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Diagnosed TB. Had pleural effusion. Started with NH,Rifampicin,Pyrazinamide & Ethambutol. CT scan showed large lymphnodes. Guide?

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Hello Doctor,
I have been diagnosed for TB since Nov 11. I had pleural effusion(right lungs) with collapse & lymphnodes enlargement. Started with INH,Rifampicin,Pyrazinamide & Ethambutol. But, I was fine for couple of weeks, then got fever, so the doctor gave me Zanocin for 15 days. Then in the month of Feb'12 again fever. I went for CT scan it showed more and large lymphnodes. I was not convinced with the doctors explaination, then moved to another doctor. He asked me to go for biopsy on one of my lymphnode, it turned out to be a confirm TB and AFB no growth for culture test. So, the doctor said last 3 month treatment was a success, but somehow I am still not convinced on this.
New doctor changed the dosage and drugs. Starting from March '12, I was given INH,Rifampicin,Pyrazinamide,Ethambutol,Zanocin & Streptomycin for first 3 months. End of the 3rd month, all the lymphnodes were gone, my ESR came down to 17. Then for next 5 months I was given INH,Rifampicin & Ethambutol. End of the 5th month, my ESR jumped to 33 and CRP 65. But CT scan showed reduced left over residual pleural effusion. Doctor stopped Ethambutol, then continued with INH and Rifampcin. Now my ESR is back to 6 after 18 months of treatment.
During the course I went thru several CT scan,blood work and side effects. I was given Vitamin supplements, steriods for CRP(Burning feet),Livorus and Benadon.
I am tired of this treatment and not sure when I will complete my treatment, I still have a residual pleural effusion with fibrosis, lymph nodes are classified. Firstly I am really worried for more than a year and it affecting my personal life. I request someone to give me a positive direction on this treatment esp about relapse!! Also, at times I have a scare of am I having MTB? But, my doctor said I dont have, because you are respoding to first line drugs, but still why is it taking this long? My doctor said, you require because you got it really severe form of TB, but lucky it is just only withing lungs.
My doctor had ordered TB Quantiferron Gold test to conclude if I can stop the medicine. I want to know when to stop the medicine. Is this a write way to conclude the treatment?
Let me know if you need more details, I can provide CT scan reports and other details.

Posted Mon, 1 Jul 2013 in Lung and Chest disorders
Answered by Dr. Shashi Dangwal 1 hour later
Hello XXXXX,

Thanks for posting your query on XXXXXXX

First and foremost i would like to tell you that i can very well understand your concern and anxiety. In following few lines i will try and answer your queries.

You have suffered from TB of lymph nodes and pleural effusion. The diagnosis have been confirmed by the biopsy as mentioned by you.

You have been given TB treatment. Though it is not exactly as per the laid down guide lines however you have not been undertreated. Your treating physician had to resort to slightly different regimen probably because you responded slowly to the treatment which is sometimes seen in some individuals.

You are not suffering from MDR TB as you have responded to the primary drugs.

TB Quantiferron test is not used to either diagnose response to the treatment like no fever or cough, gain in weight and general feeling of wellbeing, certain lab tests and x XXXXXXX and CT scan. Calcification of lymph nodes indicate healing. Pleural fibrosis also means the same in this context.

You have taken more than adequate treatment but your doctor is probably being overcautious since you have been a slow responder. I suggest you follow your doctor`s advice since he is the one who is seeing you in person and do as he tells you.
Above answer was peer-reviewed by
Follow-up: Diagnosed TB. Had pleural effusion. Started with NH,Rifampicin,Pyrazinamide & Ethambutol. CT scan showed large lymphnodes. Guide? 20 minutes later
Thanks Doctor. Thats really motivating me, esp you had mentioned I dont have MDR TB.
My family dont have TB history and I was a well built and healthy adult till Nov'11. Surprisingly I was told and learnt TB is not easy to spread unless we have someone really close having active disease, but I was staying alone in Bangalore for 2.5yrs and at the end I fell sick because of TB. I still cant convince myself how I got this. Also, due to this treatment wife and I are delaying family planning.

