should go ahead with this current regime then. At the rate we are going her Sputum test results will probably be available before any K-1 medical exam can be scheduled (probably - I'm just guessing for this scenario) so if her Sputum results show positive for the culture groth after two months and then she is scheduled for her K-1 medical exam soon after can she present that results to St. Luke's during the K-1 medical exam and then St' Luke's will have her continue the treatment for the remainder of the six months treatment period under thier supervision? Maybe? Or after this Sputum she will start tomorrow and then wait 2 months for the culture and it show positive then soon after she has scheduled K-1 medical exam and she present the positive sputum they will x-ray her and maybe see something and have her do Sputum again regardless that she did Sputum now and results are positive already?

Just trying to figure out what will happen at her K-1 medical exam after her 2 month Sputum maybe show positive what will St. Luke's do? Any idea?

Or what if the Sutum she takes now comes back negative in 2 months and she present that to St' Luke's? They probably want thier own Sputum right and then we will wait the two months from that point. That would be fine with me.

Thanks again for any thoughts you may have.

The information below, from the Center for Disease Control and Prevention, may help answer your questions:

My link.

For applicants who present for the medical examination already on tuberculosis treatment begun elsewhere or for applicants diagnosed with tuberculosis who transfer into a DGMQ-designated DOT program, therapy should be continued in the following manner:

 As soon as patients transfer into the DOT program, they should provide three sputum specimens for AFB analysis and culture. Positive isolates should undergo drug susceptibility testing. If drug resistance is detected, the patient’s regimen should be modified accordingly.

 The patients should continue their treatment regimen according to the ATS/CDC/IDSA guidelines and provide sputum monitoring as described in these TB TI.

 If the patient was being treated by using a WHO continuation phase of 6 months of isoniazid and ethambutol (which is not consistent with the ATS/CDC/IDSA guidelines):

 If the applicant has completed 2 months or less of the 6-month isoniazid and ethambutol continuation phase (and has no drug resistance), the 6-month isoniazid and ethambutol continuation phase should be stopped and the patient should be started on the standard 4-month continuation phase of isoniazid and rifampin.

 If the patient has completed >2 months of the 6-month isoniazid and ethambutol continuation phase (and has no drug resistance), the patient should complete the 6-month isoniazid and ethambutol continuation phase.

 For the benefit of receiving health departments, for those patients who complete a 6-month isoniazid and ethambutol continuation phase, please document that this is a WHO-approved regimen.

For panel physicians who do not want to perform tuberculosis therapy, DGMQ will identify programs that adhere to these standards. When applicants are sent for treatment to national or other in-country programs that are approved by DGMQ, panel physicians should collaborate with these designated treatment programs to help ensure adequate completion of therapy for the applicants.

Applicants treated at non-DGMQ-designated treatment sites will need to provide documentation of their treatment summary to demonstrate having completed tuberculosis treatment. A letter from a physician stating they were treated is not sufficient. Documentation of treatment should include―

 Medication names

 Dosages of medications

 Dates of delivery of each medication

 Results of sputum smear, culture, and DST results performed by the nondesignated treatment center

 Reports of CXR performed by the nondesignated treatment center

Without this documentation, the applicant may not be further considered for travel to the United States

[Tahoma 2,292]

Here is more information from the same web site:

For applicants requiring tuberculosis treatment prior to U.S. immigration, the panel physician is required to document the following:

1. Chest radiograph findings before, during, and after treatment as recorded on the DS 3030.

2. Tuberculin skin test documentation should include date of TST reading, name of product, expiration date, amount administered, and the type of product used (e.g., 5TU PPD-S), and results in millimeters of induration.

3. Interferon Gamma release assay results should include type of IGRA used (i.e., Quantiferon® or T-SPOT®), expiration date, and test result including units of measurement.

4. Sputum smear AFB microscopy results obtained before, during, and after treatment.

5. Cultures for mycobacteria results obtained before, during, and after treatment, including cultures that were contaminated.

6. Drug susceptibility test results performed on any positive cultures.

7. DOT regimen received (including doses of all medications), start date, and completion date, and any periods of interruption.

8. Clinical course such as clinical improvement or lack of improvement during and after treatment, including resolution of symptoms and signs and weight stability or gain.

9. Pre-departure screening evaluations, when required by CDC (screening that is performed within 3 weeks of departure).

[TeddyHoney 42]

The information below, from the Center for Disease Control and Prevention, may help answer your questions:

My link.

