Tb Sputum Test/Best test for TB

[myauq]

Hi,

My misses went to BNH (hospital) for a TB sputum test for her Australian Visa, and we were charged a breath-taking 2660 Baht! I wouldn't mind if this was a one off, but we have to pay for three separate tests at a grand total of 7980 Baht! This is just for pathology fees, and they said the increased cost was due to keeping the culture for an extended period - 10 weeks.

Still, I'm not convinced that this is right. I checked at a few other hospitals and they gave us the price of 350B for the sputum test, and 100 B for the AFB stain (total = 450 . When we called back today and said we'd like to check out another hospital they said that all of our other results would be invalidated if we did so. I'm sure this is not right, as they have already forwarded her results to the Australian embassy.

Similarly, I called the doctor after my wife had the first general check-up. Everything was fine, though he said but her x-ray showed possible signs of something - and he didn't say what. I asked if that was normal, and he said it was not normal. Then he said that it was serious enough to send the x-ray to Australia for a proper check. That got me as worried as hel_l. Then I find out that they send all x-rays to Australia as a matter of course, so I was a bit pissed off about this guy's phone manner. The following day we see a specialist at the hospital. He shows us the x-ray, which has (to us) an imperceptible trace over one of her ribs. He tells us that this is very common, and nothing to worry about, but she needs further tests to rule out TB. Granted the first doctor is not a specialist, but there is clearly more than a bit of a disparity between these two encounters.

At hearing this I was naturally releaved to find out it was *only* TB they were testing for. I also told the doctor that she had the Mantoux test a year back and that came back negative, but he dismissed that out of hand, saying that it doesn't show if the person has the disease (I know that's not entirely true, as this is the test we actually use in Australia for refugees from this part of the world). Still, dismissing other results was pretty poor form I thought.

Anyway, she took the first sputum test and that came back negative (as expected). We have two more to go, but we've stopped at the second and third in order to shop around for a better price and perhaps even another diagnosis at another Oz certified hospital.

I'm a bit worried that this will may delay our visa application process? I told them we'd contact the embassy next week, then call them again to let them know what our plans were. Again, they said that all of our previous results would be invalidated - is this a load of <deleted> or what?

Any input would be appreciated.

Myauq.

[myauq]

Hi,

I've worked with lots of clients from Myanmar in the Western world, and have been through the gamut of testing procedures for TB. I'm not a medical doctor, and I'm a bit confused about the current procedure for testing for Australian Spouse visa applicants.

From what I understand, the process may go something like this:

eg A

1) x-ray > abnormality is detected > 2) sputum test > positive result > 6 month course of medication > 3) retest > another x-ray > another sputum test ? This seems like the process would take between 8-12 months (12 mark being the time the initial medical becomes invalid).

However, if there is an abnormality on the x-ray, and the client is negative with no exposure to tb, then the process can still take a year. A doctor explained the following scenario to us:

eg B

1) x-ray > abnormality is detected > 2) 3 day sputum test > negative result > 3) 8 week sputum culture sample > negative > 4) another x-ray at the 6 month period after the sputum test > negative.

So despite the final negative result, the latter process will take approximately the same amount of time as the first, which is a positive. The abnormality in the x-ray could be caused from a number of factors, and is not necessarily indicative of any kind of history of TB.

I spoke the doctor today and said that my fiance had returned a negative mantoux test a year ago, but he said that this was an unreliable method for testing for TB. He also criticised the QuantiFERON-TB Gold test, and said that it wouldn't show the difference between immunity and active TB. I didn't understand what he was saying, and it made me suspicious as to why this hospital would chose not to accept these other methods which I know for a fact are used in other parts of the world for screen TB cases.

So, I'd just like to know why any doctor would chose the x-ray/sputum tests over a combination of all tests (ie - q-feron, mantoux, in addition to the x-ray/sputum) for better overall and faster diagnosis.

8 months is a long time to wait for something which may be completely unecessary.

Anyone??

[myauq]

I'm a bit pissed off today as the sputum tests were all negative, and the doctor pointed to another area on the x-ray from where he pointed to last week. He said we should be prepared to wait a year until we get the approval, even though he conceeded she may not test positve to any of the tests!!!!!!

He also ruled out her previous negative mantoux test results from a year ago (saying that this method was unreliable), and the possiblity of doing a QuantiFERON-TB Gold test at Bumrungrad. I'm not sure why.

