Question: Hi doctor, its me again, TB patient from UK. I hope you are well. I am good now. My haemoptysis is gone now and sputum turned negative. This query is now regarding my wife for latent TB treatment. You remember she was given Rifampicin and Isoniazid and after two weeks she had severe headache, nausea and little rashes. Her blood tests were ok. Dr stopped all medicines and after 10 days started Isoniazid with Pyridoxine. She took for two weeks and felt ok. But after two weeks she developed red rashes ALL over her body and moderate itching. For two days rashes continued to increase. She did not have headache or nausea this time. She had not eaten/done anything unusual. Dr did blood test, all ok. She taken some antihistamine but no benefit. Dr stopped Isoniazid. She is off Isoniazid last three days. Her rashes are little lighter today. And you know that we were planning for IVF.

Sorry so many questions again but I do not want HCM to block my queries saying overuse like last time.

1>     Is it necessary to treat latent TB before going for IVF? Dr here think so.
2>     Can they stop latent TB treatment now and go for IVF and then start latent TB treatment again?
3>     If the wife stops latent TB treatment now and start in future, will she have more chances of drug resistance?
4>     Why she was not having any side effects for first two weeks of taking medicines and suddenly getting adverse effects after two weeks?
5>     Does the above scenario mean she has intolerance to Isoniazid only?
6>     If Isoniazid can not be continued in her case then what other options/medicines are to treat latent TB?
7>     Nurse suggested that she may be given only Rifampicin for six months to treat latent TB. Is this the option to treat latent TB?
8>     Are these rashes common? Are they serious? When the rashes should clear?
9>     Are there any medicines to treat these rashes? She has taken for two days cetrizine hydrochloride and Chlorphenamine to reduce symptoms of rashes but seems no effect till now.
10>     Is she really reacting due to TB medicines or it is something else?

Await your reply.

Thanks doctor for great detailed answers. It comforts us.

Her Rashes are almost gone now. Just a little redness and swelling on feet. She did apply Hydrocortisone cream. But I think rashes have improved naturally.

1> Dr here thinks that its better to treat latent TB before IVF. This is to reduce chances of becoming it active in case immune suppressants needed to be used at any stage of IVF. We want to be on safe side so probably will treat latent TB first. One Dr also said that treating latent TB before IVF improves chances of success a little. Other Dr said not urgent to treat latent TB before IVF. What will be your view to improve IVF chances and to remain safe side?

2> This slow acetylators affect for only some medicines or all medicines? Do you think if Rifampicin is started she will have some side effects due to slow acetylators?

3> When she was taking combination of Rifampicin and Isoniazid she had nausea, headache after two weeks. This time also when she was on only Isoniazid she had rashes after two weeks. Do you think this is due to Isoniazid only and to take only Rifampicin should be ok? Her blood reports were ok including liver and kidney.

4> Do you think if we wanted to treat latent TB, Rifampicin can be started as soon as possible or do we need to wait couple of weeks?

As usual awaiting your reply.

Thanks again.

Hi doctor,

We have been to the Dr here for both of us and below is the outcome:

They have started Rifampicin 600mg for my wife. No other medicines. I hope she should be ok this time. They have not given any pyridoxine or other vitamin tablets.
- Are any vitamins (B6 or other) required with Rifampicin 600mg?
- I noticed that her CRP (last week's blood report) was 38 and previously about a month ago CRP was 56. Do you think we should worry about this? Nurse said nothing to worry as this is not too high. Her Body Mass Index (BMI) is 31.

For me: Dr was little cautious with my latest x-ray. Dr noticed something but not urgent or serious. She also checked my previous sputum cultures and thought I need to stay on all four medicines for another one month. This is to be safe side. She said I am not infectious. So I will continue Rifampicin, Isoniazid, Moxifloxacin, Ethambutol and Pyridoxine and next month they will see me again. I am awaiting latest blood test report.
- Do you think they are going right?

Thanks a lot.
- XXXXX XXXXXXX

Thanks doctor. We will continue as planned unless there are complications.

My wife's blood report of last week showed CRP (C-reactive Protein) at 38. Last month's CRP was 56. I think normal range is under 5. Nurse said its not too high and nothing to worry.

Do you think this is unusual? Anything to be done??

Thanks.

Hi, no she does not feel warm. Normally she feels cold even at normal temperatures. At the monent she is normal. What it could be to remain CRP high? Her body mass index BMI is 31. Overweight for her age and height .

Hi doctor, my wife took yesterday Rifampicin 600mg. After two hours she had headache but not severe as last time. Her eyes were relatively red. This morning at work she still feels little headache and thinks her shoes are little tight so could be little swelling but we need to examine this evening when she returns from work.

- I hope she is not going to react like last time when she had SEVERE headache, nausea and small rashes when she had Rifampicin + Isoniazid together for two weeks.

- If Rifampicin also is not tolerated by her then what?

- Is there any other option to continue latent TB treatment?

- Or just stop the treatment and wait for it to become active in case it does?

- Is Rifampicin also creating problem for her or she should take Rifampicin for few more days and see what happens?

Regards,
XXXXX XXXXXXX