For applicants who present for the medical examination already on tuberculosis treatment begun elsewhere or for applicants diagnosed with tuberculosis who transfer into a DGMQ-designated DOT program, therapy should be continued in the following manner:

 As soon as patients transfer into the DOT program, they should provide three sputum specimens for AFB analysis and culture. Positive isolates should undergo drug susceptibility testing. If drug resistance is detected, the patient’s regimen should be modified accordingly.

Okay this is good stuff to know wther a VJ member is in a situation like mine or not. Any VISA filer especially those petitioning for someone from one of the high risk TB countries should read this. Can the moderator pin this to an appropriate forum? Or has this been done already?

BTW it did answer many of my questions - between this infor and that in the link you provided. Thanks for finding this for me(us)!

 The patients should continue their treatment regimen according to the ATS/CDC/IDSA guidelines and provide sputum monitoring as described in these TB TI.

 If the patient was being treated by using a WHO continuation phase of 6 months of isoniazid and ethambutol (which is not consistent with the ATS/CDC/IDSA guidelines):

 If the applicant has completed 2 months or less of the 6-month isoniazid and ethambutol continuation phase (and has no drug resistance), the 6-month isoniazid and ethambutol continuation phase should be stopped and the patient should be started on the standard 4-month continuation phase of isoniazid and rifampin.

 If the patient has completed >2 months of the 6-month isoniazid and ethambutol continuation phase (and has no drug resistance), the patient should complete the 6-month isoniazid and ethambutol continuation phase.

 For the benefit of receiving health departments, for those patients who complete a 6-month isoniazid and ethambutol continuation phase, please document that this is a WHO-approved regimen.

For panel physicians who do not want to perform tuberculosis therapy, DGMQ will identify programs that adhere to these standards. When applicants are sent for treatment to national or other in-country programs that are approved by DGMQ, panel physicians should collaborate with these designated treatment programs to help ensure adequate completion of therapy for the applicants.

Applicants treated at non-DGMQ-designated treatment sites will need to provide documentation of their treatment summary to demonstrate having completed tuberculosis treatment. A letter from a physician stating they were treated is not sufficient. Documentation of treatment should include―

 Medication names

 Dosages of medications

 Dates of delivery of each medication

 Results of sputum smear, culture, and DST results performed by the nondesignated treatment center

 Reports of CXR performed by the nondesignated treatment center

Without this documentation, the applicant may not be further considered for travel to the United States

Here is more information from the same web site:

For applicants requiring tuberculosis treatment prior to U.S. immigration, the panel physician is required to document the following:

1. Chest radiograph findings before, during, and after treatment as recorded on the DS 3030.

2. Tuberculin skin test documentation should include date of TST reading, name of product, expiration date, amount administered, and the type of product used (e.g., 5TU PPD-S), and results in millimeters of induration.

3. Interferon Gamma release assay results should include type of IGRA used (i.e., Quantiferon® or T-SPOT®), expiration date, and test result including units of measurement.

4. Sputum smear AFB microscopy results obtained before, during, and after treatment.

5. Cultures for mycobacteria results obtained before, during, and after treatment, including cultures that were contaminated.

6. Drug susceptibility test results performed on any positive cultures.

7. DOT regimen received (including doses of all medications), start date, and completion date, and any periods of interruption.

8. Clinical course such as clinical improvement or lack of improvement during and after treatment, including resolution of symptoms and signs and weight stability or gain.

9. Pre-departure screening evaluations, when required by CDC (screening that is performed within 3 weeks of departure).

Again, great stuff. Should be pinned somewhere for everyone's reference.

[ladyangel341 0]

I did experience that...They said they found something in my chest x-ray and was advice to have sputum test. I don't know why they have TB skin test done. That was so lame to do. Most of the Filipinoes are positive of the TB skin test for we received BCG (immunization for TB) when were young. I wait for several months for my sputum results and it was negative..when I came here in USA they suggest to undergo X-ray again and been subject to skin test while waiting for the reading of my X-ray. I don't know why but I let them know I'm fully immunized and I know it will be positive but they still want me to have the skin test. I just chose to be quite and bear the pain. Result was 12mm positive skin test and the chest X-ray result was no possible TB disease in progress. I look up CD that St. Luke's give me, the chest x-ray image and found out that that was not the chest x-ray film they showed me in there small room explaining I got some spot. I felt bad about that. I don't know who's fault it is but I pretty sure that the Chest x-ray image save in the disk is not the same chest xray they present me when they explained I'm going to delay my visa. I remember an inch spot on that x-ray that keeps occupying my mind on where did I get that. I was thinking that I'm not that good nurse to be affected with my TB patients. I just want to share it with you that noone is perfect. I just hope you won't lost hope after several months doing the drug regimen... Everything have reasons.... ^^