- What is the role of Tuberculin test(Mantoux test) in the diagnosis of tuberculosis?
The tuberculin test is very often used in measuring prevalence of infection in epidemiological surveys.But its routine use in diagnosis of tuberculosis in India is discouraged for the following reasons:
1.Because of the high prevalence of infection in adults,the test is likely to be positive in many individuals with infection altough no disease is present
2.Infection by other(even non pathogenic) mycobacteria can result in a positive test,but usually a weakly positive test.
On the other if other evidence suggests the diagnosis of tuberculosis,a negative tes does not exclude tuberculosis.False negative tests may be obtained in:
2.Diseases which affect T cell dependent immunity viz :HIV infection,or patients receiving corticosteroids.
A positive test only shows that the patient has previously been ifected.It does not prove that he has active tuberculous disease.It is merely a point in favour.A positive test is particularly valuable at an age when fewer children in the community will normally have positive tests(Please refer publication:Clinical tuberculosis by Sir John Crofton,NormanHorne,FredMiller)
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- What is the difference between the management of drug resistant TB and drug susceptible TB?
In areas of minimal or no drug resistance DOTS achieves cure rates of up to 95%; rates high enough to dramatically reduce the TB burden while preventing the emergence of drug resistant TB. However unlike drug susceptible TB that has a solid, effective management strategy, management of drug resistant TB is still in a pilot stage. While the former can be cured within 6 months, forms of drug resistant TB requires, extensive chemotherapy (that is more toxic) for up to two years.
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- Does a unclear X ray, mean TB?
NO.It is wrong to diagnose TB purely on the basis of Xray.Lung shadows can be due to many causes like congenital conditions,pneumonia,brochiectasis,bronchogenic carcinomas etc.Please see http://www.tbindia.net/xraydiag.html for a discussion on the subject
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- When do you suspect HIV coinfection in TB patients
From TB/HIV A clinical manual WHO/TB/96.200
|Clinical features suggestive of HIV coinfection in TB patients
- Sexually transmitted disease(STD)
- Herpes Zoster(Shingles:
- Recurrent pneumonia
(especially Salmonella typhi murium
- Weight(loss(>10kg or >20% of original weight)
- Pain on swallowing(suggests oesophageal candidiasis)
- Burning sensation of feet(Peripheral neuropathy)
- Scar of herpes Zoster
- Pruritic papular rash
- Kaposi sarcoma
- Symmetrical generalised lymphadenopathy
- Oral candidiasis
- Oral hairy leucoplakia
- Persistent painful genital ulceration
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- REQUEST YOU TO PLEASE LET ME KNOW WHETHER "MEDIASTINAL TB LYMPHADENTIS" IS FOUND ONLY IN HIV+ PATIENTS OR ALSO IN PATIENTS WHO HAVE TESTED HIV-.
Mediastinal TB lymphadenitis can be found in HIV negative patients also.However under Indian conditions mediastinal TB lymphadenitis is rare above the age of 15 in HIV negative individuals(because this is a manifestation of primary infection and widespread prevalence of TB disease in the community a majority come in contact with bacilli fairly early in life).Above the age of 15 other causes of mediastinal enlargement(Metastasis from primary tumor elsewhere,lymphomas,sarcoidosis etc)have to be ruled out first.It must be remembered that in many of these conditions Mantoux will be negative.Complete physical examination including examination of abdomen to rule out organomegaly besides thorough investigations are crucial.If other criteria of TB disease are present or histopathological evidence is forthcoming,TB etiology can be thought of even in HIV negative individuals.
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- basic investigation done to diagnose Tuberculosis
The basic investigation to diagnose pulmonary tuberculosis is sputum smear for AFB then radiological.The diagnosis is discussed in detail in the site.Please view http://www.tbindia.net/clindiag.html and other associated pages
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- a patient is having elevated anti tb antibodies(IgG,IgM,IgA).DOES THE PATIENT HAS TB & DOES HE NEEDS TREATMENT
The specificity and sensitivity of serodiagnostic tests are as yet not
uniform in different laboratories aand disease populations.It is not wise to
rely on a single test to to start antitubercular treatment.The whole
clinical picture and investigation profile should be taken into
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- My father tested negative in sputum tests. His CT and bone marrow are positive. Can this happen? Please advise me on whether he should start ATT?
