Positive TB skin test & RFEs & Treatment?

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Depressed.Alien

Registered Users (C)
RFE & Positive skin test: What to do?

Hello Everybody,

A friend of mine just received an RFE on his medical stuff. They want him to do his TB skin test. He knew the test would be positive and the doctor just did the chest X-ray, which was clear. But apparently for the medical specialists in Nebraska Service Center, this is not good enough.

I myself received an e-mail recently about an RFE issued on I485. I do not know what it is about, but I suspect (hope?) it would be the same, since my medical form is identical. Skin test "Not Done", X-Ray - "Normal."

Even though the procedure seems straightforward, I am in fact very concerned about my friend and possibly myself.

We are both from Russia and in Russia as well as in many other countries, everybody got so-called BCG vaccination against tuberculosis. Oftentimes (I gather about 50% of cases or more) it leads to a positive mantoux test for life. So, my friends' and mine are bound to come out positive.

Even the real medical professionals are debating whether this post-BCG positive result implies a latent TB or this result is completely benign, but what matters the most to the folks in NSC is the official guideline. The latter suggests that each and every person, who has a positive skin test (never mind the X-ray) has to go through a treatment of latent tuberculosis.

The problem with this treatment is that it involves Isoniazid, which must be taken for 6-9 months. This is an EXTREMELY toxic substance, which can damage your liver. Statistically, a notable percentage of treated people (especially elderly and people with any kinds of liver problems) may develop fatal liver failure, i.e. die. Many other will develop non-fatal but long-term liver injuries and experience a variety of serious side effects. However, the official guideline has been that these unfortunate results do not outweigh the positive effect of reducing the probability of developing active tuberculosis arguably from 15% to 3% (which BTW is treatable by the same substance, should it develop). Again, many medical professionals are fighting against this doctrine, but for some strange reason (perhaps some hidden economical reason) it still holds. I have seen both types of doctors and noticed that those who are not recommending any treatment are reasonable in many other ways, whilst the other type are mostly idiots. From this observation and from common sense considerations, I made the conclusion that one should avoid by any means possible the unnecessary treatment, which can irreversibly damage your health.

But if you get an RFE like that and you know your PPD skin test is positive. What do you do?

I myself am not prepared to be the subject of a medical experiment. However, I have no idea how to deal with this ludicrous situation (well, actually, I have some, but I am not going to share them publicly).

The issue is open for discussion.
So, please share your thoughts and/or experience (if you are among those unfortunate Aliens, who encountered this unexpected obstacle on your way to American Dream). Is there any way to respond to "the tuberculosis RFE" by providing a positive test result and convincing them NOT to start the treatment?
 
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from what i know positive skin test...........does not mean a thing........unless your X-Ray also comes positive....

if i was prescribed such forced treatment....i think i will just go through the process.....and not take the pills as simple as that....

so now...if you dont mind....can you please share your plan.......the possibility of USCIS reading our post.......tracing our whereabouts is impossible.....
 
techy2468 said:
from what i know positive skin test...........does not mean a thing........unless your X-Ray also comes positive....

if i was prescribed such forced treatment....i think i will just go through the process.....and not take the pills as simple as that....

so now...if you dont mind....can you please share your plan.......the possibility of USCIS reading our post.......tracing our whereabouts is impossible.....
Click to expand...


techy! once you are in the process the doctor can figure out by doing the blood work whether you have taken the medicine or not. The doctor has to certify that you are cleared from bla..bla.. I think.

I agree with Depressed.Alien about taking INH tablet for TB. It has got real side effects and about 5-10% will have side effects BUT not all. The liver will be damage for sure. What I think here is as long as your chest X ray is normal then you should be OK. Even if you get RFE in your cover letter you can argue this valid points on side effects by giving evidences available in the literature.

This issue has been discussed in this forum quite often.
 
Depressed.Alien said:
Hello Everybody,

A friend of mine just received an RFE on his medical stuff. They want him to do his TB skin test. He knew the test would be positive and the doctor just did the chest X-ray, which was clear. But apparently for the medical specialists in Nebraska Service Center, this is not good enough.

I myself received an e-mail recently about an RFE issued on I485. I do not know what it is about, but I suspect (hope?) it would be the same, since my medical form is identical. Skin test "Not Done", X-Ray - "Normal."

Even though the procedure seems straightforward, I am in fact very concerned about my friend and possibly myself.

We are both from Russia and in Russia as well as in many other countries, everybody got so-called BCG vaccination against tuberculosis. Oftentimes (I gather about 50% of cases or more) it leads to a positive mantoux test for life. So, my friends' and mine are bound to come out positive.