I didnt fall sick after Feb 12(no fever and cough). I was 76KG in Nov 11, 2 months back I was 92KG, recently I reduced my weight to 90KG doing daily workout. I feel better since March 12, occassionaly due to side effects I used to get feet burning, at times during deep breath pleural pain, neck pain and joint pain. Now I feel much better.

My ESR is 6(1hr) was 33(1hr) during March 13. With reduced ESR is it a sign of treatment completion?

Did you get a chance to look at recent CT Scan attachement?

As you had mentioned, what sort of tests I need to conclude my treatment?
On the other note, I went thru several CT scan in the past 18months, so I am scared of CT scans due to radiation. Will MRI work? X XXXXXXX report is clear, it says nothing abnormal found. Scars are not seen in X-ray.

Thanks a again! Thank you so much for your postive and encouraging response.
Sorry to ask you all sort of silly questions, it is just that first time in my life I am getting in to serious health problems.

Answered by Dr. Shashi Dangwal 1 hour later
Hello XXXXX,

TB is a very common infectious disease in developing countries. Though close contact with a person suffering from TB increases the chances of getting tb but even a single encounter with a person suffering from tb may result in getting it. There are many factors that come into play.

I have seen your last CT scan report and based on that and other input from you i said that you have been adequately treated. I have already mentioned the tests required to be done which have already been done on you. You should follow your doctor`s advice as to when to stop the treatment which in my opinion should be any time now.
Above answer was peer-reviewed by
Follow-up: Diagnosed TB. Had pleural effusion. Started with NH,Rifampicin,Pyrazinamide & Ethambutol. CT scan showed large lymphnodes. Guide? 20 hours later
Thanks Doctor.

Once I stop the medicines, what sort of follow up & precautions I need to follow. What are the chances of Rellapse? I just want to be 100% sure I dont get this again! If relapse happens, will I be treated for MDR?

Will my scar size to reduce in future or will remain at the same size? Because every small discomfort in my body reminds me about TB, if my leg pains it makes me to think did it spread to my leg! I know this is silly but because of the pain and anxiety I encountered in last 18months making me think of TB for everything.
Answered by Dr. Shashi Dangwal 59 minutes later
Hello XXXXX,

Once you have been declared cured, you may go in for a follow up once in 3 months initially and then once in 6 months for a year or two. Mostly these are not required.

Chances of relapse or reinfection are always there and depend on many factors especially if the body immunity is compromised. However it is not very common.

The treatment in case of relapse is with first line ATT drugs and only if the response is not satisfactory, one is investigated for MDR TB and treatment changed accordingly.

In most of the patients scar size reduces with time but in some it may remain forever.

Above answer was peer-reviewed by
Follow-up: Diagnosed TB. Had pleural effusion. Started with NH,Rifampicin,Pyrazinamide & Ethambutol. CT scan showed large lymphnodes. Guide? 11 hours later
Hello Doctor,

I think I have few last questions before I stop troubling you!

When I was treated in the begining, I take ATT at different time, Rcinex as the first thing in the morning(empty stomach), after breakfast Etambutol and after dinner Zanocin,PZA. I have heard all ATT should be taken in one shot, so could this be a reason why my treatment is taking long to complete.

Also, my doctor said my CRP got elevated due to drug induced arthitis, then why is CRP is take in to factor for treatment success? Will ESR and CT alone will help to determine the treatment success?

Thanks for all your responses.
Answered by Dr. Shashi Dangwal 4 hours later

All ATT to be taken together in the morning on empty stomach and nothing to be taken by mouth for 1/2 hour for better absorption of drugs. Why it was given differently to you, only your treating physician can answer. Though now that you are cured, it becomes inconsequential.

CRP is not taken into consideration to determine satisfactory response to ATT.

To determine response to treatment ESR and CT Scan have to be considered along with other parameters which i have already mentioned in my answer above.

Take care.
Above answer was peer-reviewed by
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