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Is It Necessary To Start Treatment For TB When Diagnosed With Basal Pneumonia?

Posted on Sat, 20 Jun 2015

Question: Dear doctor my wife aged 37 year old had pulmonary Koch 4 year back, treatment completed and follow up x Ray impression was significant radiological recovery , and scarring ,now we have done X-ray for cough with expectorant since 8 days , the impression of X-ray is fibrotic cystic Koch and basal pneumonia , so do we have to start the treatment for tuberculosis again

Answered by Dr. Drkaushal85 (44 minutes later)

Brief Answer:
First get done sputum examination for AFB.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
No need to start anti tubercular treatment directly only on the basis of x ray findings.
First get done sputum examination for AFB (acid fast bacilli-bacteria causing tuberculosis).
Please let me know
1. Does you wife have fever with weight-loss and decreased appetite?
2. Since how many days she is having cough with expectoration?
3. Has she tested for sputum examination?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your wife.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (23 hours later)

1) no fever but body is worm on touch,loss of 4 kg weight over 1 month, appetite is decreased
2) cough with expectoration since 10 days
3)sputum for AFB done the test is negative

Answered by Dr. Drkaushal85 (12 minutes later)

Brief Answer:
Don't start anti tubercular drugs without confirmation.

Detailed Answer:
Thanks for your follow up question on HCM.
Since her sputum for AFB is negative, don't start anti tubercular drugs without confirmation.
Can you please send me image of x ray film /plate?
I have gone through the report but want to see x ray.
Also tell me name of drugs she is taking.
Please reply me all these needed information, so that I can guide you better. I will be happy to help you further.
Wishing good health to your wife.
Thanks.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Drkaushal85 (2 hours later)

Dear sir I have tried to scan the X-ray so one X-ray has different scanning modes

she was taking cephalaxin 500mg two times but no effect seen now she is on roxithromycin 150mg two times a day ,T.deriphylin retard 150mg two times a day,syrup ambrolite D

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
X ray film is not attached.

Detailed Answer:
Thanks for your follow up question on HCM.
I have seen all your attachments. All are showing CBC (complete blood count) report.
This report is normal except slightly low hemoglobin and slightly raised ESR.
Her total WBC count is normal.
If possible please send me chest x ray PA view film or plate. This will give more idea about activity of the lesion whether she is having fresh infection or having previous healed TB scar lesions.
She may need higher antibiotics too.
Also let me know
1. What kind of expectorant she is having? Is it thick? What is the color of the expectoration? Is it yellow or white?
2. Is she having shortness of breath on exertion?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your wife.
Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Drkaushal85 (57 minutes later)

Sir X-ray images attached
White colour sputum and scanty , shortness of breath on exertion

Answered by Dr. Drkaushal85 (26 minutes later)

Brief Answer:
No need for anti tubercular drugs.

Detailed Answer:
Thanks for your follow up question on HCM.

I have gone through the x ray. She is having old fibrotic lesions. So according to me she is not required anti tubercular drugs.

Along with this she is having emphysemous changes in lungs. Her lungs are enlarged as compare to her age.

So in my opinion she is having bronchitis. And Bronchitis also cause similar symptoms like cough, expectoration, fever, weight loss, shortness of breath on exertion etc.
So possibility of bronchitis is more in her case.

Please let me know
1. Does she have wheezing (whistling) sound while having shortness of breath?
2. Has she ever undergone PFT (Pulmonary Function Test)?
3. Has she ever tried inhaled bronchodilators or inhaled corticosteroid (ICS)?
Please reply me answers of above asked questions, so that I can guide you better.

I will be happy to help you further.
Wishing good health to your wife.
Thanks.

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Above answer was peer-reviewed by : Dr. Vaishalee Punj