MEDICAL FITNESS FOR (TB) TUBERCULOSIS IN QATAR

JOIN HANDS TO END TB

I have seen many peoples posted there queries about TB during the medicalfitness and visa processing stage. But nobody came and answred the final outcome of the process. Since i have undergone this stage i would like to share the process to ease the tension of the persons suffering from the same.

I have done blood test and X-ray at medical commission on last week of July 2018 after 2 days i got a message to attend re-x-ray. I have done the same.

i would like to share some tips for going for re-X ray.

(1) Attend X-ray only you are fit, if you have any cold, sinus, cough or pneumonia the x-ray shows some indication of lungs inflamation which leads to further examination for TB.

(2) Take a long breadth and hold it till finish each shots. Otherwise the X-ray will not have clarity, which will also lead to failure.

(3) Dont move and carefully obey the technicians instructions and respect the positions he keeps. which will help the doctors to examine all images and interpret the suspect flaws.

Usually TB affects the upper part of lungs only very rarely appers on lower lobes. If you had any previous infections some scars will appear in the lungs, which will cause a suspect.

Unfortunately, same day after noon i got a message to attend medical commission Room-99 for further examination on next day between 7-12 except wednesday with passport and MC receipt.. I had attended the same and They had given appointment for PPD test and the test conducteda t room-99.

In my case in the lower lungs zones some linear opacities are observed, i doubt which was due to my old virus infections and i had cold and cough during the test. which might have shown some infection flaws on lungs.

(A purified protein derivative (PPD) skin test /TST or called Mantoux test is a test that determines if you have tuberculosis (TB). TB is a serious infection, usually of the lungs, caused by the bacteria Mycobacterium tuberculosis. This bacteria spreads when you breathe in the air exhaled by a person infected with TB.)

 A  nurse had asked the family history of TB and swab the skin of your inner forearm with alcohol. then got a small shot that contains PPD (10 TU of 0.1 ml) under the top layer of your skin. i felt a slight sting. A bump formed, which gons away in a few hours. They marked the spot and told not to rub, wash, apply cream or soap till come back to see doctor.

After 72 hours between 7-9am , i had to return to your doctor’s office. two doctors will check the area where you received the shot to see if you’ve had any reaction to the PPD.

If the PPD measurement is >10mm, they will decide the result is +ve and to proceed for further examination.

Tips: (1) Do not rub, if itching comes also. only wipe with samll cotton clothes

(2) Do not apply soap, shampoo, cream, perfumes, ice or chemicals.

(3) Dont expose to dust and sweat 

(4) Take bath without soap and in normal  temp. water only.

I had returned after 3 days the reading was 11 mm and this was measured and confirmed by 2 doctors. Again i got a message to come to 1/118 of medical commission to undergo further blood test from 7-10am exactly after one month (first week of september 2018)

I have reached the medical commission and They have instructed me to take QFT on same day as per the SMS date.

(QuantiFERON-TB Gold (QFT) is a simple blood test that aids in the detection of Mycobacterium tuberculosis, the bacteria which causes tuberculosis (TB). QFT is an interferon-gamma (IFN-γ) release assay, commonly known as an IGRA)

QFT is highly specific and sensitive: a positive result is strongly predictive of true infection with M. tuberculosis. However, like the TST and other IGRAs, QFT cannot distinguish between active tuberculosis disease and latent tuberculosis infection, and is intended for use with risk assessment, radiography, and other medical and diagnostic evaluations. 

QFT-G may be especially useful in patients suspected of having possible false-positive Tuberculin Skin Testing (TST) due to previous BCG vaccination or environmental (non-tuberculosis) mycobacterial infection. ... A positive response to the QFT-G does not mean the person has ACTIVE TB.

They have issued a mask and then sent to phlebotomy for blood drawing, they have  taken 3 test tubes of blood for lab testing

Nil tube

Negative control to adjust for background IFN-γ

TB Antigen tube

To detect the CD4+ T cell responses to TB antigens

Mitogen tube

Low response may indicate inability to generate IFN-γ

My result came after 3 days as an SMS as usual to TBC-Appontment and instructed to go communicable Dis. centre at Rumila on second week of september 2018 between 7-12 pm to get an appointment for follow up referral.

I went to the CDC , which is located opposit to HMC ( if you go from Al saad which is located  first right after HMC signal, a pink coloured building.) I got token and waited for few hours. later called for physical examination and asked for the history , then consulted with a doctor. I have asked him the result of QFT and he told me it is positive. Now the time to decide the TB is active or Latent.

