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Biopsy done. Report confirmed bone TB. Prescribed AKT-4 kit. Suggestion required?

Dear Sir, The biopsy report of my brother is given below : Surgical Pathology Report --------------------------------------- Specimen : Sinus , Right Forearm , Excision Biopsy. Gross : Received light brown soft tissue bits and pieces together measuring 1.5 X 1 X 0.5 cm, Cut surface is light brown, soft. (Entire tissue : 0000). Microscopy and Inspection : Sinus, Right Forearm. Excision Biopsy: Cutaneous sinus with suppurative necrotiziing granulomators inflammation. Consistent with Koch s. ESR = 16. Advised : TB-PCR / AFB culture. The doctor has found out the disease called Bone TB from the report and prescribed AKT-4 kit for two months. Please give your views based on the report. With regards, Navin.
Asked On : Tue, 12 Feb 2013
Answers:  3 Views:  71
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Orthopaedic Surgeon, Joint Replacement 's  Response
Jul 2013
Hi, thanks for writing to HCM.

Unlike Pulmonary tuberculosis, Bone & joint tuberculosis is a paucibacillary lesion. It implies that very few number of TB bacilli are present in a bony lesion when compared to a lesion in the lung.

So, it has been proved in many clinical studies that bone tuberculosis cases on short course regimens with 4 drugs (AKT_4) had favourable results in 99% of patients at 10 year follow-up.

A minimum of 6 -9 months course of antituberculous drugs is needed to achieve a favourable clinical outcome in bone tuberculosis.

Hope this information is helpful. Good day
Answered: Thu, 29 Aug 2013
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Pathologist and Microbiologist Dr. Vandana Khare's  Response
Hi Navin!
your brother's biopsy report suggests tuberculosis.Bone tuberculosis is a completely curable disease and responds well to the medicines.Ask him to take the medicines regularly and there is nothing to worry!
Answered: Thu, 29 Aug 2013
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Pathologist and Microbiologist Dr. Gunjan Singhal's  Response
hi navin,
The report has confirmed Tuberculosis of bone which requires at least 12-18 months of ATT course so it is necessary to get a TB PCR and AFB culture done to get an immediate response of the specific drugs that can be started following the culture reports. However AKT4 is very effective but is broad spectrum, so much so that in two months all the TB reports will be negative. But if the Tubercle bacilli is not of the strain identified in the culture then it could relapse and combination of the drugs will have to be changed and the treatment might have to be prolonged.
AFB culture with drug sensitivity gives you the exact drugs sensitivity which will be effective for the specific bacilli found.

Please note in most of the cases AKT4 is effective and shows a good response but if advanced techniques are available then why not go for it .
Answered: Thu, 29 Aug 2013
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