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Discussion about tuberculosis - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: General Health
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3622 Questions
User :   Hi doctor      
User :   hello doctor
Doctor :   hi
Doctor :   Dr. XXXXXXXX here
Doctor :   please proceed with your health query
User :   this is regarding a discussion abt tuberculosis
Doctor :   ok.
User :   my wife was having a swlling ariund her neck 3 weeks back and we took her to an ent who suggested us to tak a test for tb as the swell is not in the tonsils area
User :   we took anti tb tests Igg etc
User :   all are postive
User :   mauntex was negative
User :   we went for an FNAC wchich was positive
User :   so we started with akt-4
Doctor :   ok. when were these tests done? for whom it was done? what were the symptoms?
User :   but the swell didnt reduce so we iopened it and puss came out in large quantity
User :   anti tb tests,mauntex test and FNAC
User :   it was from an chest physician
Doctor :   please provide details of age, gender, location, occupation, height, weight, details of past medical illness and treatment for any for the patient.
User :   symptoms wer fever lack of apetite
User :   age:25 gender:female lcation:chennai,tamilnadu,india
User :   occupation:software weight befor tb 54 after tb 49
User :   past tb illness none
User :   doctor
User :   may i continue
Doctor :   ok. let her continue to the AKT-4. repeat the tests after 6 months.
Doctor :   yes please proceed
User :   agfter takin akt-4 she was able to recover from fever apetite problems etc
User :   but swell didnt reduce
User :   but later we found she developed rashes
User :   throut her body
User :   in hands and thighs
User :   so we stopped akt-4
Doctor :   ok. the fact that she recovered from loss of appetite and fever, suggest that the treatment has worked
User :   doctor prescribed to add 1 medicine a day and add the other one after two days
User :   INH was the frst
Doctor :   did you informed the treating physician about the rashes and stopping of medications?
User :   sh took fr 2 days
Doctor :   ok.
User :   yes yes all are done by him only
Doctor :   ok. please proceed
User :   after INH she was asked to take phyrazine 1000
User :   after takin that with INH immediately she had rashes and itchin
Doctor :   ok. when was this? how long back?
Doctor :   continue to give her INH, and stop the pthyrazine, instead add the Rifampicin and see if the rashes are there
User :   yes doctor im comin to that
User :   after adding rifa
User :   she didnt feel anythin for 4 hrs
User :   after that aroun 2 am in midnight she started itchin heavily:(
User :   and morn there was light fever
User :   vomit also in orange color
User :   so my worry is is this also failed?
Doctor :   ok, the orange color will be due to the rifampicin
User :   she is takkin streptomycin injection daily
User :   ya
User :   phyrazine gave rashes immediately
User :   but rifa gave it after 4 hrs
Doctor :   yes it could suggest failure of AKT-4, she should be considered for alternate therapy
User :   can she continue with this INh + rifa combi 2 day also and see
Doctor :   how many month sin total did she continue the AKT-4?
User :   is this side effects of rifa will vaniosh in course of time
User :   ?
User :   we started with akt-4 only 3 weeks back
Doctor :   even rifampicin caused her vomiting and rashes, so i would suggest not to give her
Doctor :   instead report all the reactions to her treating doctor.
Doctor :   she will need injectables to correct the problem.
User :   ok the next one is Ethambutol
User :   if all the medicines are xcraetin side effects im worried
User :   will the tr8ment is effectuive
Doctor :   yes, you can try adding that too and see if she continues to have rash
Doctor :   and if she does, then the treatment should be discontinued, and she should be helped to get along with different treatment
User :   my doctor has asked her to tak rifa today also and see whther she is gettin the sideeffects again
Doctor :   what is her current height and weight?
User :   weight is 49
User :   height is 5"2
User :   doctor will strpetomycin and INH and ethambutol alone is enuf to cure this
Doctor :   ok, she is underweight, slowly try and improve her diet, she should feel better with that and have better tolerance for the medications
User :   also wen takin akt-4 combined she ddin get these rashes vigoruously
Doctor :   ok. then consider discussing with her doctor about starting her back on the combination therapy
User :   can we involve in intercourse
User :   if so wen
Doctor :   either with AKT-4, or with any other combination by a different company.
User :   alsso she has to travel to canada shortly wen sooon can she start
Doctor :   yes you can involve with sexual relationship if she is comfortable.
User :   ok will this transmit to me
User :   if so
Doctor :   she can start with her Canada trip when her symptoms are controlled and she is better.
User :   her only worry now is the side effects doctor
User :   all other fever apetite problems are solved by now
Doctor :   it will not get transmitted sexually, but it can get transmitted if she is having respiratory symptoms.
User :   also the swelling
Doctor :   if your immunity levels are good, you will resist the infection
User :   doctor
User :   one more
Doctor :   the swelling should be repeatedly dressed every 48 hours with proper cleaning of adhesions and pus, for faster relief
Doctor :   yes. please proceed with your query.
User :   if rifa is not working then only inh streptomycin and ethambutol will be there is it effective
User :   will we be able to get all this medicines in canada
Doctor :   you will get the medications in Canada, but until her infective status is cleared, she may get clearance to travel to Canada
User :   if rifa is not working then only inh streptomycin and ethambutol will be there is it effective
User :   doctor
User :   also
Doctor :   INH, streptomycin and ethambutol are combined in case rifampicin and pyrazinamide is not suiting the patient
User :   can we test takin rifa for 2 days and see wether she s able to adapt
User :   willm these side effects disappear after adaptation
User :   after 2/3 days
Doctor :   yes you can try it, but let her be in contact with her doctor when you try it.
User :   sure dctor
Doctor :   if she adapts to it, then you can continue with them
Doctor :   is she on any antacids?
User :   will it be fruitful to takle it fr 2/3 days and wait to see if it adapts
User :   ?
Doctor :   these medications cause severe gastritis, getting her started on Digene syrup on empty stomach two times a day will be helpful
User :   wen shud she tak this medicines
Doctor :   no, if you start on it and she does not adapt on 2-3 days, then no point in giving that
User :   soo we can take fr 2/3 days and wait
User :   ?
User :   wen shud she take this medicines doctor?
Doctor :   if she does not have any symptoms after staring it agian, she can continue
Doctor :   if she develops any symptoms stop it.
Doctor :   *starting it again
User :   doctor
User :   wat is the timings
User :   she shud take
User :   dosation
User :   ?
Doctor :   the antitubercular medicines are best taken in the morning
Doctor :   in the prescribed dose
Doctor :   Digene syrup can be taken about 10-20 ml 2 times a day before food
User :   oh since we are testing for side effects my octor has asked her to take it in the night after foos
Doctor :   let her stick to non fatty/spicy/oily food
User :   is it ok?
Doctor :   ok. if the side effects are more, it is sometimes advised as told by your doctor
Doctor :   she can continue as advised
User :   after how long she shud take after food
User :   after 1 hr?
Doctor :   after 1/2 to 1 hour
User :   also will this crate problems in child birth
Doctor :   not later than 1 hour after food
User :   ok doctor
Doctor :   yes it can cause serious problems, use contraceptive measures
User :   will it lead to infertility in futire
User :   ?
Doctor :   if she is taking birth control pills, then she will not have the proper efficacy of the pills
User :   no no not that
Doctor :   while she is on the anti-TB treatmnet
User :   we are using condoms anyways
User :   thanks a lots sir was gr8
Doctor :   that is if uterus and tubes are affected
Doctor :   if it spreads more, it will cause problems of infertility
Doctor :   otherwise it will not cause problems with fertility
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