The Doctor has informed me to give sputum tests (1) sputum smear test (2) sputum culture (3) CBC.

I went to sputum collection room and given the first sample and given the second sample after one hour. Once you go to sputum collection room , you can understand the seviourness/seriousness of TB disease. 

(Sputum smear microscopy as a test for TB. Smear microscopy of sputum is often the first TB test to be used in countries with a high rate of TB infection. Sputum is a thick fluid that is produced in the lungs and the airways leading to the lungs. A sample of sputum is usually collected by the person coughing.)

Tips for Sputum collection.

(1) Take a very deep breath and hold the air for 5 seconds. Slowly breathe out. Take another deep breath and cough hard until some sputum comes up into your mouth. Keep doing this until the sputum reaches the 5 ml line (or more) on the plastic cup. this is to collect the sputum from lungs. 

(2) Dont spit saliva or  mucus from mouth or nose.

(3) Tightly close the plastic cup and put in a disposible plastic bag and seal it before handing over to the counter.

After giving sputum i have given blood for CBC (CBC alone is a poor indicator of tuberculosis. ESR in range of 90 + is indicative enough that one has to either confirm or rule it out. If ruled out, patient needs to be monitored both clinically and with repeat ESR.)

I have booked an appointment with the doctor on last week of september 2018 to review the result of the sputum and CBC.

Once you have positive results  with X_RAY, PPD and QFT . TB is confirmed with 90% , the sputum test is the only factor to decide Active and Latent.

You will have lot of mental stress and fear about the employement and worry about health condition. You will search and study a lot about this diseases and read lot about others experience.Unncessary thinking will come. Will be worried about how it came to me etc.

Advice:

1. Dont be panic.

2. Dont worry about the employement , instead more involve in work.

3. If people keep distance , be away from negative people.

4. Think about good thinks and take nice sleeps with sweet dreams.

5. Dont inform your families, they will get panic unncessarily.

6. Avoid smoking and liquor habits, which will worse the situation.

7. Control and maintain your diabetese.

(Diabetics have a three to five time’s higher risk of developing tuberculosis (TB) than those without diabetes disease. Diabetes mellitus is an important risk factor for tuberculosis and may affect disease treatment and also the response. Additionally tuberculosis may induce glucose intolerance and worsen the glycaemic control in people with diabetes. )

8. Dont try to loose weight.

9. Observ the below symptoms , The symptoms that occur with an active TB infection are:

➢ Tiredness or weakness,

➢ Weight Loss

➢ Fever,

➢ Night sweats.

My case my family and my colleagues and my GM was very suppotive and they kept me happy and mentally supported me a lot. But as a human being i read and done some research on these. Finally the appointment Date came, i went to CDC. They have did the physical examinations and followed by met the doctor.

I have asked 3 questions to doctor.

1. what is the result of my Sputum smear and culture?

Ans: Sputum smear is negative and cultur result will take 6 weeks from test date and as of now , no growth of bacteria observed.

2. Am i a TB patient?

Ans: Yes, You are having Latent TB, means not active.

3. How it happend ? i never had TB and not trated , then how it become Latent?

Ans: Latent TB means you have exposed with some Active TB patient. But you will not spread. The bacteria is within you. whenever your immunity become weak the bacteria will grow. 

(TB bacteria are spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, speaks, or sings. People nearby may breathe in these bacteria and become infected.)

(Sometimes, the body’s immune system becomes weakened, and the TB bacteria break through the scar tissue and can cause active disease, referred to as reactivation tuberculosis or secondary TB . For example, the immune system can be weakened by old age, or with the development of any infection or cancer, or certain medications used such as cortisone, anticancer drugs, or certain medications used to treat arthritis or inflammatory bowel disease . The breakthrough of bacteria can result in a recurrence of the pneumonia and a spread of TB to other locations in the body. The kidneys, bone, and lining of the brain and spinal cord (meninges) are the most common sites affected by the spread of TB beyond the lungs.)

The doctor asked my family History and my type of work. Afterward he asked my permission to start medication. He expalianed the procedure.

There are there different medications are depends on the stages of TB. 

1. CAT1-New Case (smear-pos., seriously ill, Smear neg. or EP (EPTB refers to TB involving organs other than the lungs (e.g., pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones, or meninges). A patient with both pulmonary and EPTB is classified as a case of PTB. For example, miliary TB is classified as PTB because there are lesions in the lungs.)

2. CAT2 - Retreatment, failure

3. CAT3- New Case (Smear neg. EP)

4. PROPHYLAXIS - (Contact, old infection , Preventive)

For me he described about PROPHYLAXIS Latent/ Preventive TB medication and given the below medicines.