[myauq]

Also found out the results had not been sent to the embassy yet (which means that the hospital lied to us, and perhaps has something to hide).

[Dakhar]

Both the Montoux (sp) test for TB exposure but they really can not determine or distinguish between TB active and non-active TB. There is some debate that the Montoux can but I doubt it can. No I am not a physician, just well read in this area. Now the Montoux test can and usually does show positive for TB if one has had the TB vacine during their life. So if a Montoux test is positive and you have had the vacine, a physician would not know exactly why you tested positive. Also, the Motoux test will test positive if you have been exposed to a few other bacterias too. In other words the Montoux is not 100% specific for TB bacterium.

The Qunti Feron Gold is Specific for TB, and this is where the major advantage is. A person will not test positive with QFG test if the person has had the TB vaccine but has never been exposed to the real bacteria. They will only test positive if they have been exposed to the real TB, it is a speciific test, accurate and results are fairly rapid. The specimen or sample is blood, so it is also a good source for a sample.

But the draw back is, the QFG can not distinguish between active of non active, it just tells you if you are a carrier that is all.

The only test that I know of that is used to determine if you are "active" is the sputom test called AFB. The AFB is not extremely accurate, and this is why you have to take it 3 times or so. The truth is currently no real "good" test for determining active and non active TB on the market today.

X-Ray it can show signs of activity, or at one time activity.... so if they see something suspicious, you will be then given the sputom test.

Regarding the legal matters Visas ETC I can not comment, because I do not know much about that.

I can tell u that in the states they tried to make my wife take INH because she tested positive for the montoux test, but her liver could not tolerate the meds, so they took her off and let her go on without it.

Wish you luck

[myauq]

The Qunti Feron Gold is Specific for TB, and this is where the major advantage is. A person will not test positive with QFG test if the person has had the TB vaccine but has never been exposed to the real bacteria. They will only test positive if they have been exposed to the real TB, it is a speciific test, accurate and results are fairly rapid. The specimen or sample is blood, so it is also a good source for a sample.

But the draw back is, the QFG can not distinguish between active of non active, it just tells you if you are a carrier that is all.

The only test that I know of that is used to determine if you are "active" is the sputom test called AFB. The AFB is not extremely accurate, and this is why you have to take it 3 times or so. The truth is currently no real "good" test for determining active and non active TB on the market today.

Hi there Dakhar,

What a great post - thanks.

Just a couple of follow-up questions. If my fiance takes the QFG and it's negative, meaning that she's never been exposed to the bacteria proper and therefore never been a carrier, do you think that'd be acceptable at a medical exam? In other words, could a negative QFG result rule out any further testing?

Also, the current sputum tests show negative. If they show negative in 2 months time, why would we need to wait a further 6 months for another x-ray? Is it because they want to know for certain if the scarring or mark on the x-ray has changed at all? From my gf's history (medical and personal) I'm convinced she doesn't have TB, but the hospital want more tests. Is there anyway around having to wait a year?

I'm an intelligent person, and I'm disappointed and sceptical that neither of our doctors at the hospital explained the process very clearly at all.

[Sheryl]

If it is for visa purposes, you will have to follow the required testing procedure of that country's immigration service, period -- regardless of whether or not it is the best, medically speaking.

No doctor or hospital has the authority to override this, so even if the doctor/hospital agreed that a different diagnostic approach made sense medically it would not help you visa-wise. Sorry, but that's the way it is....

[myauq]

yes, i realise that they have to follow the protocol of the oz government. i just think they were being unethical in the way they divulged information to us. i contacted the australian embassy today and they said that they don't have the authority to decide based on the information they sent to australia. i think they just ordered the sputum tests because i phoned up straight away after the initial appointment, and it was an opportunistic way to get free money. they made my wife's case sound like it could have been anything else, even more serious than tb, leaving us really worried.

the second doctor - a specialist - told us there was nothing to worry about, and that this kind of occurence was quite common and may not in fact be indicative of tb. but he said that we'd be expected to stay for a year, and booked us in for another round of tests. the embassy said that our results had already been sent to australia, and that it was in the hands of a panel of australian doctors. so these two doctors lied to us. i could have saved myself 10,000 Bhat.

another red flag was when the doctor backtracked yesterday and said that he hadn't sent *all* the information to australia yet, as i told him we may just apply for a tourist visa and go from there. he seemed concerned and changed his tack talking about her prospects of getting the health clearance. he then gave me his email address, and told me to contact him should we change our minds.

i made an official complaint on the switch board, and introduced myself as doctor, which is true btw. when we came back for the final appointment with the specialist, we were given a discounted price.

when we get the visa i'm going to email the doctors concerned and ask for a refund from the hospital, otherwise i will lodge a formal complaint with the australian government/embassy. my sense of pissed-offness, however, is tempered by the relief i now feel from talking with the embassy.