Even the real medical professionals are debating whether this post-BCG positive result implies a latent TB or this result is completely benign, but what matters the most to the folks in NSC is the official guideline. The latter suggests that each and every person, who has a positive skin test (never mind the X-ray) has to go through a treatment of latent tuberculosis.

The problem with this treatment is that it involves Isoniazid, which must be taken for 6-9 months. This is an EXTREMELY toxic substance, which can damage your liver. Statistically, a notable percentage of treated people (especially elderly and people with any kinds of liver problems) may develop fatal liver failure, i.e. die. Many other will develop non-fatal but long-term liver injuries and experience a variety of serious side effects. However, the official guideline has been that these unfortunate results do not outweigh the positive effect of reducing the probability of developing active tuberculosis arguably from 15% to 3% (which BTW is treatable by the same substance, should it develop). Again, many medical professionals are fighting against this doctrine, but for some strange reason (perhaps some hidden economical reason) it still holds. I have seen both types of doctors and noticed that those who are not recommending any treatment are reasonable in many other ways, whilst the other type are mostly idiots. From this observation and from common sense considerations, I made the conclusion that one should avoid by any means possible the unnecessary treatment, which can irreversibly damage your health.

But if you get an RFE like that and you know your PPD skin test is positive. What do you do?

I myself am not prepared to be the subject of a medical experiment. However, I have no idea how to deal with this ludicrous situation (well, actually, I have some, but I am not going to share them publicly).

The issue is open for discussion.
So, please share your thoughts and/or experience (if you are among those unfortunate Aliens, who encountered this unexpected obstacle on your way to American Dream). Is there any way to respond to "the tuberculosis RFE" by providing a positive test result and convincing them NOT to start the treatment?
Click to expand...

It is common for people who have been given BCG vaccination to have the skin test turn positive. Some foreign doctors practicing here are aware of this and ask you if you were given the vaccination. If you say yes, then they do not prescribe the skin test and put the remarks of BCG Vaccination. It is upto USCIS to decide further. The culprit is CDC who have reccommended the skin test as mandatory. Generally USCIS asks treatment statements via RFE if skin test is positive. Get started on the prescribed treatment without wasting time (generally 6 months of intake). This gives you the required paper work needed from physician and the local public health office. To consume the tablets is between you and your personal physician depending on the implications... And lastly taking the treatment will not result in the skin test turning negative afterwards. This is complicated.
 
ZLXC2Y said:
It is common for people who have been given BCG vaccination to have the skin test turn positive. Some foreign doctors practicing here are aware of this and ask you if you were given the vaccination. If you say yes, then they do not prescribe the skin test and put the remarks of BCG Vaccination. It is upto USCIS to decide further. The culprit is CDC who have reccommended the skin test as mandatory. Generally USCIS asks treatment statements via RFE if skin test is positive. Get started on the prescribed treatment without wasting time (generally 6 months of intake). This gives you the required paper work needed from physician and the local public health office. To consume the tablets is between you and your personal physician depending on the implications... And lastly taking the treatment will not result in the skin test turning negative afterwards. This is complicated.
Click to expand...

My teenage son might have the same problem, since we are also from Russia. I decided to avoid complications with his skin test, and insisted only on his chest X-rays. I knew that his test could be positive - since early childhood he has had skin ALLERGY, and when we were in Russia, his tests came always positive. If they make him take this awful medicine that destroys liver, we would better go back home to Russia!!! We have been here for more than 7 years...
 
I am not a doctor or anything like that and I do not see any solution here. What you have to do, you got to do. In fact, I would not recommend anybody not following doctor's instructions or interfering with test results. For example, the following is completely unacceptable (since it may interfere with the test results):

Before the test never use antihistamine medications especially strong ones. Never use them after the test either, because the TB skin test result may come out false-negative.

Another thing, which should be avoided is using substances like activated carbon continuously for a week before the TB skin test.

And finally common sense suggests that one should not under any circumstances apply any oitments (especially corticosteroids) to the exposed area. This may suppress the immune response locally. Since, the TB skin test is essentially your immune response to a certain type of neutralized bacteria, this may lead to unexpected results.
 
Wait, let me get one thing straight - did the RFE from NSC expressly request that you or your friend should receive treatment of latent tuberculosis just because skin test came back positive, while X-ray was clear? Or are you speculating at this point?

Could the reason for RFE be as simple as the fact that you chose not to undergo skin test (knowing it would be positive and wanting to spare yourself the trouble) - and, even though it makes perfect sense, that might have gone against the "rulebook" ("Every immigrant has to take the TB skin test!") that some ardent officials take too literally? In that case, get another medical done, only take the stupid test this time. Skin test "positive" (as opposed to "not done") and chest X-ray "normal" might prove to sound more feasible to someone who goes strictly by the book.

