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    How can brain tuberculosis be treated?

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Posted on Thu, 13 Jul 2017 in Lung and Chest disorders
Question: Hello Doctors,

Good Evening.

My mom has been diagnosed with Lymph node TB (swelling of lymp nodes) and Brain TB. Here is the history

2012 - Diagnosed with TB of lungs. TB treatment for 8 months and was cured.

Feb 2015 - Diagnosed with lymph node TB. TB treatment started (4 TB treatment tablets)

March 2015 - She had a seizure, MRI SCAN showed brain TB. Continued same medicines and 60 injections(streptomycin). MDR TB test was Negative

Nov 2015 - MRI SCAN showed that TB in the brain increased. TB of lymp node reduced. Continued with the same tablets. Lymph nodes TB almost reduced completely.

July 2016 - MRI Scan showed improvement, moderate decrease of TB in the brain. Reduced to 1 TB tablet(Macox plus) for the next 6 months
XXXXXXX 2017 - She was feeling weak, dizzy, slight headaches etc

March 2017 - MRI SCAN shows significant increase in brain TB as compared to July 2016 scan. No visible swelling of lymph node TB
Neck Scan of lymph nodes showed still slight traces of TB bacteria in the lymph nodes

May 2017 - PET Scan report showed that the TB bacteria in the brain is completely cured but the lesions from it are still there

Doctor advised to continue 1 TB tablet for 3 months and also prescribed Descort 30mg for 10 days and reducing the mg every 2 weeks. Currently she is taking Descort 3 mg on alternate days

Here are my questions related to lymph node TB
(1) Since there are still traces of it in the lymph nodes, one of the doctors we went for second opinion suggested getting the culture done to test for MDR TB from the lymph node area. It was done 2 years back when there was swelling and it came out negative for MDR TB. Now there is no visible swelling in the area, it is completely reduced, so from where will the sample for the culture be taken? Or can it even be taken if there is no swelling?

(2) Would you recommend going for the culture testing for MDR TB?

(3) Is it common for lymph node TB to take this long to cure?

Please let me know if you need any other information. Thank You
Regards, XXXXXXX

doctor
Answered by Dr. Kaushal Bhavsar 3 hours later
Brief Answer:
Sample should be taken by excision biopsy.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.

Answer to your 1st question.

Sample should be taken by excision biopsy. In this, local area is explored and enlarged lymphnode (or suspicious tissue) is carried out and sent for histopathological examination.

Answer to your 2nd question.

Yes, culture report must be done from sample to rule out MDR TB.

Answer to your 3rd question.

It is not that common for lymphnode TB to stay this long.
But patients with low immunity tend to show long time for cure.
So please let me know following things about patient.
1. HIV status
2. Diabetes status
3. Is she taking other drugs (other than you mentioned)?
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 mother. Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Kaushal Bhavsar 41 hours later
Thank You for your prompt response Doctor.
Here are the answers to your questions

1) HIV Status is Negative
2) Non Diabetic
3) She started with regular TB medication but currently only Macox plus and Descort. Also multi vitamins.



(1) Even if there is no enlargement or swelling of lymph nodes, will the culture give you accurate results?

(2) She has an occasional head ache and her tongue turns white, are these any kind of symptoms or indications

(3) Since the swelling is completely gone and there is no pain around that are but there is still traces of the bacteria left, can we say that she is responding to the medicines well?

Please let me know if you need any other information. Thank You





doctor
Answered by Dr. Kaushal Bhavsar 27 hours later
Brief Answer:
Yes, culture will give you good results.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Sorry for late reply as I was busy.

Answer to your 1st question.

Yes, culture will give you good results even without lymphnode enlargement on palpation.

Answer to your 2nd question.

No need to worry for these symptoms.

Answer to your 3rd question.

Yes, she is responding well to medicines and as a result, her swelling is reduced.

Hope I have solved your query. I will be happy to help you further. Wishing good health to your mother. Thanks.





Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Kaushal Bhavsar 3 days later
Thank You for your response, Dr. XXXXXXX I really appreciate it
doctor
Answered by Dr. Kaushal Bhavsar 15 minutes later
Brief Answer:
It is good to hear positive feedback from patients.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
It's always encouraging for doctors to hear positive feedback from patients.
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 mother. Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14646 Questions

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