Tb (non)-diagnosis

[myauq]

hi all,

i'm interested in finding some information about tb diagnosis. you see, my gf is applying for an australian spouse visa. we went for the initial check-up and x-ray a few months ago. the doctor said that there was a possible trace/history of tb (opacity) in her lungs, but said that it was very small, and he doubted it was serious. nevertheless he said it needed to be noted, and checked further. fair enough.

so we came back to the hospital a few days later and had the sputum culture and afb stain tests. after giving each sputum sample (3 in all), we were told to wait at the hospital for a few hours. a nurse came and said that they all the tested negative (1 each day), but that we would have to wait another 10 weeks for the sputum culture.

8 weeks later the doctor asked us to come back, and said my gf needed another x-ray (reason = the stain was positive, even though cultures were negative). another two weeks (10 weeks at this stage) later, and we went back to the hospital where the doctor wanted another x-ray. at this 10 week stage he also mentioned that he'd write in his report how he thought the stain was a false positive, the result of 'contamination', to use the exact words. all the culture results were negative and there was no change in the x-rays.

he said that everything was ok, and it was unlikely she had any tb. in fact he said he was happy to say that he'd never see us again, unless he went on holiday to australia. we were, of course, very happy.

so you can imagine how we became worried when we got another letter from the embassy a few weeks later, and it asked my gf to return to the same hospital for treatment!!?? the only option now seems to be a 6 month course of treatment, which would be followed by another 2 month sputum culture sample.

i can't quite understand this as we have all of the doctors reports and copies of the x-rays, and my gf has never been diagnosed with either active *or* latent tb. we also have negative results from the mantoux skin test a few years ago which we discussed with the doctors, but she still has to undergo this course treatment. the panel doctors also said that they were finished with us back at the 10 week mark, so i'm not sure why she has to go back at all.

i do understand the importance of tb screening, but this is just a bit surreal. it's been a roller-coaster, and a bit scary because we have no interaction or connection with the people making these decisions, and no knowledge of the reasons for our predicament.

i have also read this thread, but i think my gf's diagnosis is different... http://www.thaivisa.com/forum/Tb-Testing-iom-t210649.html

i reiterate - my gf has not been diagnosed with any form of TB!!!! the above thread doesn't fill me with any confidence, and i don't see why she should take any drugs for what may be nothing at all.

is there anything we can do here?

Edited October 31, 2009 by myauq

[namoo]

Don't do the drugs. Seems obvious you need to go back to the embassy armed with letters and medical records stating that your gf does not have TB get second opinion letter also.

I would not be undergoing treatment just to please the embassy thats for sure.

[myauq]

that's what i would like to do, but i called the embassy last week and they were doubtful anything could be done.

i think i should get a second opinion before taking the medications though (quantum-feron and the mantoux test again, as these are the quickest), and take them to the panel doctor asking to have them considered whilst she nevertheless starts the meds. that way we have more evidence, but in the case of not getting a review she would have started the medications anyway. btw - she is asymptomatic, and has no history of symptoms (though of course i know that does not rule out having the disease).

it's been so stressful... yesterday the doctor said that after the 6 month mark she would need another 10 week sputum culture test and i freeked a bit. i said that i would consider going to another hospital, so he gave me the documents i needed and told me to give them to the new panel doctor. today (next morning), i get a call from the doctor and he said that there was a miss-communication, and that, at this stage, all they would do is complete the course of meds, then send another report (meaning that any other subsequent tests would be at the request of the australian doctors, not the thai hospital).

[FBN]

You seem to be stuck in the visa beaurocratic process and it is unlikely that the medical reports have been reviewed by anybody medical.

Further tests, unless specifically ordered by the Ambassy are unlikely to affect the outcome at all as there would be no formal "process" related to those specific tests and may therefore just be ignored by the clerk processing the application.

INH treatment carries quite a risk of inducing liver problems, especially for Asian people and to take treatment without proper medical indications is quite inappropriate.

Mantoux test is not really reliable in Thailand as most locals will have a response (she has also had one test before any may be sensitised now) as TB is endemic here so I would not suggest to go that way as it may create more confusion.

The "Gold Standard" Quantiferon test is most reliable but it does not seem that the immigration authorities have incorporated this test in their assessment process and are largely unable to take that into account.

Best option is to pursue this with the immigration authorities, not with the local hospitals. There is no guarantee that, even after doing the treatment and another 10mths, that the process will be any easier.

This issue is not unique to the Australian Embassy; also UK and also Canadian, in my experience.

Good luck!

[myauq]

we have started the medications, but i'm still very concerned about how long all this may take in the end. we saw the doctor last week at the 2 week stage and he said everything was going well. he phoned me (as i mentioned in the op) a few weeks before that to say that the second sputum test and x-rays two months after the treatment may not be necessary - he was just requested to send the report back to the embassy. then again, he also said that we'd have the all clear before we got the letter tell my gf to take the meds

my question is this - if we have ongoing x-rays over the next few months (which show no change), and she has already given a negative sputum test (though one positive stain - attributed to 'contamination'), then why would we need to wait the further two months for any further tests after treatment? i'm worried that this will just drag out for no reason. it's very depressing

Edited November 28, 2009 by myauq

[Sheryl]

Unofrtunately no one but the Australian immigration authorities can answer this. We are not dealing here with what makes medical sense but rather with what immigration authoritizies in Oz require.

As FBN said, based on what you report it sounds like what you are getting are responses from clerical level personnel without medical training.

All I can suggest is that you try to get hold of the appropriate department back in Oz or a Medical Office at the Australian Embassy here and do nto stop until you are actually speaking to a medically qualified Australian national.

As these medications are fairly toxic, I would persist in trying to get this resolved. In the case of people who actually have TB, the risks of the disease outweight the risks of the drugs, but for anyone else they (the drugs) are well worth avoiding.

[myauq]

i'm also wondering why we were initially told that the afb stains were all negative, as we waited a couple of hours for each one specifically for the results, then only to find out that one was positive two months later.

from what i understand the afb stain results should be available the same day - is this correct? can the results of these samples change over time? why would the hospital tell us that the stains were all negative, when one of them turned out to be positive??? how could that happen?

[myauq]

it seems, from reading the report, that another stain was done on the culture samples (at the 8 week point) - and one of these was positive (attributed to contamination by the panel doctor).

the x-ray had not changed, but in a letter the panel doctor said that this was interpreted differently by the doctor in australia. so, yes, i am wondering if any doctors in australia have actually seem this report, or are they just outsourcing to save (themselves, not us) time...

i am starting to write a letter of complaint, even though our case officer advises us just to go with whatever we've been asked to do

[Sheryl]

I doubt a complaint will achieve what is needed, it won't even be read by anyone medical.

What you need is to have a dialogue with a medical authority. Even if they outsource much of it, there will be a medical unit somewhere in the Oz beaurocracy. I would start by trying to find out if there is a Medical Officer attached to the Embassy. If there is, although S/he probably is not involved in the visa screening process, they'd probably be able to point you in the right direction in terms of who to talk to in Canberra.

If the Xray was interpreted differently by the docs in Australia that may be the problem. For the sake of her health, you need to know what their interpretation was.