[myauq]

we've been ripped off!

embassy said today that the x-rays and check-up results have been sent to australia (without information about the sputum testing), and that it was likely they'd approve. <deleted>. i'm writing a formal letter, asking for my money back - all 10,000 Baht of it.

when talking to the doctor yesterday i said in dispair that it'd just be easier to apply for the tourist visa, get married in oz then go for a bridging visa as a means to pr as my spouse. after i said this, and complained about a number of other issues i had with them, he said that if we did so the embassy may stop us because my wife would be flagged as a potential health risk. fuc_k off, i thought (and almost said)!

then the doctor did something very strange - he gave me his personal email address. he confessed that he hadn't sent all the results to australia yet, and that i should email him if i really intended to change the visa application. reason for this: if we change to the tourist visa we would have wasted lots of money and time, and would have been invonvenienced on the basis of a lie to scam us out of money. we would have found this out that there was nothing wrong with my wife after arriving in australia to get a proper check-up. the reason for the email address is that, if we were to apply for the tourist visa on the basis of this bogus medical advice, he would possibly get into trouble. giving him notice, he would then be able to advise against the tourist visa, saying that we'd be ok to travel without further tests. what a load of <deleted>!

basically, because they're accredited by the oz government, it's like they've been given the permission to rip us off, and we're in no position to argue, as our visa and time depends upon their advice. fuc_kers!

[Dakhar]

As for me, if I were applying for my wife's Visa, I would get a Quanti Feron Gold test done previous to meeting with doctors for her TB testing. I would submit the results to the doctors before any testing took place (copy only).

In my opinion, this would help remove the "subjectiveness" involved in x-ray evaluations etc.

The QFG is around 5K baht, but at that point in time, money is not really the issue, the hassles that could be removed (theoretically) would be well worth 5K baht.

Again, Sheryl is right, but my point is, the doctors would feel really stupid trying to defeat a negative QFG with a suposed positive X-ray.

(one would expect)

[myauq]

As for me, if I were applying for my wife's Visa, I would get a Quanti Feron Gold test done previous to meeting with doctors for her TB testing. I would submit the results to the doctors before any testing took place (copy only).

In my opinion, this would help remove the "subjectiveness" involved in x-ray evaluations etc.

The QFG is around 5K baht, but at that point in time, money is not really the issue, the hassles that could be removed (theoretically) would be well worth 5K baht.

Again, Sheryl is right, but my point is, the doctors would feel really stupid trying to defeat a negative QFG with a suposed positive X-ray.

(one would expect)

yes, that's exactly what i was going to do. i explained that to the embassy and they said it was better for us to save our money, as they doubted there would be any problems with the x-rays. i found it strange that they readily discounted her previous tests, and criticised the QFG tests. they exploited the subjectivity of the x-rays and our non-medical backgrounds.

what's annoying is that the hospital lied about the visa health clearance procedure and deliberately withheld information about the findings, and recomendations to the panel doctors in australia.

more info here... http://www.thaivisa.com/forum/Tb-Sputum-Test-t283515.html

[Dakhar]

Well this is what the CDC has to say about the use of the QFG

http://www.redorbit.com/news/health/332065...f_tuberculosis/

and you are not surprising me about running in to a wall when it comes to dealing with Thai physicians regarding the QFG. None of the doctors I met at Bum. had ever heard of the QFG!!!!!

An ENT at Vichayut knew a lot about it, and another young doctor at my sons childrens hospital did too (forgot the name of the children's hospital, but it is expensive and hi-so, this is not to say I am hi-so)

[Dakhar]

sorry to hear about your TOTAL scam. I think I got AFB testing done for around 150 maybe 300 at most at a local private hospital I think it is called "Rangsit."