My skin test was positive (just as suspected - BCG vaccine), X-ray clear and I was approved with no problem at TSC. I would think that as long as the civil surgeon in I-693 DOES NOT check the box that you need a follow-up of medical condition and signs the certification at the bottom, "My examination showed the applicant to have met the medical examination and health follow-up requirements for adjustment of status") - you should be fine. Could your doctor have made a mistake in filling out the form? Check your copy.

If NSC does indeed request that you receive treatment (with skin test positive and X-ray clear), it is an outrage! Maybe the particular clerk dealing with your case is incompetent. You might want to get help of an experienced immigration attorney when replying to that RFE.

I sincerely wish you good luck!
 
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I agree with Civ2ru........i really doubt that we will be advised for a treatment based on skin test only.....even if X-Ray is negative........thats absurd............isnt it a common knowledge that negative X-Ray confirms that there is no TB
 
techy2468 said:
I agree with Civ2ru........i really doubt that we will be advised for a treatment based on skin test only.....even if X-Ray is negative........thats absurd............isnt it a common knowledge that negative X-Ray confirms that there is no TB
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guys, i have a question here. i was looking today at my medical examination, and it says that my tuberculin skin test was negative but the doctor didn't do for me an X-ray. so would this trigger an RFE bcs i didn;t do the chest x ray?
 
Re: civ2ru

Hey civ2ru,

Before I answer your very reasonable questions, let me get one thing straight. It really bothers me, you know:

You got your Green Card fast in September 2006. WHAT THE HELL ARE YOU DOING HERE IN THIS PATHETIC FORUM? If reading this forum is fun for you, let me give you an advice: Ask your doctor about Prozac. Or may be you are thinking about a career of an immigration attorney? You know, I am really curious.

I know one thing for sure. If/when I get my GC I will never come here again. I will want to forget forerever (or at least for 5 years) about USCIS and all this sh*t.
 
Depressed.Alien said:
Hey civ2ru,

Before I answer your very reasonable questions, let me get one thing straight. It really bothers me, you know:

You got your Green Card fast in September 2006. WHAT THE HELL ARE YOU DOING HERE IN THIS PATHETIC FORUM? If reading this forum is fun for you, let me give you an advice: Ask your doctor about Prozac. Or may be you are thinking about a career of an immigration attorney? You know, I am really curious.

I know one thing for sure. If/when I get my GC I will never come here again. I will want to forget forerever (or at least for 5 years) about USCIS and all this sh*t.
Click to expand...
take it easy dude........civ2ru, ginnu, UN & few more people help others with their questions.........i have been greatly benefitted by these folks.....

i never needed a attorney thanks to these guys...
 
Re:

I just got my RFEs. Yes!!! They want us to do the skin test. Eventhough in the original medical form the X-ray was indicated as normal.

Based on the (unreliable and scattrered) information on the web, there have been many cases when people were required to go through "treatment" with positive skin test & negative x-ray. I myself know that my reaction is going to be very positive most likely due to the BCG vaccination and a bunch of allergies I have.

I doubt that you guys know what to do in this situation, but if you think you do, please let me know. How to avoid the fcuking "treatment"?

You know, this situation reminds me of the one in the forties, when the Jews were subject to medical experiments by the Germans. Well, here we go again.
 
antonio - you cry so much about the namecheck but asked a dumb question here. if your skin test is negative, you are good to go- there is no need for a chest x ray
 
Depressed.Alien said:
I just got my RFEs. Yes!!! They want us to do the skin test. Eventhough in the original medical form the X-ray was indicated as normal.

Based on the (unreliable and scattrered) information on the web, there have been many cases when people were required to go through "treatment" with positive skin test & negative x-ray. I myself know that my reaction is going to be very positive most likely due to the BCG vaccination and a bunch of allergies I have.

I doubt that you guys know what to do in this situation, but if you think you do, please let me know. How to avoid the fcuking "treatment"?

You know, this situation reminds me of the one in the forties, when the Jews were subject to medical experiments by the Germans. Well, here we go again.
Click to expand...

Wow, talking about being paranoid. I did read your experience somewhere on the forum and all the difficulties you have gone through. But you do sound depressed. You need help.

You were only asked to do a skin test by USCIS - or tell them why the skin test wasn't done. I don't think the person who reviewed your document was a doctor so he/she might just be following a procedure.

My suggestion for you is to take it easy. Everything is going back to your attitude towards things. Be positive and you life will be better.

