St. Lukes is Full of Tae!

[manilaraf 28]

Just an addendum to my previous posts.

I was previously wondering why the sputum tests were taking 60 days to do. Thankfully tolitzpogi's timeline cleared that up for me.

Okay here it goes:

-The Sputum AFB smear that St Luke's does and that we do in my clinic is the standard on which TB treatment is usually done. Usually it takes from a few days upto a week for those to come back. Again, if it's positive for us, the Pulmonologist will start treatment (e.g. DOTS). Again, a positive "3 day" (quoting above) is enough to start drug treatment and on the other hand, a negative test is enough to clear a patient for work or to confirm that treatment is effective (once therapy is complete). The AFB smear basically consists of you taking the sputum, smearing it onto a microscope slide, staining it with a dye which will stick to the bacteria which you're trying to find and look for any evidence of the bacteria being present under a microscope.

-The Sputum Culture, on the other hand, is another, higher level of sensitivity. Basically, you take the sputum, swab it in a sterile/aseptic manner onto a culture medium, such that if TB bacteria is present, the TB will thrive and form colonies after a certain amount of time (4-8 weeks).

(http://www.who.int/tb/laboratory/policy_liquid_medium_for_culture_dst/en/)

The sputum culture is something I personally haven't come across in my practice since our goal is to start treatment as soon as it's recognized (Pos AFB smear). Sputum Culture is a whole 'nother level. Basically, this (the sputum culture & waiting for it) is, in my opinion, less a matter of St Luke's and liability (although that'll still be a consideration) and more of the US Embassy, the US Government, & the CDC being concerned about the outbreak and transmission of TB in the US. Which as I mentioned before is much, much rare (as it is in the developed world) compared to the 3rd world.

As an aside, if you've visited your doctor and wondered what those circular plastic dishes were with the red/orange looking jello-like substance in it next to the swabs, cotton balls, and reflex hammers; those are culture media for Strep. So if you've had Strep throat or tonsillitis and had your MD swab your throat and seen him/her rub the swab onto there (or he/she does it later), it's basically just like the TB culture. Except the Strep culture takes much less time to get results back.

Edited October 31, 2014 by manilaraf

[chillin4me 15]

Sputum exam doesn't cost money even the meds if your have to undergo the 6-month treatment. They have to comply with US rules or else they don't have a business or in worst case US will have stricter rules about immigrants to have possible TB infection.

[minions2 24]

did they do PPD test first or they CXR'ed them right away?

[chillin4me 15]

did they do PPD test first or they CXR'ed them right away?

x-ray first

did they do PPD test first or they CXR'ed them right away?

x-ray first

[mymarley 14]

coz USA trusted them so they need to be careful....

[mymarley 14]

the sputum culture is 60days coz they are using a machine...so if the bacteria grows the machine automatic alarm then they will check who own that sputum....that's why they asks 3sputum so if all positive you need to do the treatment freemonths...if 2 nega and 1 positive you need to repeat the sputum...and if they told you to take clarithromycin they found out that u have pneumonia and need to repeat the xray aftr two months...

[M and C 32]

Keep in mind also that TB is common in the Philippines. Very common. I have friends practicing in the States and in Europe who have and will never come across TB. Here, basically it's common enough among the population that if there's suspicion of TB, there's the mindset of mask up, isolate the patient until the labs clear the patient. So maybe that's one factor behind the increased frequency of followup labs.

Now, will St Luke's end up having people undergo the AFB when it's probably not necessary? Yes, they probably will. But remember, this is the US Embassy and the US Government we're talking about. Remember the stink that happened a few years back when that Yahoo with Multiple Drug Resistant TB getting on a plane in the States to get married in Greece? Well, imagine the shitstorm if more than a few TB cases that pop up in the US get traced back to St Lukes clearing them.

As with everything medical and related to possible unnecessary medical exams and procedures, it all comes down to liability. Basically, they're treating you as a US Physician would, calling for possibly unnecessary labs, because of fear of getting sued or losing their license/accreditation from the US Embassy and by extension the other embassies that have their medical thru St Lukes.

Personally, my wife (who's also an MD and carries that much more risk of exposure to a TB case) will probably have a baseline CXR, PA & Lateral & APL soon. And maybe an AFB since it's early yet just as an FU to St Luke's. Although hopefully once the staff at St Luke's finds out we're both MD's maybe they give us a pass as a courtesy. =)

Just my $0.02 as a Physician and a USC petitioning my wife for an IR-1.

As a Filipino MD myself, I would have to agree on this. In the Philippine setting, there would be a higher index of suspicion on a probable case of TB since it is common there -- hence it would be "TB until proven otherwise". This is what infection control is all about. We would want the disease to be contained and eradicated, if possible, in where it is and prevent further spread. As one of my mentors said, "it is better to err on the safe side."