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Tuberculosis

Regarding TB old healings

11/09/2005

Question:

Person (myself believe little less immune to respiratory diseases) moved to moderately polluted South Indian city in search of employment stayed in conjusted (slum area) about 2 years. Within 6 months eventhough shifitng to a good area started expreienced occassional fever, vomiting when eating food and prolonged dry cough for 4 months. Consulted many doctors in this 4 months, got temporary relief for few weeks but every time restarted the same symptoms. But seeing the history and very week body with dry cough with loss of weight ~ 10 to 15kg (<20%) one doctor detected bilateral pulmonary TB and started following medicine on 12-05-2001. sphutum culture never done in my case as there was only dry cough. Doctor told me that it is not required as TB is detected and medicine gives good response. Report in 12-05-2001 ==================== height 163 cm weight ~ 40kg non smoker,non tobacco, non-veg Igm - negative (0.88) ESR - very high (88) X-ray shows - patchy infiltrative bilateral pulmonory opacities 1. Isonex 200mg and Rifampicin 450 gm - 6 months 2. Ethambutol 800mg & PZA 1gm - 2 months. Within 15 days the conditions totally changed and high improvement shown. Within 2 yrs. weight has increased to 53 kg. Now regular checkup doing. Following are the reports. But in all reports old healings are reported. 2002 - not done test 2003 - patchy fibrotic leisions and left hilar shadows distorted 2004 - Fibrotic lesions left and mid zones with elevated left hilum on either side 2005 - Now Weight 58 kg. Ill defined oppacities left upper zone. Broncho vasuclar marking appear prominent. This time new doctor suggested CT scan to make sure the condition. High resolution CT scan of thorax findings. Multiple nodular & fibrotic lesion seen in both upper lobes invlovinng bilateral optical pleural theckenng noted left more than right. Mutilpe small parenchymal and plural based nodules(<1 cm) seen in the upper lobes Mutiple small cystic lesion seen in the poterior segment left upper lobe. Multiple small calcific densitites seen in both upper lobes. There is no focal plueral effusion on either side. There is no hilar mass section. Mediastinum findings normal and bone thorax normal. Impression:- Bilateral old healed pulmonory kochs with multiple granulations, fibrotic lesions and plural thickening left more than right.Cystic bronchiectasis posterior segment lef upper lobe At present ---------- Clinically looking normal healthy and normal matching weight for my height. and not showing any symptoms of TB, but x-rays shows patches, but cannot understand whether it is stable or not for me but definitly improved than the first one. I used to get allergic cough and sore throat during drastic climate changes some times in a year and chilling during winter or in AC. Doctor said it is because of your body characteristics not because of old TB. How long it will take me to clear the healings ? Or from the above reports/history shall i still do some advanced diagnosis even if i am feeling healthy (like sphutum tests ?) Is still TB hidden in my body which can attack in future when i am not healthy ? If so Which is most clear way of identifying hidden TB ? Among a weak person or a TB treated weak person Who is more prone to TB if both live in identical conditions ?

Answer:

1.  The treatment that you describe for your case of bilateral pulmonary tuberculosis is standard treatment that is endorsed by the World Health Organization and the Centers for Disease Control and Prevention.  This treatment is usually more than 95% successful in eradicating TB.  Up to 5% of patients who receive this therapy will relapse, generally within the first 2 years after completing treatment. 

2.  In terms of the findings on your current CT scan.  It can be difficult to determine whether the CT scan findings are simply the scars left from your original tuberculosis or evidence of recurrent disease.  To determine this one would look for clinical symptoms (you appear to have none), send sputum for smear and culture.  consider bronchoscopy (a more detailed exam of the lung) for smear and culture if worried, and  repeat your chest x-ray in 2-6 months to see if the scars are stable.  Since you are now more  than 4 years out from the original diagnosis of TB, the findings on your x-rays may well be scars from old TB and will probably remain the same for the rest of your life. 

3.  TB is probably not still hidden in your body at this time.  The treatment you received is 95% effective in eradicating the TB bacteria.

4.  Unfortunately there is no test to see if you still have some "hidden" TB bacteria in your body.  We will only find out if you relapse with active TB disease and have symptoms. 

For more information:

Go to the Tuberculosis health topic, where you can:

Response by:

Catherine A Curley, MD, MS Catherine A Curley, MD, MS
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University