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Suggest Treatment For TB In A Child

Posted on Tue, 25 Aug 2015

Question: Hi Sir/Madam, My Son 2years old affected by latent TB we got to know by A skin test for called a Mantoux test. now we started the treatment giving tablet " AKURIT KID" . i am worried about this.
could you please send what are other precaution or test we need to follow.

Answered by Dr. Pradeep Kumar Jain (6 hours later)

Brief Answer:
Prophylaxis with isoniazid is sufficient

Detailed Answer:
Hello

Thanks for the query

Please let me know why he was advised for mantoux test.
Is there anyone in family suffering from tuberculosis?
What is the current weight?
Is there any cough?
In few condition prophylaxis with isoniazid is given for TB if mantoux comes positive.
Akurit contains isoniazid with rifampicin.While prophylaxis with isoniazid is needed in most of the cases.
So please provide details so that I better able to help you out.
Waiting for your reply.
Regards

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

Follow up: Dr. Pradeep Kumar Jain (2 days later)

Hi XXXXXXX

thanks a lot for quick reply. here i have attached the report for your concern.

thanks,
XXXX

Answered by Dr. Pradeep Kumar Jain (1 hour later)

Brief Answer:
I don't think anti tuberculosis medication is needed

Detailed Answer:
Thanks for follow up

I have gone through the details and I just want to summarise it.
Your child had fever for five days with cough and cold and for this you got admitted to the hospital where they did not find any abnormality on clinical examination and child was afebrile since then.
They started treatment with inj montaz (antibiotic) and iv fluids.
Investigation showed almost normal hemogram.
The urine test shows pus cells and e coli on culture. (The number of organism per hpf is not mentioned).
The widal test was negative (I am surprised to see the dilution 1:50 and 1:100????????
As far as I know the dilution should be in multiplication of 80 like 160,320,640.
I doubt on the reliability of widal test.

Now for such short history of fever your physician also advised mantoux test at time of admission.
There was no suggestive history or clinical picture of tuberculosis.
After that they did ESR which was positive 46.
Chest Xray was normal.Child did not have any fever.Cough cold also was not severe.Tgere is no family history of tuberculosis.
Even then they made a diagnosis of latent tuberculosis and started Akurit Z kid tablet which contains isoniazid,pyrazinamide and rifampicin??????
Management of latent tuberculosis is isoniazid for 9 months or isoniazid with rifampicin fir 3 months.
Pyrazinamide is no where in the management of latent tuberculosis.
On their discharge they made a final diagnosis of viral fever.
There is so much confusion.
Now I have concluded that such short duration fever can be due to some viral infection or UTI which got improved with antibiotic.
Only on the basis of mantoux and ESR I would not like to continue ATT as there is no other suggestive feature and child is afebrile.
Mantoux and ESR can be positive even in absence of active tuberculosis.

I hope this helps.
Please let me know if you have any more query.
Regards

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

Follow up: Dr. Pradeep Kumar Jain (1 hour later)

Thanks for your quick inputs XXXXXXX and your precious time.

here i have attached other reports taken Blood culture, URINE, WIDAL.

Now my son completely alright as usual, still i need to do any test.

+ my doctor suggest that need to take AKURIT KID for next 6 months. it is required to take. as of now in morning empty stomach my son is taking.

Again thanks for the advise,
XXXX

Answered by Dr. Pradeep Kumar Jain (2 hours later)

Brief Answer:
I don't think that anti tuberculosis medication is needed

Detailed Answer:
Thanks for writing back

I have gone through the reports.The urine report shows growth of E coli a count of 50000/hpf.
In presence of fever and while on IV antibiotic I would consider it significant.
Again I don't think that your son needs proper treatment for tuberculosis (for 6 month with all the combinations).He may need to be treated for latent tuberculosis but then the regimen will be different.
In case of UTI further investigation like USG abdomen may also be needed.
So I would suggest you to get a second opinion from any pediatrician for better clarification.

Regards

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

Follow up: Dr. Pradeep Kumar Jain (25 hours later)

thanks your very much for details update XXXXXXX

As per your advise will shall go for 1 more pediatrician and get the details. if any concern will call/update you.

Again thanks, XXXXXXX

Answered by Dr. Pradeep Kumar Jain (18 minutes later)

Brief Answer:
It's my pleasure

Detailed Answer:
It's my pleasure that you found my suggestion helpful.
I shall be glad to help you in future.Please keep me updated.

All the best
Wishing for good health of your baby
Regards

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

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