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What Does My Lab Test Report Indicate?
Question: My father aged 74yrs and weighs 46kgs tested AFB positive in sputum. After taking AKURIT 4 (3 tabs) for two months and RCINEX(300+ 450) for four months he was tested negative for AFB. But after eight months he was again tested AFB positive. HE was given RCINEX 450 , Combutal 1000, Pyzina 1250 .He was also given Ambistryn( Strptomycine)(.75). His condition became worst . he could not walk and eat food , His appetite was lost. He has gastro problem .His But later, Ambistryn was discontinued after 18 days.
Stll his condition was not better.He could not walk properly. His appetite was lost.
His LFT shows SGPT(188) and SGOT(167) Bilirubin( .23), Creatanine 1.5 .One Medicine Doctor Advised us to Continue Rcinex450 and Combutal 600mg..We went to another pulmonologist. He has only prescribed Combutal 600 and (Levoflox 500)Levofloxacin 500mg and rabeparazole .Now he feels better and appetite is becoming normal .But still his LFT shows still shows SGPT(198) and SGOT(109) Bilirubin( .23), Creatinine 1.3.
He is now taking only Combutal 600 and Levofloxacin 400 along with other vitamins ,Qumoktum. How long he can continue Levoflox 500?
We could not go for drug (RIF and INH)sensitivity and resitance test as AFB is negative now.
Kindly advice me. In this crucial situation. Which Doctor should I follow.
Stll his condition was not better.He could not walk properly. His appetite was lost.
His LFT shows SGPT(188) and SGOT(167) Bilirubin( .23), Creatanine 1.5 .One Medicine Doctor Advised us to Continue Rcinex450 and Combutal 600mg..We went to another pulmonologist. He has only prescribed Combutal 600 and (Levoflox 500)Levofloxacin 500mg and rabeparazole .Now he feels better and appetite is becoming normal .But still his LFT shows still shows SGPT(198) and SGOT(109) Bilirubin( .23), Creatinine 1.3.
He is now taking only Combutal 600 and Levofloxacin 400 along with other vitamins ,Qumoktum. How long he can continue Levoflox 500?
We could not go for drug (RIF and INH)sensitivity and resitance test as AFB is negative now.
Kindly advice me. In this crucial situation. Which Doctor should I follow.
Brief Answer:
Get done sputum culture and sensitivity report.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
You can still go for sputum culture and sensitivity report. Actually sputum AFB can be negative. But culture can come positive. This is because culture needs 1-2 months time and in this time bacteria can grow and show colony. TB bacilli are slow growing bacteria. So culture can come positive despite negative sputum AFB.
And if culture is positive, you can go for drug sensitivity testing to rule out multi drug resistant tb (MDR TB).
At present you should continue combutol and levofloxacin. Complete total 8 months of treatment.
No need to worry for elevated liver enzymes if he is not having symptoms like abdominal pain, vomiting, Itching etc.
Please let me know
1. How's his condition at present? Is he improving in terms of gaining weight, improved appetite etc.
2. Sputum culture and sensitivity sent or not?
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 father. Thanks.
Get done sputum culture and sensitivity report.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
You can still go for sputum culture and sensitivity report. Actually sputum AFB can be negative. But culture can come positive. This is because culture needs 1-2 months time and in this time bacteria can grow and show colony. TB bacilli are slow growing bacteria. So culture can come positive despite negative sputum AFB.
And if culture is positive, you can go for drug sensitivity testing to rule out multi drug resistant tb (MDR TB).
At present you should continue combutol and levofloxacin. Complete total 8 months of treatment.
No need to worry for elevated liver enzymes if he is not having symptoms like abdominal pain, vomiting, Itching etc.
Please let me know
1. How's his condition at present? Is he improving in terms of gaining weight, improved appetite etc.
2. Sputum culture and sensitivity sent or not?
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 father. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply and guidance and description with detail for my concern.
He is now better ,his appetite is now gaining. Gastro problem is less .He is not having Symptom of vomiting itching.
One Medicine Doctor has given a test for Sputum AFB DST for INH & Rifampicin.
Important :(The test sample was given before staring Combutol 600 and Levofloxacin 500)
The Report shows MDR-TB RAPID GENOTYPIC TEST.It took seven days time. Mycobacterium tuberculosis Complex not detected. And Commented "Since this patient is not detected for mycobacterium tuberculosis Rifampicin and isoniazid resistence detection are not possible."
1. Sould I give again for culture and sensitivity? What should I ask to LAB for?
2.Whether the strength of Combutal i.e. 600 mg is correct? As his weight is 46kgs.
Thanks
He is now better ,his appetite is now gaining. Gastro problem is less .He is not having Symptom of vomiting itching.
One Medicine Doctor has given a test for Sputum AFB DST for INH & Rifampicin.
Important :(The test sample was given before staring Combutol 600 and Levofloxacin 500)
The Report shows MDR-TB RAPID GENOTYPIC TEST.It took seven days time. Mycobacterium tuberculosis Complex not detected. And Commented "Since this patient is not detected for mycobacterium tuberculosis Rifampicin and isoniazid resistence detection are not possible."
1. Sould I give again for culture and sensitivity? What should I ask to LAB for?
2.Whether the strength of Combutal i.e. 600 mg is correct? As his weight is 46kgs.
Thanks
Brief Answer:
Ask for sputum AFB culture and sensitivity (LJ media).
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
No need to worry for drug resistance because he is improving in symptoms and gaining weight too.
But you should give sample for culture (solid medium) and sensitivity report.
For this ask fir LJ culture and sensitivity.
LJ media is gold standard for the diagnosis of AFB culture.
If it is negative then no need to worry for drug resistance.
Dose of combutol and levofloxacin are appropriate.
So complete total 8 months of treatment.
Don't worry, he will be alright.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wishing good health to your father. Thanks.
Ask for sputum AFB culture and sensitivity (LJ media).
Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
No need to worry for drug resistance because he is improving in symptoms and gaining weight too.
But you should give sample for culture (solid medium) and sensitivity report.
For this ask fir LJ culture and sensitivity.
LJ media is gold standard for the diagnosis of AFB culture.
If it is negative then no need to worry for drug resistance.
Dose of combutol and levofloxacin are appropriate.
So complete total 8 months of treatment.
Don't worry, he will be alright.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wishing good health to your father. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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