sputum test

[ADW & JOP 146]

10 minutes ago, Lone Wolf said:

From experience I think you are wrong. My GF was sick, got chest X-Ray that did not look good at all, did the SPUTUM test and it showed NEGATIVE.  

Her symptoms and X-Rays convinced the doctor different and she was referred for treatment.

Another SPUTUM test was done, it was 3+ weeks before it showed positive. And she was seriously active already.  

I do not know why this can happen in some people, but I do believe it is the reason the guideline is 8 weeks. Short term SPUTUM can give a false negative.

 

Tb is a fastidious organism. The reason your test came back in 3 weeks is because it grew something. You need to grow it for an extended period of time before you can say there is nothing there. Hence, the 8 weeks.

[ram1009 42]

38 minutes ago, ADW & JOP said:

So happens that I am an MD. Trained completely in Canada, board certified in Canada and US and medical licensed in Canada/US.

 

I also volunteer in a developing country where I met my wife. We had our own Tb floor, and I order the rapid sputum test more than 100s of times, not because it is a more superior test to exclude Tb, but because the follow-up rates in the country are very low. Multi-drug resistant Tb is also a thing there.

 

The source I use is https://www.uptodate.com/contents/diagnosis-of-pulmonary-tuberculosis-in-adults. If you are so inclined to review it, it does cost money for a subscription. 

 

I am not arguing for or against immigration policies, I am strictly referring to the use of the test. Again, the gold-standard test to exclude pulmonary Tb is sputum culture.

Thank you Doctor for your learned advice.  It's a pleasure to hear someone speak intelligently instead of speculatively, including myself.  You have convinced me of the medical necessity of the 8 week test but I continue to be jaded against immigration policy in general.   Thanks again.  I meant no disrespect.   BTW, I've got this pain in my back.......just kidding.

[Hank_ 9,173]

Slam  and dunk!   Two points!     

[Hank_ 9,173]

1 hour ago, ADW & JOP said:

So happens that I am an MD. Trained completely in Canada, board certified in Canada and US and medical licensed in Canada/US.

 

I also volunteer in a developing country where I met my wife. We had our own Tb floor, and I order the rapid sputum test more than 100s of times, not because it is a more superior test to exclude Tb, but because the follow-up rates in the country are very low. Multi-drug resistant Tb is also a thing there.

 

The source I use is https://www.uptodate.com/contents/diagnosis-of-pulmonary-tuberculosis-in-adults. If you are so inclined to review it, it does cost money for a subscription. 

 

I am not arguing for or against immigration policies, I am strictly referring to the use of the test. Again, the gold-standard test to exclude pulmonary Tb is sputum culture.

 

[ram1009 42]

4 hours ago, ADW & JOP said:

Tb is a fastidious organism. The reason your test came back in 3 weeks is because it grew something. You need to grow it for an extended period of time before you can say there is nothing there. Hence, the 8 weeks.

So, if I understand you correctly even a rapid response culture that shows negative in 24 hours can still grow if left for the remainder of the 8 weeks?  Is there any documentation of the % of this kind of false positive?

[ADW & JOP 146]

4 hours ago, ram1009 said:

So, if I understand you correctly even a rapid response culture that shows negative in 24 hours can still grow if left for the remainder of the 8 weeks?  Is there any documentation of the % of this kind of false positive?

So to clarify, what you are referring to as a rapid response culture is actually not a culture but a gene amplification technique (eg, NAAT).

 

The answer to your question is yes. A negative NAAT test can still lead to a positive culture. The clinical epidemiology aspect of diagnostic testing is difficult to explain in a forum such as this.

 

If you are interested in this particularly topic, I will refer you to the guidelines on Tb, see recommendation 7 in the Infectious Disease Society of America (the leading ID organization in US).

 

Link is available to the public so I will post it here.

 

https://www.idsociety.org/practice-guideline/diagnosis-of-tb-in-adults-and-children/

 

As a public health measure, we are must worried about active pulmonary Tb. This is the one that spreads by air. Scarring on the x-ray in the right clinical context is concerning for active or latent Tb. Latent Tb means previous exposure and has a higher risk of reactivation of pulmonary Tb if untreated. That is why chest x-rays are done and no other diagnostic testing for Tb outside of the lungs.

Edited August 29, 2019 by ADW & JOP

[ram1009 42]

2 hours ago, ADW & JOP said:

So to clarify, what you are referring to as a rapid response culture is actually not a culture but a gene amplification technique (eg, NAAT).

 

The answer to your question is yes. A negative NAAT test can still lead to a positive culture. The clinical epidemiology aspect of diagnostic testing is difficult to explain in a forum such as this.

 

If you are interested in this particularly topic, I will refer you to the guidelines on Tb, see recommendation 7 in the Infectious Disease Society of America (the leading ID organization in US).

 

Link is available to the public so I will post it here.

 

https://www.idsociety.org/practice-guideline/diagnosis-of-tb-in-adults-and-children/

 

As a public health measure, we are must worried about active pulmonary Tb. This is the one that spreads by air. Scarring on the x-ray in the right clinical context is concerning for active or latent Tb. Latent Tb means previous exposure and has a higher risk of reactivation of pulmonary Tb if untreated. That is why chest x-rays are done and no other diagnostic testing for Tb outside of the lungs.