To me it wasn't even close to the forties like you described. Why would you want to migrate to the US if you think the country is that bad?
 
Some people say; we don't want to do TB skin test and we will go directly to chest X ray, the X ray will turn mostly normal, for those the USCIS may need TB skin test as RFE.

Other people already did TB test before and will mention that to the physician and he will order chest xay because of history of positive TB test, the USCIS mostly will not need TB test.

If the TB test is negative, you do not need chest x ray.

The physician (NOT THE USCIS), if your TB skin test is positive (whatever the result of chest x ray is) should advice you to take prophylactic antibiotic.

You (AND ONLY YOU), can decide to take that course of medication or not to take it at all, up to you.

Some BCG vaccinated persons may have negative skin TB. and me, as a physician, can not say Oh! yes it is positive because the BCG vaccination, simply because it may not.
 
Here's the deal:

A positive TB test does not mean you have active TB. It only means you were exposed to TB in the past, or you had the BCG.

The lung xray is to determine if you have active TB (TB in your lungs destroying the tissues)

What can you do about a positive TB skin test due to previous BCG? It's simple. Go and get a QuantiFERON TB Gold test (QFT-G). It is offered in many labs, and it was recently approved by the FDA as a new TB test.

Why is this good for people with BCG historys? One of the major advantages to the QFT-G is that it is specific for mycoplasm, and it doesn't come back positive because of BCG. (Disclaimer: The QFT-G is approved for almost any situation where the skin test was used "clinically" but I am not sure if the USCIS will accept it - I would guess if your Civil Surgeon was OK with using it, then you would be fine)

ONE LAST MAJOR POINT:

If your TB test is positive, and you haven't had a BCG in the past, then you NEED to start taking Isoniazid (INH -the medicine that people are afraid of in the previous posts)

TB is a serious problem and there is a reason the policy is in place. Fulminant liver failure occurs in way less than 1%, so the risk is small and your doctor should be able to pick up on it quite easily. The other side effects are minor. We don't prescribe drugs to people who we don't think need them. We aren't making money off INF, (it costs next to nothing, and is given away for free in many clinics). There is extensive data confirming the effectiveness of INH at preventing a latent TB infection from becoming an active infection, even if the chest x-ray is negative.

Bottom line: Tylenol is worse on your liver than INH, so stop freaking out.

-just trying to give back some medical advice in exchange for all the immigration advice I have gotten.

-good luck
 
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Get a life, Depressed Alien!! Automan, as a medical expert has given his opinion. It is your onus to check out the facts and decide whether to follow or not follow. Its the same with the immigration advice that ppl give or take from here. We always run it by an attorney after getting the facts from here. And thats why so many people have found this forum to be a goldmine of information. Its your call on how you take it. No need to get so paranoid.
BTW, just to get you out of your depressed state, even if, for a moment, my whole family had been given the BCG vaccination including my daughter who also has allergies. All our skin tests came in negative. The doctors say that if the BCG has been given a long time back, its effect wears off. So relax and take the test. Worry abt consequences only when the situation arises. And as everyone else said, backups are in place in the form of chest X rays and what your doctor writes. Good Luck and stop chasing away the people who volunteer information
 
For those interested and need more information, you can check many web sites regarding this issue out there, for example you can check the web site of the American Lung Association among others. http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35813
The USCIS just want you to do the test and if it is positive you should do X-ray. Take it simple and do whatever required from you.
The treatment is another story and has nothing to do with your application (for sure if anyone has active TB not just positive skin test his application may be adversely affected). I want to till you, being a physician in the field, that; if anyone has severe TB infection especially if he has AIDS or any other immunodeficiency syndromes, the skin test may turn to be negative at that time.
 
Depressed Alien,

You might be making a big noise about nothing. http://www.cdc.gov/ncidod/dq/updates.htm - all immigrants have to take the TB skin test. The clerk (who may know nothing about medicine) gets your case, sees that the skin test wasn't done - hence, RFE. Like I said in my previous post (I'm sure depression makes it hard to pay attention), go back to your doctor and take the stupid test. Yes, you know it will be positive, but at least you'll satisfy the rulebook. Skin test: positive AND X-ray: clear - and you should be good to go (like I was). But if not, if you (not someone you read about online) get another RFE for treatment - then your paranoia will have ground. Right now it's just you stewing in your own juices.

In regards to your rhetorical question (as to what I'm still doing in this "pathetic" forum) - call it old-fashioned kindness. Better yet, gratitude. The folks here helped me tremendously when I was going through my AOS, so I'm just giving back (or paying it forward) a little. Good Karma. Try it sometime.
 
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