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Suggest Treatment For Recurrent Lymph Node TB
Question: Hello,
I was diagnosed (biopsy) to have lymph node tb in 1999. I had multiple glands on the left side of my neck. I have initially advised for 9 months medication. Even after months the glands didn't disappear even though it reduced the size and it continued for another 6 months and the medication was stopped after completing the course for 15 months. Even then there were left overs of these glands and doctor confirmed these could be ignored. I used to have annual check up for next couple of years and everything was fine.
In 2008 I have observed a new gland in the left side near the ear. I have consulted a Pulmonologist, she has done chest x-ray, PFT test etc and confirmed there is no evidence of TB and advised to have periodic check up. I didn't observe any growth for this gland nor any other new glands formed. Also the periodic check up (blood, x-ray) didn't showed any issues. Last September (2014) I have consulted Surgeon again as this gland was still there. He did certain blood test and ultra-sound and later recommended for Biopsy. The result was Necrotising granulomatous inflammation - Consistent with Tuberculosis. So I have again recommended for AKT4 for 3 months and AKT3 for 5 months (total 8 months). During the initial period I have observed a new gland formed in the same place where it was removed for biopsy but subsequently it reduced and almost gone now. Also the old ones, I feel they are reduced in the size. At present I have taken 3 months of AKT4 and 3months of AKT3. During the course started I have tested for blood test such as CBC, LEFT etc and even this was repeated in last month and all were fine. Now below are my concerns.
1. What was the reason for re-occurrence after these many years?
2. Will all these glands (mainly old ones) will dis-appear with another 2 more months of AKT3?
3. If not, what will be the next course of action (Diag and treatment)
4. How do I confirm, I am cured completely.
5. I am 36 years (male) and we are thinking for our second kid, what is your advise?
6. Is there any special precautions I need to follow?
7. Does the lymph node TB is contiguous ?
Thank You.
I was diagnosed (biopsy) to have lymph node tb in 1999. I had multiple glands on the left side of my neck. I have initially advised for 9 months medication. Even after months the glands didn't disappear even though it reduced the size and it continued for another 6 months and the medication was stopped after completing the course for 15 months. Even then there were left overs of these glands and doctor confirmed these could be ignored. I used to have annual check up for next couple of years and everything was fine.
In 2008 I have observed a new gland in the left side near the ear. I have consulted a Pulmonologist, she has done chest x-ray, PFT test etc and confirmed there is no evidence of TB and advised to have periodic check up. I didn't observe any growth for this gland nor any other new glands formed. Also the periodic check up (blood, x-ray) didn't showed any issues. Last September (2014) I have consulted Surgeon again as this gland was still there. He did certain blood test and ultra-sound and later recommended for Biopsy. The result was Necrotising granulomatous inflammation - Consistent with Tuberculosis. So I have again recommended for AKT4 for 3 months and AKT3 for 5 months (total 8 months). During the initial period I have observed a new gland formed in the same place where it was removed for biopsy but subsequently it reduced and almost gone now. Also the old ones, I feel they are reduced in the size. At present I have taken 3 months of AKT4 and 3months of AKT3. During the course started I have tested for blood test such as CBC, LEFT etc and even this was repeated in last month and all were fine. Now below are my concerns.
1. What was the reason for re-occurrence after these many years?
2. Will all these glands (mainly old ones) will dis-appear with another 2 more months of AKT3?
3. If not, what will be the next course of action (Diag and treatment)
4. How do I confirm, I am cured completely.
5. I am 36 years (male) and we are thinking for our second kid, what is your advise?
6. Is there any special precautions I need to follow?
7. Does the lymph node TB is contiguous ?
Thank You.
Brief Answer:
TB diagnosis has to be confirmed.
Detailed Answer:
Hi
Greetings from Dr.Divakara.P
Thanks for choosing HealthcareMagic.
1. Cause of Recurrence : It's either due to improper treatment or due to re exposure to TB bacteria.
By improper treatment I mean , sometimes the TB bacteria doesn't respond well to the conventional TB drugs . In that case it may show a partial response but would not have cured . This can be substantiated as there was still lymph ode swelling at the end of treatment.
Since it was not completely cured your TB re occurred.
2. Whether these nodes will disappear totally : I don't think so because you have been given still the same TB medicines ( conventional TB medicines ).
Also the diagnosis of TB has to be doubly confirmed . A biopsy report of Necrotising granulomatous inflammation - is very much Consistent with Tuberculosis but it can also be seen in other conditions like Fungal infections or Sarcoidosis.
3. So a TB PCR of the biopsy sample or Culture of biopsy sample for Tb bacteria showed have been done to confirm TB. If it comes negative then evaluation for Sarcoidosis and Fungal infections has to be taken .
4. It is very difficult to confirm complete cure but complete resolution of the size of nodes is one sign .
5. You can go ahead and plan for your second child , no issues.
6 and 7. No special precaution needs to be taken as Lymph node TB is not contagious.
Hope this information was useful to you.
Any clarifications feel free to ask .
Regards
TB diagnosis has to be confirmed.
