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What Causes Pelvic Tuberculosis?

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Posted on Mon, 11 May 2015
Question: i have been put on empirical att post cesaearan for last 18 days. (cesaran nov 14). as there was a soft tissue track and ultrasound reported of hypoechoic avascular track.0f 14mm.pls guide me is it safe to take att post op as i have taken lots of antibiotics on and off for last 5 months..there might hav3 been some devlopment of fibrosis and adhesions also,.does att help in that even if there is some kind of intestinal blockage

.plsprovide me how to counter the side effects of these medicines in liver eyes etc with diet to be taken and name of probiotic supplements that i can take to maintain the healthy gut flora ..
also is there any blood test to confirm whether the antibiotics of atti m taking have become resistant as its been 18 days and sometimes o feel the problem is still same,that is heaviness and sweelling of lower abdomen with pain sometimes..have a history of allergic asthma also


mantoux tsets reding was 11 mm at 72 hour
tb platinum gamma interfereo positive 0.81
chest x ray negative
usg suggestive of avascular hypoechoic track ist 27 mm then 14 mm from properitonial upto skin in anterior abdominal wall
ist mri suggestive of adhesions and soft tissue track ii suggestive of possibilty of pelvoc infllamtory disease
can this be tuberculosis(as they say it has originated from uterus and went upto skin

pls guide in a detailed manner

has this been converted into cancerous or tumour as there was a delay in nproper diagnosis.is there any blood work to confirm that if the track has become cancerous

also can att be given through iv to show more effects as i m afraid tht it might have making its place further as my hands becom numb with too much pain in my lower back with same discomfory of abdomen ..difficilty in passing stools too..

one of my doc has presribed for diagnostic laproscopy is that safe if i have devloped tb inside..as my immunity has always been low and it is just five months post op..pls guide
i m taking aktb4 bevon folvite rabicip l/pan d and sorbilin syrup and softreon z.
doctor
Answered by Dr. Sameer Kumar (20 minutes later)
Brief Answer:
it is likely to be TB

Detailed Answer:
Hello,
Thanks for the query to HCM,
Your concern about pelvic tuberculosis is based on your mantoux test positivity and tb platinum gamma interferon positivity which are sensitive ( mantoux) and specific tests( interferon test for tb). this ensures or confirms that you have tuberculosis. If there has been constipation and adhesions accompanied with pelvic pains then there is likelihood that Tb has manifested. However as you have been operated 5 months back and no severe adhesions or tuberculous tubercles were seen on the peritoneum or adjacent structures, it is unlikely to be florid yet to cause pelvic pains.
The most common symptom of pelvic or abdominal tuberculosis are weight loss and evening sweats and rise of temperature especially in evening with often a doughy feel in case of an abdominal tuberculosis.
It is suggested that you may get ADA or adenosine deaminase levels also done to confirm the diagnosis completely . Once confirmed then you can continue on orals AKT4 kit for 2 months and the akt2 for remaining 4 months along with b-complex capsules.
Diagnostic laparoscopy may not be indicated unless there are severe pains due to adhesions either in menses or during defecation or just pelvic pains. The diagnostic lap can identify any tb tubercles under vision and a targeted biopsy may then be taken to confirm the diagnosis by histopathology.
It is suggested that if You have started then you should continue and complete the treatment on the base that your mantoux and interferon tests have been positive and if there is a tract of 14mm and non healing then it can be tuberculosis induced non healing.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar (21 minutes later)
thanks sir

1.pls guide me regarding tne probiotic( name that i can take) and other medicines to counter side effects and 5heir safety post op with lots of other antibiotic intake.

2how is adenosine ada test done. is it a blood test..

3can tht track be cancerous.how can it be confirmed

4i feel bulging of my lower abdomen and a discomforr while coughing sneezing and laughing and moving sidewrads while sleeping..does not defecate properly as cant exert mucn pressure downwards..however there is not much pelvic pain except till the time a flatus is passed or motions b ut i do feel some kind of blaoting and fullness wen i take meals and feels it gets accumulated at left lower side below navel and above lscs scar.. trying to take soft diet only. can it be starting of incisional hernia.