It can happen.The number of germs per ml of sputum must be above a certain number for it to be seen in microscope.If it is below it will test negative.To decide whether to start ATT one should have examined the case in person following the temperature pattern,auscultatory signs,perused the CT and read the full report of bone marrow etc.You must rely on a nearby chest physician for the purpose
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- i have lymphadenopathy cervical and axial i feel it on touching radius is of about 5cm i have performed biopsy for small node it was come to be acuumulation of skeltal muscle and fat tissue.i feels very week no weight loss is there rarely cough small incr
If the specimen for the biopsy had been adequate and if it had beenexamined by a competent pathologist.the negative value can e taken to face value and not antitubercular treatment will be justified.However the case needs further observation to establish the diagnosis
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my mom is suffring from spinal tb
doctor said there is a method to remove the pus from spine through some tube or injection to get speedy recovery
How safe is it, is it preferable
does it cause any pain
is AKT 4 PREFERABLE OR AKuriT 4 PREFERAB
The site does not provide online consultation.The following are only general remarks.As no doctor can treat a patient without examining the patient ,ordering relevant investigations and interpreting them in the light of the clinical data.
Usually the patients with TB spine are immobilised for the first few months at least.The period of immobilisation and when can be allowed to move about will depend upon the extent of the disease as judged by bedside examination,Xrays and MRI or CTscan findings,complicating factors if any and the duration of and response to treatment.This is for your information only please do not cross examine your doctor with these.You should have faith in the treating doctor.Getting multiple opinions will only confuse you.
There are surgical methods to treat TB spine.When to have recourse to these will be determined by the ortho specialist after careful bedside examination of the case and investigating with XrayCT scan MRI etc.As surgery is done after anesthesia no pain will be experienced during the procedure but post operatively the patient will have some pain for which drugs can be given.Regarding safety no surgical procedure is free from risk.The extent of rsik will vary depending upon the stage of disease and patient factors.
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- Does a patient with mediastinal lymphadenitis with a highly postive mantoux with no other group of lymph node involvement with a lesion in the lung need a lymph node biopsy to diagnose tuberculosis?
The whole clinical picture has to be taken into account.CT scan and bronchoscopy might be advisable before undertaking biopsy.Since mantoux is highly positive sarcoidocsis seems less probable(HIV coexisting with TB also seems ruled out) and absence of other lymph node involvement seems to rule ou lymphomas.
We agree that ther should be high degree of suspicion of TB
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- My relative has got bone tb( lower part of spinal chord).
will it be cureable?
How much time will it take?
is it contageous?
Shouls she feed her baby?
What all type of precautions she should take
Bone TB is curable:In some patients some deformity may reamin.If there is no coexisting TB in lungs,the disease is not contagiousShe can feed the baby.These are general guidelines only.A doctor personally examining the patient only can give accurate answers applicable to a particular individual
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- can a person have beer and smoke occasionally when he is having tb in his small intestine ?
Smoking(even occasional) is not advisable for any one leave alone for one with TB.Beer is also inadvisable
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- what is the diet that should be taken and the things that has to be avoided when a person is having tb in the small intestine ?
For uncomplicated tuberculosis there is no dietary restrictions.Avoid smoking and alcohol,spicy food,hot food.If you had been operated follow the surgeon's advice
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- my Mantoux test shows positive and my X-ray shows negative is there any possiblity of having TB
Mantoux test shows only infection and not disease.You may have remnants of germ in the body withou having adverse effect.Xray interpretation may sometimes vary vary from specialist to specialis.In general if you are not having symptoms there may be no need to worry
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- My sister is suffering from MDR and has recently undergone thoracoplasty where PC window was closed. She has been taking second line of drugs for a year. Are we at risk of getting the disease? How can we test ourselves?
We dont understand what you mean by "PC window closed"
The following general guidelines can be given:
A patient with tuberculosis of lungs with positive sputum can infect those who come in contact with him/her.The risk however decreases when treatment is started.Simple precautions like closing the mouth while coughing sneezing etc are essential Indiscriminate spitting should be avoided.Sputa collected in a container with antiseptic and disposed by burning
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- What is the new URL of www.tbindia.net?