Detailed Answer:
Hi
Greetings from Dr.Divakara.P
Thanks for choosing HealthcareMagic.
1. Cause of Recurrence : It's either due to improper treatment or due to re exposure to TB bacteria.
By improper treatment I mean , sometimes the TB bacteria doesn't respond well to the conventional TB drugs . In that case it may show a partial response but would not have cured . This can be substantiated as there was still lymph ode swelling at the end of treatment.
Since it was not completely cured your TB re occurred.
2. Whether these nodes will disappear totally : I don't think so because you have been given still the same TB medicines ( conventional TB medicines ).
Also the diagnosis of TB has to be doubly confirmed . A biopsy report of Necrotising granulomatous inflammation - is very much Consistent with Tuberculosis but it can also be seen in other conditions like Fungal infections or Sarcoidosis.
3. So a TB PCR of the biopsy sample or Culture of biopsy sample for Tb bacteria showed have been done to confirm TB. If it comes negative then evaluation for Sarcoidosis and Fungal infections has to be taken .
4. It is very difficult to confirm complete cure but complete resolution of the size of nodes is one sign .
5. You can go ahead and plan for your second child , no issues.
6 and 7. No special precaution needs to be taken as Lymph node TB is not contagious.
Hope this information was useful to you.
Any clarifications feel free to ask .
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello,
Thanks for the prompt response, but I need few more clarification.
1. Regarding point 2, does this means (interpretation of biopsy result) the nodes appeared where could be something other than TB? If that the case what will be the impact of the medication I am following?
2. How to confirm whether it is TB or something else (what are the possible diseases )?
3. After completing the 8 months AKT course, in case the nodes are not disappeared (completely), what could be the next steps? Another Biopsy, or any other test? Which specialist I should consult in this case?
4. Is there any chance for TB to be infected to any other part of the body? How to check this ?
5. Once we cured from TB, what are the periodic check should be taken? Also how to improve the immunity power especially to avoid further infection of TB as well as for general health.
Regards,
XXXX
Thanks for the prompt response, but I need few more clarification.
1. Regarding point 2, does this means (interpretation of biopsy result) the nodes appeared where could be something other than TB? If that the case what will be the impact of the medication I am following?
2. How to confirm whether it is TB or something else (what are the possible diseases )?
3. After completing the 8 months AKT course, in case the nodes are not disappeared (completely), what could be the next steps? Another Biopsy, or any other test? Which specialist I should consult in this case?
4. Is there any chance for TB to be infected to any other part of the body? How to check this ?
5. Once we cured from TB, what are the periodic check should be taken? Also how to improve the immunity power especially to avoid further infection of TB as well as for general health.
Regards,
XXXX
Brief Answer:
Repeat Biopsy if nodes doesn't disappear.
Detailed Answer:
HI
1. Yes there is a possibility that it could not be TB . The impact of your present medication if it is not TB is nothing but no resolution of the problem.
2. For confirmation of TB a TB PCR of the biopsy sample or Culture of biopsy sample for Tb bacteria has to be done . If these tests come negative for TB then evaluation has to be done for certain other conditions like
-- Sarcoidosis.
--Adult onset Still's disease.
-- Fungal Infections.
-- SLE
-- Toxoplasmosis.
There are specific tests for each of these conditions but first let us make sure whether your disease is TB or not. If it comes as negative for Tb then we shall proceed for testing for others.
3. If nodes doesn't disappear then get another biopsy and get the tests mentioned above.
4. There is a chance of other part of the body infected with TB but it is very difficult to check where it is infected. And I don't recommend for that kind of testing also . But just to answer your query a PET scan of whole body will show if other parts are affected or not . If the scan shows any part as affected then from that part biopsy has to be taken and examined.
5. There are no periodic check up or precautions that has to be taken after complete cure . But a complete cure has to be documented by a repeat test.
Hope this information was useful to you.
Any clarifications feel free to ask .
Regards.
Repeat Biopsy if nodes doesn't disappear.
Detailed Answer:
HI
1. Yes there is a possibility that it could not be TB . The impact of your present medication if it is not TB is nothing but no resolution of the problem.
2. For confirmation of TB a TB PCR of the biopsy sample or Culture of biopsy sample for Tb bacteria has to be done . If these tests come negative for TB then evaluation has to be done for certain other conditions like
-- Sarcoidosis.
--Adult onset Still's disease.
-- Fungal Infections.
-- SLE
-- Toxoplasmosis.
There are specific tests for each of these conditions but first let us make sure whether your disease is TB or not. If it comes as negative for Tb then we shall proceed for testing for others.
3. If nodes doesn't disappear then get another biopsy and get the tests mentioned above.
4. There is a chance of other part of the body infected with TB but it is very difficult to check where it is infected. And I don't recommend for that kind of testing also . But just to answer your query a PET scan of whole body will show if other parts are affected or not . If the scan shows any part as affected then from that part biopsy has to be taken and examined.
5. There are no periodic check up or precautions that has to be taken after complete cure . But a complete cure has to be documented by a repeat test.
Hope this information was useful to you.
Any clarifications feel free to ask .
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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