Hi and thanks for the query,

Tuberculosis, and especially miliary TB is associated with a chronic fever. This is because because, before diagnosis, there is already a chronic inflammatory process going on for quite sometime, with the system adapted to it. Ant Tubercular drugs take time to reduce the concentration the bacterium at the origin of the inflammation, explaining the time lapse required after initiation of treatment to obtain a decrease in the fever.

It is not unusual therefore to have persistent fever after initiation of anti TB therapy. Normally, the fever should subside after initiation of treatment. Persistence of the fever could result from a paradoxal reaction, reason why corticosteroids are prescribed at the onset of this treatment, to avoid these symptoms. Also, in case the Mycobacterium TB at origin of the disease is resistant to the drugs (multi drug resistant TB, MDR), fever could stay high. This explains purpose for doing a culture and anti biotic sensitivity tests on the samples.

I suggest you sit calm for two to three weeks to observe the evolution of the fever, and also wait for the result of the culture and sensitivity tests. The key issue in TB treatment is compliance to drugs and an appropriate nutrition. Carrying out an HIV test in TB patients is also a good idea.

Do not hesitate reporting any unusual events to your treating physician.

Thanks and best regards as I wish good health.

Luchuo, MD.

---

Hi and thanks for the query,

I understand it can be disturbing to have persistent fever meanwhile on treatment. It is not unusual to obtain negative culture results even when the cause of the symptoms is still TB. Other invasive diagnostic tests are done in this case like the lymph node biopsy in search of particular histologic pictures suggestive of TB. I think in this case other causes of chronic or persistent fever should be considered. It is a bit too early to be conclusive on the fact that its not TB, although a bit unusual.

1. I would suggest a lymph node biospy be carried out. Pathologies like lymphomas which could produce a similar clinical picture would easily be caught up.
2. Sarcoidosis could give similar clinical picture
3. Blood cultures should be done
4. Active search of a tumour by carrying out an abdominal ultrasound and CT scans
2. A rheumatologic evaluation to exclude vasculitis,, systemic lupus erythamtosus.

The opinion of an infectiologist / Internist in this case would be highly needed. I suggest you book a consultation with one for a clearer clinical evaluation.

Thanks for the the report and do not hesitate asking any further questions if need be, it's the pleasure of the XXXXXXX team.

Best regards,
Luchuo, MD.

---