Please log on to www.angelfire.com/indie/tbindia
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- I have visited Resident General Surgeon on 12 Apr 2005 with the diagnosis SWELLING ON THE LEFT SIDE OF THE NECK. The surgeon inspected me and give his advise that :-
Local - 2 swelling
From the particulars that you have furnished it looks that you are having tuberculous lymphadenitis.You may require about 6 months antitubercular treatment.The above reply is only tentative and a correct judgement can be made by clinical examination .Please follow the surgeon's advice
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- i have done igg iga igm and pcr test except igg all is normal igg value is 699 is i have a tb or any
other diseas according to test
It is not advisable to attempt diagnosis purely on the basis of laboratory tests.The whole clinical picture has to be taken into account.
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- IgG = 400, IgA = 225, Montoux = =+ve.
Mils pain persists in right shoulder. One doctor rules out TB. The other doctor suggests treatment.
Should I go for further tests?
If the only symptom is shoulder pain tuberculosis is not the first thing to be thought about.Mx and IgG and IgA are not very reliable.Personal examination by a competent physician /orhto specialist will clear the diagnosis
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- My father has emphysema. He was recently admitted for hemoptysis.He has COPD also. His CT revealed multiple cystic lesions in all lobes and emphysema. His sputum has been negative so far for AFB. He had bronchoscopy which showed possible cavity/infection suggestive of TB in left lung. His CXR also shows some ?Koch lesion in addition to emphysema. The consultants want to start TB treatment.
1.Does he have active TB?
2.How long should he get AKT-4 3.How long should he get two drug regimen?
4. How do we monitor progress of treatment? What contact precautions do you advise?
Question1-It is not possible to diagnose without seeing the patient,only a doctor who has clinically examined her and having direct access to Xrays and other investigation results
Question2 and 3-If the patient is not seriously ill and sputum is repeatedly ill an intensive phase with 3 drugs for two months followed by two drugs for 4 months is generally advised
Question4-Treatment is usallu monitored by regular clinical exams and sputum exams at specified intervals.The patient should cover up his/her mouth while coughng,sneezing,avoid indiscriminate spitting,and most importantly taking drugs regularly
Disclaimer:The above are answers are of a general nature only.(There may be circumstances in which some deviation will be justified).This information should NOT be used to "cross examine" your consultant in whom you should have full confidence.
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- my daughter coughed once a day without wheezing for a period of 20 minutes almost continously and nasal discharge accompanying. Blood count is all normal, x-ray is normal, Igm is positive 1.49, mantoux is negative, pcr is positive and the cough responds to L montus tabs for allergy rhinitis. Can she have TB? she is 15years.
When Xray is normal,the probability of the child having Tb is very low.However only a doctor who has personally examined the patient will be in a position to assert with a degree of certainty
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- i am a lactating mother of 1 month old baby,i had c-section under spinal anaesthesia.from the fourth post op day i had evening fever with chills lasting for one hr.on the seventh post op day i had tachypnoea resolved with nebulization,then i was given antibitic magnex and azithromycin for ten days,everything settled, the reports came as strptococcal broncho pneumonia,smear -ve for acid fast bacilli.then 3 wks later culture by mgit method came positive for acid fast bacilli.i hv no clinical symptoms,x rays were clear.shall i start ATT?shd my child receive INH prophylaxsis?
Your case seems very unusual.The significance of a positive culture in an asymtomatic person with clear chest is highly debatable.One course of action would be to wait for a period of 6-8 weeks (Without antitubercular drugs) then repeat culture in a reliable laboratory and Xray chest.However a competent pulmonologist with direct access to patient Xray and culture result will be able toguide you better
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- i have just 21 years old,i am having a lymph node at right shoulder which is between neck n shoulder my all reports are normal,i am a healthy girl i got no symptoms of tuberculosis or cancer can you please tell me whats the possibility can be,i am having pain in arm due to it because its on vain...
The possibilities are many.It is advisable to get the opinion of a physician who can personally examine you and do the necesary tests.
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- i am 33yrs having a daughter of 9yrs.had 2misscariages.after my 1st mishap. in 2006 got my igm test negative.now again for ahealthy pregnancy the dr.told to have igm,skin test,qft which all are +ve.is it an active tb.should i start akt4.is it contagious.dont have any other symtom except feel tired at times.
Tuberculosis is rarely blamed for repeated miscarriages.Your consultant may have other reasons to suspect TB.If you do not have lung TB with sputum positive for AFB you are unlikely to be contagious to others as TB is an air borne infection spreading when a diseased individual coughs ,sneezes etc
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