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Diagnosed with TB meningitis, on medicines. Awaiting drug sensitivity report. Right treatment procedure?

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Internal Medicine Specialist
Practicing since : 1996
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Dear doctors,
My sister (Age 23) was suffering from miliary tuberculosis 5 months back and she was diagnosed with TB meningitis 2 month back. She is shown with all the symptoms of meningitis, she was medicated with IV Levofloxacin along with INH, rifampicin and PZA. Since there was no response with IV Levofloxacin, IV Amikacin was given. She is now continuing with this medication, since the disease is progressing with mild improvement, the doctors are awaiting for drug sensitivity report. Whether her treatment proceeds in correct way? Pls help me with future steps of treatment.
Posted Wed, 22 May 2013 in General Health
 
 
Answered by Dr. Prasad Akole 57 minutes later
Dear friend, welcome to Healthcaremagic!
I am Dr. Prasad Akole (Critical Care Expert- http://bit.ly/Dr-Prasad-Akole) and am glad to address to your query here.


Tuberculous meningitis with MDR TB bacilli can cause treatment lesions and progression.
Resistant bacteria can be demonstrated on AFB culture and sensitivity.
Resistance makes treatment refractory. Initial incomplete/ irregular therapy also contributes to poor response and spread.
Her picture is of a bad cerebral involvement with numerous nodules and RDELs (Ring diffusion enhancing lesions). Raised ADA is typical of TB though TB PCR is negative on CSF (which may be the case sometimes).
She has received the right regimen so far. Her CSF looks a bit better cell count wise, though proteins are high.

If culture reveals MDR/ XDR bugs, third line of therapy or reserve drugs may be added monitoring for any complications. MDR/ XDR (multi drug resistant/ extensively drug resistant TB) is a major cause of mortality in the country.

Your team of experts would be able to decide on that depending on the clinical response. She has clinically improved and discharged, isn’t she?

Keep patience and follow experts' advice.
Wish all the good luck and health!!

I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Take care and please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
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Follow-up: Diagnosed with TB meningitis, on medicines. Awaiting drug sensitivity report. Right treatment procedure? 6 hours later
Dear Dr,

Thank u for your future perspectives and valuable suggestions on how to handle the disease. I wanted to know, experts and specialty hospitals in tamil nadu to treat TB. I am afraid, as miliary TB has the tendency to spread all over the body and affect the whole organ system. Since the TB has affected the brain, is there any possibility of other organs affected? or she must undergo any premilary testing for normal functioning of organs? Dr what is the clinical significance of creatinine in CSF? What does the level indicate as in her case.
 
 
Answered by Dr. Prasad Akole 4 hours later
Disseminated TB can affect all organs. She has already lungs and brain affection.
Kidneys, bone marrow, abdomino-pelvic organs all can be affected.
We do not do CSF creatinine, it must be serum creat you must be asking. It is normal.
USG/ CT scan can show macroscopic affection of other organs. Urine concentration test for AFB may show GU (genito-urinary) TB. Extensive blood tests can show various organ dysfunction.
Her liver seems functioning ok as are kidneys. Most blood tests are already done for her. But treatment being the same for all organs, you need not bother search for other organ affection unless there are disabling symptoms.
Treatment will base on culture reports. Sometimes, reserve drugs are used if there is rapid deterioration before culture becomes available (which takes few weeks)
As for doctors in your area, you can search for pulmonologists/ chest physicians in Tamilnadu on the XXXXXXX “find a doctor” feature or with a Google search.

Try finding a good reputed tertiary care center for extensive treatment under one roof.

I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Take care and please keep me informed of your progress at http://bit.ly/Dr-Prasad-Akole
Good Luck!
It helps us to improve continuously if you could please write a rating review before you ‘accept’ and ‘close’ the query.
Thank you!!

Above answer was peer-reviewed by
 
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