I just told them (or the wife I should say) that i did not want to see the physician, I just want their labs to do an AFB and they complied.

you sir have been scamed

Edited July 29, 2009 by Dakhar

[Sheryl]

OK, now I see the whole picture. As some of the facts were in a diofferent thread in a different forum it was not very clear, so if you don't mind I have merged the 2 threads, leaving a link in the visa forum.

If the 2,660 Baht per test was for a sputum AFB (as opposed to culture), it is indeed excessively high. A simple AFB should be under 500 Baht even at an upscale hospital.

In your particular case it sounds like the "abnormality" on Xray was not necessarily one suggestive of TB so not sure if even an AFB was needed. Thai doctors/hospitals cannot speak for Oz immigration and I wouldn't put much stock in their suppositions. Wait and see what they say in Oz, assuming all records have now been sent. If some records have NOT been sent then I suggest you contact the hospital Custiomer Service representative at once.

Good luck.

[Sheryl]

P.S. It would be interesting to know exactly what the radiology report of the chest film said, have you seen it? If not, you can request it. By law patients have a right to all their medical records.

This would be helpful in terms of figuring out if there is anything of any sort (not necessraily TB) that needs further investigation

[myauq]

P.S. It would be interesting to know exactly what the radiology report of the chest film said, have you seen it? If not, you can request it. By law patients have a right to all their medical records.

This would be helpful in terms of figuring out if there is anything of any sort (not necessraily TB) that needs further investigation

hi Sheryl,

thanks for merging the threads - it certainly will make things easier to follow.

as for the medical report, it is conveniently vague as this is what it states:

-----------------------------------------------------------------------------

diagnosis: abnormal chest x-ray

treatment: - sputum examination

- follow up

doctor comment:

she has abnormal CXI findings, unclear etiology

further reinspection/Follow up is reason needed

------------------------------------------------------------------------------

any idea how we may go about acquiring a more accurate assessment (i.e. location and description of the 'abnormality')?

Edited July 29, 2009 by myauq

[sunnymarky]

we've been ripped off!

embassy said today that the x-rays and check-up results have been sent to australia (without information about the sputum testing), and that it was likely they'd approve. <deleted>. i'm writing a formal letter, asking for my money back - all 10,000 Baht of it.

when talking to the doctor yesterday i said in dispair that it'd just be easier to apply for the tourist visa, get married in oz then go for a bridging visa as a means to pr as my spouse. after i said this, and complained about a number of other issues i had with them, he said that if we did so the embassy may stop us because my wife would be flagged as a potential health risk. fuc_k off, i thought (and almost said)!

then the doctor did something very strange - he gave me his personal email address. he confessed that he hadn't sent all the results to australia yet, and that i should email him if i really intended to change the visa application. reason for this: if we change to the tourist visa we would have wasted lots of money and time, and would have been invonvenienced on the basis of a lie to scam us out of money. we would have found this out that there was nothing wrong with my wife after arriving in australia to get a proper check-up. the reason for the email address is that, if we were to apply for the tourist visa on the basis of this bogus medical advice, he would possibly get into trouble. giving him notice, he would then be able to advise against the tourist visa, saying that we'd be ok to travel without further tests. what a load of <deleted>!

basically, because they're accredited by the oz government, it's like they've been given the permission to rip us off, and we're in no position to argue, as our visa and time depends upon their advice. fuc_kers!

Believe me all these private hospitals here see a Falang Tourist or even resident and they see the $$$ or Baht sign. Its about making money. I learn the hard way. They either want to admit you into the hospital overnight or charge exhorbitant fees for tests. Of course all done with a in the LoS

[Sheryl]

as for the medical report, it is conveniently vague as this is what it states:

-----------------------------------------------------------------------------

diagnosis: abnormal chest x-ray

treatment: - sputum examination

- follow up

doctor comment:

she has abnormal CXI findings, unclear etiology

further reinspection/Follow up is reason needed

------------------------------------------------------------------------------

any idea how we may go about acquiring a more accurate assessment (i.e. location and description of the 'abnormality')?

What you want is the actual radiology report, a one or 2 page document signed by the radiologist. This will describe exactly what was seen on the film.