Thanks, doc.  I will read this when I have more time as I have cataract surgery in the morning.

[Hank_ 9,173]

It doesn't matter how many doctors believe the process at SLEC is good or not .. still boils down to - follow the rules/requirements or you don't get the visa.  

 

 

 

[ram1009 42]

12 hours ago, ADW & JOP said:

So to clarify, what you are referring to as a rapid response culture is actually not a culture but a gene amplification technique (eg, NAAT).

 

The answer to your question is yes. A negative NAAT test can still lead to a positive culture. The clinical epidemiology aspect of diagnostic testing is difficult to explain in a forum such as this.

 

If you are interested in this particularly topic, I will refer you to the guidelines on Tb, see recommendation 7 in the Infectious Disease Society of America (the leading ID organization in US).

 

Link is available to the public so I will post it here.

 

https://www.idsociety.org/practice-guideline/diagnosis-of-tb-in-adults-and-children/

 

As a public health measure, we are must worried about active pulmonary Tb. This is the one that spreads by air. Scarring on the x-ray in the right clinical context is concerning for active or latent Tb. Latent Tb means previous exposure and has a higher risk of reactivation of pulmonary Tb if untreated. That is why chest x-rays are done and no other diagnostic testing for Tb outside of the lungs.

FYI, my fiance contacted a local clinic who told her they would provide a free sputum test producing results in 5 days.  I just thought you'd like to know.

[ram1009 42]

On 8/28/2019 at 3:21 AM, Hank_ said:

Because if the culture test shows positive for TB she will then have to complete 6 months of DOT (Direct Observation Therapy ... taking medication at SLEC)

 

As a K-1 you are only allowed to reschedule a limited number of times (2), after which you would be given a "time out" for 90 days and possibility paying a 2nd visa fee.

First of all, applicants are only allowed one free reschedule of a visa appointment.  The second one incurs a second visa fee.  I know this because she cancelled her first appointment and I was warned about the second fee at that time.  I've never heard of the "time out" rule but I don't see why I would care about it in this situation because the second cancellation would be because the sputum test was positive and she would be treated daily at SLEC for the next 6 months.  The fee is the least of my worries.

[Hank_ 9,173]

If that is the new policy with the embassy they should update their website:

 

 

Restrictions to Changing Appointments

Please be reminded that even though nonimmigrant visa fees are valid for one calendar year, options to schedule an appointment are limited. The U.S. Embassy in Manila schedules hundreds of thousands of nonimmigrant visa appointments each year and must accommodate requests both for new appointments and for those applicants who need to reschedule their appointments for whatever reason. Applicants are only allowed to reschedule twice (not including the initial appointment) without penalty. If the second rescheduling attempt is canceled, an applicant will only be allowed to reschedule a new date after a waiting period of 90 days. Please plan your visa application accordingly to avoid problems securing an interview appointment.

[ram1009 42]

3 hours ago, Hank_ said:

If that is the new policy with the embassy they should update their website:

 

 

Restrictions to Changing Appointments

Please be reminded that even though nonimmigrant visa fees are valid for one calendar year, options to schedule an appointment are limited. The U.S. Embassy in Manila schedules hundreds of thousands of nonimmigrant visa appointments each year and must accommodate requests both for new appointments and for those applicants who need to reschedule their appointments for whatever reason. Applicants are only allowed to reschedule twice (not including the initial appointment) without penalty. If the second rescheduling attempt is canceled, an applicant will only be allowed to reschedule a new date after a waiting period of 90 days. Please plan your visa application accordingly to avoid problems securing an interview appointment.

This is not the first time I've witnessed a conflict of rules on various web pages.  You've been at this a lot longer than I have so I'm sure you've seen your share.  I have not had to pay a second fee yet so I can't say for sure which is correct.  I'll leave amending their webpage to your expertise along with contacting the CDC.

[Hank_ 9,173]

  

[ram1009 42]

On 8/28/2019 at 7:07 PM, ADW & JOP said:

So to clarify, what you are referring to as a rapid response culture is actually not a culture but a gene amplification technique (eg, NAAT).

 

The answer to your question is yes. A negative NAAT test can still lead to a positive culture. The clinical epidemiology aspect of diagnostic testing is difficult to explain in a forum such as this.

 

If you are interested in this particularly topic, I will refer you to the guidelines on Tb, see recommendation 7 in the Infectious Disease Society of America (the leading ID organization in US).

 

Link is available to the public so I will post it here.

 

https://www.idsociety.org/practice-guideline/diagnosis-of-tb-in-adults-and-children/

 

As a public health measure, we are must worried about active pulmonary Tb. This is the one that spreads by air. Scarring on the x-ray in the right clinical context is concerning for active or latent Tb. Latent Tb means previous exposure and has a higher risk of reactivation of pulmonary Tb if untreated. That is why chest x-rays are done and no other diagnostic testing for Tb outside of the lungs.

I thought you might be interested to know that my fiance has today obtained the results of a second opinion in the form of an independent chest X ray.  The radiologists report says her lungs are clear as have past chest X ray reports.  Somebody screwed up.

[Hank_ 9,173]

...  the beginning of an " 8 year journey" ... now to take your results to CDC and have them change their regulations.