Can TB infection spread to other organs while on medication?

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Posted on Thu, 18 Jun 2015 in Infections
Question: Is it possible that tb can spread into other organs if already on anti tubercular treatment for 1.5 months..does akt 4 can be given for three months ? How to identify if on mdr tuberculosis or normal tuberculosis in case of extra pulmonary tb
doctor
Answered by Dr. Panagiotis Zografakis 41 minutes later
Brief Answer:
It is possible without prompt and appropriate treatment

Detailed Answer:
Hello,

regarding your first question: prompt and appropriate treatment is indicated to avoid spread to other organs. Even a suboptimal treatment may delay tuberculosis spread. If the treatment is initiated with a great delay then the tuberculosis might have spread already, so a suboptimal treatment won't eradicate the mycobacteria.

Regarding akt-4: it contains ethambutole, pyrazinamide and rifampicin. It is an appropriate regimen (with the addition of isoniazid) for the first two months. We use 4 drugs at first to minimize the risk of developing resistant strains. After the two month period isoniazid and rifampicin are normally used for the rest of the treatment (4-5 months).

Extrapulmonary mdr tuberculosis can be diagnosed by culturing available specimens, which depend on the site of infection. For example:
- a suspicious lymph node can be aspirated (FNA).
- a urine sample can be cultured
- pleural fluid can be cultured
- cold abscesses can be aspirated depending on their location
- cerebrospinal fluid can be cultured
etc
Please note that respiratory samples are always sought, even if the radiological evidence is lacking.

If a sample is taken then susceptibility testing is recommended, even if mdr tuberculosis is not suspected because there is a low but respectable risk for it anyway (at least on the initial isolates).

I hope I've helped!
You can contact me again, if you'd like to ask for clarifications or further information.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 20 hours later
cesarean delivery 6 months back.post op i had devloped extra pulmonary tb(though it remained unnoticed for 4.5 months as my abdominal discomfort was considered as part of my healing process)..in these three months i was given various combinations of antibiotics(list eclosed)..my tb gold test in feb in sputum sample came negative witha clear chest x ray..in month of march mantoux and igra was conducted and now ada..doc is in doubt of uterus tb tht flared upto skin but no tossue biopsy has been done.. i am on empirical att for cesarean delivery 5.5 months back.post op i had devloped extra pulmonary tb(though it remained unnoticed for 3.5 months as my abdominal discomfort was consideredbpart of my healing process)..in these three months i was given various combinations of antibiotics(list eclosed)..my tb gold test in feb in sputum sample came negative witha clear chest x ray..in month of march mantoux and igra was conducted and now ada..doc is in doubt of uterus tb tht flared upto skin but no tossue biopsy has been done.. i am on empirical att for 8 weeks..my weight is 67 kg and i have beem given akt 4 with bemadon and multovotamin...

Is that the right dose asbper my age and weight...i havent missed a single dose..but in my fourth week as i was unable to tokerate med tpgether i took them after a gap of four five hours,..does change in timings also cause drug resistance..am i on the rightvtrack...does the antibiotics given to me in a span of 3.5 months may have led me to drug resistance..as i felt feeling better in 4th week after att ,but after one week i felt same...

Also for last one week i m feeling bloating,swelling in my stomach and feels as if intestines(could be my assumtion) are falling down wen i touch my stomach upwards..what could be this..can this be strting of hernia..is hernia visible in ultrasound or ct scan or mri

Can mdr be tested in menstrualblood also and sent for culture of tb
Pls guide for urine sample also..in recent times how long does it takes for culture result also.and till that time can att work
doctor
Answered by Dr. Panagiotis Zografakis 2 hours later
Brief Answer:
There is no certainty about the diagnosis

Detailed Answer:
After checking the reports you've sent, I haven't found any certainty about the diagnosis. Your positive IGRA and Mantoux only denote coming into contact with a Mycobacterium but they are not enough to prove active infection. In what kind of fluid was the ADA measured??? ADA is normally measured in pleural fluid. Did you have pleural fluid accumulation?

Regarding dosage: I've had a look at the handwritten notes but it's not very clear and since the drug names are not known to me (I practice medicine in Greece) there was a lot of guessing that had to be done! So I'll mention the right dosage instead and you can check if you've taken enough of the drugs.

Isoniazid: 5mg/Kg. 300mg is the maximum dose regardless of the weight.
Rifampin: 10mg/Kg, 600mg XXXXXXX
Pyrazinamide: 25mg/Kg, 2000mg XXXXXXX
Ethambutol: 15mg/Kg

It's better if you're strict in dosage and time but since you couldn't tolerate it, the 4-5 hours difference once in a 2-3 month period won't do any harm.
Resistance can be developed by undertreating tuberculosis or by having recurrent tuberculosis, which means that you already have taken treatment for it in the past.

I can't say what's wrong with your intestines right now. A hernia could be visible on the scans but it should also be clinically evident (your doctor should be able to palpate it).

The best way to diagnose tuberculosis in the uterus is by taking a specimen.

Regarding the urine samples: 3 morning urine samples have a very high sensitivity for urinary tract tuberculosis (more than 90%).

The culture results may be delayed for more than a month because the Mycobacteria are very slowly growing. If you're asking about infectivity, this is very reduced since you don't have respiratory tract lesions.

I hope I've addressed all the issues!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 40 hours later
Hi,
Ada was measueed in simple blood sample.
Right now i m taking akt 4.
For abdominal tb also can urine sample be cultured for tb or mdr tb

Can menstrual blood samplebbe used for diagnosis of tb in lower abdomen and pelvic area and sent for cytology afb smear and culture for tb pcr
doctor
Answered by Dr. Panagiotis Zografakis 7 hours later
Brief Answer:
urine culture for the urinary tract only

Detailed Answer:
Hi,

The urinary culture may only detect urinary tract infection. The menstrual blood can be cultured for this purpose but the sensitivity is very low. If the genital tract is suspected of being infected, a tissue sample has to be taken. The inside of the uterus (endometrium) is an easy target, although the efficacy may vary.

Genital tract involvement is considered secondary so other foci have to be present as well.

Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 2 days later
Didnt understand ur last answer

Is laproscopysafe if there is cellutis on abd8men and tb inside abdomen or pelvos,
With history of cesarean 6 months back
doctor
Answered by Dr. Panagiotis Zografakis 3 hours later
Brief Answer:
I haven't talked about laparoscopy!

Detailed Answer:
Hi,

let me clarify my answer. I was talking about endometrial curretage. If you have tuberculous peritonitis then there has to be some fluid in your abdomen, which should be aspirated. I'm not absolutely certain after the data you've presented that you did have active tuberculosis but since you've started treatment for it, you should take it unless proven wrong.

Of course the AFB smears are a much safer option but not as sensitive.

If the aforementioned measures won't help, an open biopsy can be tried.

The gynecologist should decide whether the procedures are safe or not regarding complications like uterine rupture for example, since there is no absolute contraindication for it.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3678 Questions

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