[myauq]

as for the medical report, it is conveniently vague as this is what it states:

-----------------------------------------------------------------------------

diagnosis: abnormal chest x-ray

treatment: - sputum examination

- follow up

doctor comment:

she has abnormal CXI findings, unclear etiology

further reinspection/Follow up is reason needed

------------------------------------------------------------------------------

any idea how we may go about acquiring a more accurate assessment (i.e. location and description of the 'abnormality')?

What you want is the actual radiology report, a one or 2 page document signed by the radiologist. This will describe exactly what was seen on the film.

hi Sheryl,

conveniently, that was all they gave us. let me explained exactly what happened.

on day one, my wife went for the general check-up and x-ray. the doctor (gp) at the end of the exam said everything was fine, but said that there was a small ambiguous mark on the x-ray, pointing to the upper left portion of her chest (not the x-ray). she didn't know exactly what he said, so i called up the following day to make sure it wasn't too serious. he said it *wasn't* normal, and requested we come in and see the specialist the next day (saturday) as it may prolong the spouse visa application. this is an untruth, because apparently they send the check-up and x-ray results to australia first, then wait for the assessment before taking any further action. he was the doctor (the gp) who, based on the x-ray, refered us to the specialist.

we saw the specialist on the saturday, and his diagnosis was completely different. he said it was very common, and was probably just an old inactive scar, but because we're dealing with australia (which is very strict on tb) they needed to do all of the tests - which would take 8 months - starting then with the sputum/culture test. each day we came back we naturally wanted more information, and i said i was unhappy with their diagnosis, telling them i had worked with clients with tb before, so i asked for the x-rays and report.

what you see in the above post is the report that they gave us, which was written by the specialist. there weren't any other reports.

also, as i mentioned before, we saw the specialist on two occassions. on the first, he pointed to two very small cup like traces over one of her ribs. they were so small that he had to enlarge the picture on the computer screen for us to see it. when we came back on the final visit, we asked him to point out the problem area again. he then grabbed his pen and pointed to a more general area around her sturnum, making a circular motion, rather than pin-pointing. i distinctly remember not seeing the two cup-like shapes we had seen the first time, which is when i was 100% sure they had screwed us around. that is when i asked for the x-rays and *all* of the reports. we have the reports now, and i still cannot find the marks we saw the first time.

i am so disappointed.

[myauq]

i'm also wondering what's the best way to pursue a refund in this situation. i have the specialist doctor's non-professional email address, and i may use that to gain as much extra information as possible.

my disapointment comes not from being ripped-off per se, but by being shafted by an organisation i trusted as a representative of my own country, australia. i don't know what will happen to the doctors/hospital if i make an official complaint to the embassy/government, but i may raise this with the hospital if they don't initially offer the refund. also, i've noticed that introducing myself as doctor (which i am) certainly helps in these situations.

[Sheryl]

First of all, I am not sure that you were in fact improperly treated. If the Xray showed some small calcifications consistent with inactive TB, you would indeed have needed a series of sputum cultures, and if the sputum test done was a culture rathe than an AFB (which is a simple smear) the cost mentioned is not unusually high for an upscale private hospital. Still need to get to the bottom of what the Xray showed and also exactly what type of sputum test was done.

I'm not saying you may not have a complaint, just that it is by no means obvious or open-shut, and any medical official within the Oz giovt that might review a complaint (if it were even referred to one) would likely feel the same. So I think no value at all in making a complaint through those channels.

As for trying to get a refund from the hospital: only if either:

(1) you are sure the sputum test was a smear rather than culture and can show you were overcharged (should be possible to find out the stabndard charge for an AFB). In which case could pursue it as an issue of overcharging. it is entirely possible that they levy a higher charge on tests for visa pusposes than for the same test for other reasons, altho they may justify this on grounds that additional paperwork on their side is involved. OR

(2) can establish that there was in fact nothing on the chest film suggestive of TB and thus that the testing was unnecessary. However it sounds like there may have been a small calcification or two, this part still unclear. Get the radiology report. What you have quoted is not a radiology report. There will be a separate document, apart from the specialist's noted, which was issued by the radiologist. I suggest you just contact the medical records department and ask for all records including laboratory report and radiology report.

The fact that Oz lists this hospital as an approevd source for TB testing does notmake it in any way a representative of Australia or the Australian government. It just means that the Oz immigration service considers the hopital's testing facilities(laboratory, radiology) to be of adequate standard.