Timely Detection and Treatment of Tuberculosis

Tuberculosis (TB) has been, and remains one of the greatest public health concerns since the Neolithic ages. Unlike small pox, chicken pox, plague, leprosy, and to a certain extent AIDS, where medical science has been able to eradicate or control the ailment to a large extent, tuberculosis is one disease that continues to challenge the medical fraternity. 

There are several reasons for this:

• This airborne disease is highly contagious and simple actions like coughing, sneezing and talking, helps spread the bacteria
• Several new strains of the two primary types of bacteria that cause TB, are detected all the time
• These new strains have developed resistance to the existing medications, making treatment difficult
• TB does not present typical symptoms and most of its symptoms can be confused with that of other diseases
• Growing the bacteria in laboratory cultures, is a slow process and it often produces unreliable results. The lab cultures are used to detect TB
• Similarly, the TB bacteria take a long time to die which makes the treatment an extremely lengthy process

Risk Factors

• AIDS and HIV infection
• Poverty and poor hygiene / Poor living conditions
• A weak immune system
• Diabetes
• Medication used to prevent rejection of transplanted organs
• Certain cancer treatments (Chemotherapy)
• Drug and alcohol abuse
• Diseases that are immunosuppressant in nature, such as the final stages of kidney disease, certain types of cancer
• Exposure to migrants from high TB-risk countries
• Healthcare professionals who treat TB patients

Typical symptoms

Depending on the type of TB contracted by the patient, and the stage of the disease, the symptoms can vary. However, the most common symptoms are:

• Consistent coughing that produces sputum every time
• Few drops of blood in the sputum
• Fever
• Poor to no appetite
• Rapid loss of weight and muscle
• Excessive sweating, while asleep at night

Diagnosing TB

There are several tests used to diagnose TB; tests which use a mix of physical and diagnostic examinations.

• Chest X-ray: Used to detect acute pulmonary TB that shows up as small cavities in the lungs
• Mantoux skin test: A dose of tuberculin is injected into the arm of the patient. The site is checked for any swelling 2 or 3 days later, on the patient’s return visit to the laboratory. Swelling at the site of the injection, is a positive sign of the existence of TB
• IGRA or Interferon Gamma Release Assays: The human immune response is known to produce a particular molecule called cytokine in response to TB bacteria. In this procedure or ‘assay’, a small sample of the patient’s blood is examined, to find the presence of a particular strain of cytokine called Interferon Gamma Cytokine
• Serodiagnostic tests: The blood sample of a patient suspected to have TB, is analyzed for the presence of specific antibodies
• Sputum smear microscopy: The patient’s sputum is smeared on slides and a particular stain is added. TB bacteria are known to pick up the stain (hence called “acid-fast bacteria”), thereby confirming the presence of TB
• Ziehl-Neelsen Florescent light microscopy: The sputum smears on the slides are examined under either a quartz halogen lamp, a mercury vapor lamp, or LED lamp, to detect the presence of TB bacteria

Once the strain of TB bacteria is detected, a relevant course of treatment is designed. Depending on the diagnosis, the treatment period could be anywhere from 6 to 9 to 12 months or even longer. All medications prescribed must be taken at the time specified. The medications may contain one or more types of antibiotics.

If you suspect that you may have been infected, then contact your primary care physician immediately, who after performing the preliminary tests and confirms the presence of TB, will refer you to a doctor who specializes in lung or infectious diseases.

Immigration Medical Exam: What does it cover?

Immigrants and Refugees immigrating to the United States of America, must go through a Medical Exam, as mandated by the U.S. Citizenship and Immigration Services (USCIS) and the Department of State (DOS). The medical examination helps identify applicants, who may be inadmissible on any one of these grounds: suffering from communicable diseases of public health significance, diseases of a terminal nature, had or is having a physical or mental disorder with associated harmful behavior, has been or is a drug abuser or an addict.

Process

The applicant will need to download the Medical Examination Form I-693, from the USCIS website and DS-2053, DS-2054, DS-3024, DS-3030, DS-3025, and DS-3026 forms from the DOS website, and fill them in. After completing the forms, an appointment has to be scheduled, to complete the medical examination, which may be done only with the authorized physicians, before you / your sponsor can file your papers.  

The medical examiner will review your medical history and conduct a physical examination comprising of: a chest X-ray, a blood test for syphilis and tuberculosis. The physical examination is done on the eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes, skin, and external genitalia. Normally, children under 15 years of age are not required to undergo chest x-rays or blood tests, but they must undergo immunizations and a general physical examination.        

    

The following records / reports should be brought and submitted to the medical examiner during the medical examination:

• Applicant’s vaccination immunization records
• Any prior chest x-rays
• Copies of applicant’s medical history records
• Applicant’s passport, identity card, laissez-passer, or travel documents

The applicant must attend their medical examination on the date and time scheduled. On completion of the examination, the results will be given in a sealed envelope, together with a copy for the applicant’s records. The sealed envelope should not be opened.

The Medical Examination aims to screen applicants for three categories of diseases as shown below, in addition to specific health conditions: 

• Communicable diseases or diseases that are easily transmitted through touch and of public health significance: examples include sexually transmitted diseases such as Syphilis, Chancroid, Gonorrhea, Granuloma Inguinale and Lymphogranuloma Venereum, as well as others like Tuberculosis and Hansen's Disease (Leprosy).
• Quarantinable diseases designated by any Presidential Executive Order such as cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, and influenza caused by novel or re-emergent influenza (pandemic flu).
• Vaccine-preventable diseases such as mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus influenzae type B, rotavirus, hepatitis A, hepatitis B, meningococcal disease, varicella, influenza, and pneumococcal pneumonia.

Special Health Conditions and Measures 

• Mental Issues: If an applicant has had or is diagnosed with mental retardation, learning disability or has had any history of harmful or violent behavior resulting in injury to people, animals or inanimate objects, then a detailed report must be submitted.
• Tuberculosis / Syphilis: Applicants who have suffered from confirmed symptoms of Tuberculosis or Syphilis must furnish a certificate signed by a doctor or a public health official that the applicant was treated properly and cured. 
• Pregnancy and Chest x-ray: As a protective measure, the pregnant applicant must be provided protection for the abdominal and pelvic areas when the X-ray is being taken. This could be in the form of wrap-around lead shields (double layered) or a superior method as recommended by a pathologist or gynecologist.

Choosing an Immigration Medical Center

Only Medical Centers / Doctors who have been authorized to perform the tests and certify, will be listed on the USCIS website. Therefore, you will need to make your choice of the center, hospital or doctor from the list provided. After making your choice, you can telephone and check with the front desk, for available dates on which you may have your immigration medical exam.  In case you are unable to provide your vaccination records, the doctor will provide you with the name of the government medical center where you will have to be vaccinated again, and get your certificates from.