1. ISONIAAZID 300 mg/tab - 1 per tablet per day early morning 1 hr before food or 2 hr after food.

2. VITAMIN B6 (Pyriodoxine) 40mg/tab - 1 per tablet per day early morning 1 hr before food or 2 hr after food. 

(Vitamin B6 (pyridoxine) supplementation during isoniazid (INH) therapy is necessary in some patients to prevent the development of peripheral neuropathy. ... The routine use of pyridoxine supplementation to prevent peripheral neuropathy in high risk populations is recommended.)

History:  isoniazid was employed in the management of tuberculosis, researchers noted that some patients develop peripheral neuropathy. This was characterized by symmetrical numbness in hands and feet which is described as "stocking-glove" distribution. This neuropathy was more severe in patients who received higher doses of isoniazid. At later stages, the neuropathy was characterized also by pain involving muscles and bones. In 1954, Biehl and Vilter of the University of Cincinnati College of Medicine investigated urine excretion of vitamin B group in the patients that received isoniazid. They found elevated levels of pyridoxine, also called vitamin B-6 that were more pronounced in patients on high doses of isoniazid. This suggested that isoniazid caused vitamin B-6 deficiency, which presented clinically as peripheral neuropathy.

The Doctor indicated me that if you are diabetic, please control the glucose level, which may help the  bacteria to become active. I had given appointment for diabetic clinic also.

The total treatment duration shall be 6 months and They have given me medicine for 60 days (2 months ) and the next appointment given last week of November 2018. I will have to meet the same doctor.

They have given a Treatment card and i have to get signature of the observer of medication. either company nurse or senior person in your company has to take the reponsibility for monitoring the fulfillment of treatment. My GM had to sign daily after seeing the tablets swallowed by me.

They have given the first dose of medicines from there and educated me regarding the side effects. if any rashes, vomiting or pain , i have to come back to CDC again except friday and saturady. If it happends in friday and saturday i may have to report to HMC Emergency.

(anti-tuberculosis tablets can cause side effects. Your doctor will monitor your progress during treatment to make sure the medication is working. This will usually involve blood, sputum or urine tests and chest x-rays.

It is important to tell your doctor or health care worker immediately if you experience any unexplained illness or the following symptoms:

• Nausea or vomiting
• Jaundice – yellowish skin or eyes, dark urine (orange/red urine is a normal side effect and is not harmful)
• Unexplained fever or tiredness
• Tingling or numbness of hands or feet, or joint pains
• Skin rash, itching skin or bruising
• Visual changes or change in red-green colour vision.)

The report of the investigation has sent to medication bu CDC directly and informed me to go to medical commission room no. 118 after 5 working days with a paper given from CDC.

After 3 days i got SMS saying to proceed to MOI for completing the visa procedure. I got this clearance after 3.5 months of first day of medical.

I went to medical commission on first week of october 2018 as mentioned by CDC. they checked and wrote down the paper that FIT for 1 Year. Then told me to proceed for fingure print.

I asked about the is there any problem to issue ID. Then she infomed that you will get an ID for one year. Meantime you have to complete the 6 months mediction, undergo further blood test and clear the reslt. Then CDC will issue a fitness certificate, which is to be submitted here (medical commission) then only the Block from the system will be lifted. otherwise i will not able to process the visa further.

I Hope the procedure will be same for active patients also. but they may seek NOC from employer to proceed for the medication and stay in qatar. 

Conclusion: i am happy now because i have diagnosed with a severe disease and got treatment at right time. if i have not noticed the situations could worse and could affect the whole family and childrens. As a normal visit to clinic for cold or fever or cough , no doctor will suspect for TB, unless otherwise it is siviour. I had made parallel examination in one of the famous private clinic in Qatar as a second opinion, they had done my CBC, ESR and chest X-ray. I explained the suspet of TB , but they dont have facility to do QFT test. But based on ESR and X-ray they have confirmed my Fitness.

Hence i am very much happy with the medical system implemented in Qatar for the visa process and i would suggest to conduct every year on visa renewal also to prevent such diseases. I had Qatar ID for almost 12 years and i was out for 1 yr and when i came back to process new visa , they found this. I am lucky to have got the treatment in a world class facility healthcare system, which i may not be able to afford in my native.

Reason for my disease: Exposed to TB bacteria. i was a frequent traveller. I had been in crowd for many times and many places. 

Advise: Be cool and undergo the procedure and medication fully. Health is our wealth. 

Picture Courtesy: google and wikipedia.

EDIT: Please also visit HMC website for assistance.