5.if that track is indeed tubercular how long does the medicine takes to show its effect.( been 18 days).can it be given intravenoulsy to show rapid effects and then switched to oral pills

6.if adhesions post op or incisional hernia with aome kind of intestinal blockage have
have been devloped will they settle with att medic8nes or surgery is required

.pls guide pointwise in an elaborated manner as some points have been missed in my first query
.
doctor
Answered by Dr. Sameer Kumar (7 hours later)
Brief Answer:
answered

Detailed Answer:
hello,

1. YOU HAVE TO TAKE A B-COMPLEX+ MULTIVITAMIN TAB LETS along with AKT through out 6 months daily 1 tab each.
2. ADA IS A blood test.
3.the tract may be tested for cancer by a biopsy and subjecting it to HPE or histopathology examination.
4. bloating and gassy sensation is due to indigestion or dyspepsia and in no way indication of an incisional hernia. you may take proton pump inhibitors like ...TAB PANTOPRAZOLE 40 mg daily for a week .
5. intrvenovus medications for long term are not advisable and there would be no rapid effects on the tubercle bacilli. The bactericidal action may take 15-20 days but the important bacteriostatic action takes longer and hence it is very important to complete the course for 6 or 9 months.
6. already formed adhesions or intestinal blocakage formed cannot be treated by medicines now, they have been mechanical obstructions and shall require surgery as only mode of treatment.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar (16 hours later)
thanks doc

1got an ada done tday in blood sample...value is 9.2..is this a reilable indicator of pelvoc or abdominal tb
2
i m taking serriatopeptidase.,can i continue tht with att.also taken for 1 month earlier before at
3
how is att taken simulataneoulsy or with different meals..
4
i m attaching my medicines taken so far..pls see if my tb has become mdr
5
for how long darolac can be taken..i took it for 1 month wen i was on antibiotics..is it safe to take if i m having constipation

right now i m takung
akt 4,bevon ,folvite,cipzen forte bd softeron z and duphalac..soventis c syrup for cough as i have dry cough fpr 4 days

is that possible to have that soft tossue track becoming necrotic
doctor
Answered by Dr. Sameer Kumar (55 minutes later)
Brief Answer:
answered

Detailed Answer:
hello,

1.Tuberculosis can now be diagnosed accurately by increased levels of adenosine deaminase, above 40 U per liter. SO IF YOUR ADA LEVELS ARE LESS THAN 10 the tubercular load is less or may be since last 18 days the load has reached undetectable levels.
2. you can stop serratiopeptidase as you have already taken it for a month. Vitamin b complex is important with ATT.
3. ATT all 4 drugs should be taken in morning empty stomach just once a day.
4.the medicines used are for an empirical course of tuberculosis.
5. darolac tabs are lactic acid tabs and can be safely used as probiotic with the att but its always better to give a break of 15 days after a regular 1 month use to all natural gut flora to increase naturally.
6. The soft tissue tract may become infected or necrotic over a period of time and hence may have to be surgically intervened once the tubercular load is decreased.
Regards
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Sameer Kumar

OB and GYN Specialist

Practicing since :2002

Answered : 1782 Questions

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What Causes Pelvic Tuberculosis?

Brief Answer: it is likely to be TB Detailed Answer: Hello, Thanks for the query to HCM, Your concern about pelvic tuberculosis is based on your mantoux test positivity and tb platinum gamma interferon positivity which are sensitive ( mantoux) and specific tests( interferon test for tb). this ensures or confirms that you have tuberculosis. If there has been constipation and adhesions accompanied with pelvic pains then there is likelihood that Tb has manifested. However as you have been operated 5 months back and no severe adhesions or tuberculous tubercles were seen on the peritoneum or adjacent structures, it is unlikely to be florid yet to cause pelvic pains. The most common symptom of pelvic or abdominal tuberculosis are weight loss and evening sweats and rise of temperature especially in evening with often a doughy feel in case of an abdominal tuberculosis. It is suggested that you may get ADA or adenosine deaminase levels also done to confirm the diagnosis completely . Once confirmed then you can continue on orals AKT4 kit for 2 months and the akt2 for remaining 4 months along with b-complex capsules. Diagnostic laparoscopy may not be indicated unless there are severe pains due to adhesions either in menses or during defecation or just pelvic pains. The diagnostic lap can identify any tb tubercles under vision and a targeted biopsy may then be taken to confirm the diagnosis by histopathology. It is suggested that if You have started then you should continue and complete the treatment on the base that your mantoux and interferon tests have been positive and if there is a tract of 14mm and non healing then it can be tuberculosis induced non healing. Regards