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PTB in right upper lobe with undetermined activity, negative for acid fast bacilli. Chest X-ray, afb sputum smear done. Tuberculosis?

hi i had just received my chest xray with apicolordotoic view..results showed ptb right upper lobe with undetermined activity... however, my afb sputum smear for 3 days results... negative for acid fast bacilli .... will somebody give me an explanation... will still the consideration be tuberculosis?...for over the years, i don t experience symptoms of fever, chest pain, productive cough nor hemoptysis ...please help!
Asked On : Thu, 12 Jul 2012
Answers:  3 Views:  1047
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Cardiologist 's  Response
Hello,

Depending upon the country where you spent your childhood. Treatment for tuberculosis is based on various different criteria including symptoms you are having, signs you have and investigations we get. For example if you spent your childhood in India, tuberculosis must have been suspected for this view of Chest X Ray to be taken. If you have symptoms of fever, cough weight loss, appetite loss. Sputum for AFB can be negative but if Mountoux test is suggestive; Adenosine Deaminase (ADA)Test for non pulmonary tuberculosis is positive. One would be treated for tuberculosis. There is considerable evidence to support their use in pleural fluid samples for diagnosis of pleural TB, where sensitivity was very high, and to a slightly lesser extent for TB meningitis. In both pleural TB and TB meningitis, ADA tests had higher sensitivity than any other tests. Good Luck.

With Best Wishes
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/healthcaremagic.com/dr-anil-grover/63370
Answered: Thu, 12 Jul 2012
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  User's Response
Hello,
The diagnosis is now presumed PTB due to the fact that this is the commonest site (R/LUL Lung) where PTB infects. However, several other causes need to be excluded and a bronchoscopy with lavage and culture at 6 weeks will confirm this. Sputum negative PTB is not uncommon.
Several other tests such as ADA activity have been shown to be reliable but not 100%
New test offered is a T cell assay whereby Mycobaterial antigens are cultured with the patient's T cells and interferon gamma activity measured (IFNgamma release assay). If this shows high levels of IFNg the chances of PTB are very high. This is an indirect but the only immunology test available for PTB when sputum cultures are negative but CXR is suspicious.
Answered: Mon, 16 Jul 2012
General & Family Physician Dr. Veera Raghava Rao Buddha.'s  Response
Hi welcome to HCMForum. Xray is revealing that there ptb but it is not clear whether it is active or old.
i advise you to go for MRI and some other tests for confermation. So i advise you to consult a chest
physician for diagnosis and treatment. sputum test may not be reliable always. Thank you.
Answered: Thu, 12 Jul 2012
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