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What Causes Low Grade Fever, Diarrhea And Weight Loss With History Of IBS?

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Posted on Wed, 1 Jun 2016
Question: Symptoms since November 2015 low grade fever and Diarrhea. Low grade fever Temp is in the range 98.8-99.4 degF,Internal feverishness is felt. body temperature is normal during first few hours of the day in the morning.

Got treated for IBS and some antibiotics for fever but nothing got better.

Underwent colonoscopy, findings showed that there has been history of treated intestinal TB,but no evidence that TB is prevailing.

In February 2016, My doctor asked me to start with anti-tb drugs (prescribed drug RHE-FD) ,there was a relief in first few days when I started using the drug. but there after nothing got better,after using it for 40 days ,there was no possible response ,condition prevailed the same and there was lots of discomfort. body temperature recorded in the same range as earlier. have been using aristozyme and Benadon with RHE-FD.

My Physician (He in coordination with gastroenterologist) asked me to undergo CT enteroclysis. Findings: Mild uniform prominence of the small bowel loops proximally...(report attached in the PDF doc) after that my doc asked me to discontinue RHE-FD tablets (i.e I used it for 40 days by then).
I was prescribed to use Colospa tablets after that.

weight loss since first symptoms is 10Kgs. (no significant weight loss since past one month)
Diarrhea stopped after using RHE-FD (i.e in Feb 2016) but there has been periodic pain in stomach especially in the evening between 5-6 pm. but after using Colospa Tablets pain has not been showing up that often. Fever is still persisting.

mean while I consulted another Physician for second opinion, and he suspects it's intestinal TB and thinks I have not undergone proper treatment. He says same combination drug should not be used when it has occurred 2nd time and he was serious about stopping anti-TB drug (RHE-FD) after 40 days ( it's been 5 days since I stopped it). He wants me to continue the same drug for 6 months.

I'm not able make out as still have the discomfort and very much worried about the treatment if it's tuberculosis. Since there is no strong evidence and since there's no response, my regular doctor has asked me to stop RHE-FD.

I'm in dilemma now, how and what to proceed with. I don't want worsen my situation if it's TB, what is the best should I be doing now? is it okay to start continuing RHE-FD for 6 months after a gap of 5 days???? can new combination of drug be started???

I have attached each and every report.



doctor
Answered by Dr. Tushar Kanti Biswas (5 hours later)
Brief Answer:
Intestinal tuberculosis-likely

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

I have gone through your case history and all the reports you have attached.
You had past history of treatment for intestinal tuberculosis. What was the basis for the previous treatment.I mean was there any tissue diagnosis?

Considering low grade irregular fever,non-specific gastro-intestinal symptoms (pain abdomen,at times diarrhea),loss of weight and positive Mantoux test (20 mm) and none of the invasive or non-invasive investigation being conclusive,it would be prudent to continue anti-tubercular treatment for total 6 months.A gap of 4-5 days won't make any difference.However in stead of fixed dose combination ,ask your doctor to give Rifampicin, Isoniazid, Ethambutol as per your body weight and to add another anti-tubercular drug to which you were not previously exposed e.g Fluoroquinolone group preferably Moxifloxacin ,because of possibility of drug resistance to first-line drugs.
Meanwhile you can go for Barium meal follow through (BMFT) for ileo-cecal tuberculosis.






Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Tushar Kanti Biswas (5 hours later)
Thank you Sir for your detailed answer, My first treatment was not based on any tissue diagnosis.I lived in a small town then and my problem was not properly diagnosed , I suffered through low grade fever and discomfort for almost an year, I was prescribed antibiotics all that time. understanding the situation I consulted a reputed physician in visakhaptanam, looking at my symptoms and past year history ,he suspected a possible chance TB and prescribed AKT tablets,which brought Immediate relief within a week and I was asked to continue the course for 9 months after that.
He is the same Doctor whom I have consulted now ,where I was asked to discontinue RHE-FD after 40 days of use.


I'm bit relived after reading your reply and will start the earlier drug(RHE-FD) from tomorrow . My second doctor looked promising but he is not willing to change combination until 6 months,He has asked me to only continue with RHE-FD.but I wonder why he's being so particular in not changing the combination till 6 months even though it's understood that it's not responding. and all the while I'm using the tablets it's making me more and more uneasy, Even the thought of taking it for 6 months is scaring me because of the discomfort it's causing. I had no issues in my 1st treatment(12 yrs ago) there was immediate relief and I continued using as doctor suggested.

I'm assuming anti-TB drugs should respond within 2-4 weeks,but in my case symptoms are still prevailing.

Now I'm just hoping I'll find a right doctor who can guide me through. possibly I'm thinking of getting treated at XXXXXXX
doctor
Answered by Dr. Tushar Kanti Biswas (6 hours later)
Brief Answer:
Intestinal tuberculosis-likely

Detailed Answer:
You can continue AKT in fixed dose combination as per your doctor's advise.
You may consult a Gastro-enterologist at higher center while you are in XXXXXXX
Lack of response to second time AKT may be due to resistance to one or other drug,which is not uncommon.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1920 Questions

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What Causes Low Grade Fever, Diarrhea And Weight Loss With History Of IBS?

Brief Answer: Intestinal tuberculosis-likely Detailed Answer: Hi, Thank you for your query. I can understand your concerns. I have gone through your case history and all the reports you have attached. You had past history of treatment for intestinal tuberculosis. What was the basis for the previous treatment.I mean was there any tissue diagnosis? Considering low grade irregular fever,non-specific gastro-intestinal symptoms (pain abdomen,at times diarrhea),loss of weight and positive Mantoux test (20 mm) and none of the invasive or non-invasive investigation being conclusive,it would be prudent to continue anti-tubercular treatment for total 6 months.A gap of 4-5 days won't make any difference.However in stead of fixed dose combination ,ask your doctor to give Rifampicin, Isoniazid, Ethambutol as per your body weight and to add another anti-tubercular drug to which you were not previously exposed e.g Fluoroquinolone group preferably Moxifloxacin ,because of possibility of drug resistance to first-line drugs. Meanwhile you can go for Barium meal follow through (BMFT) for ileo-cecal tuberculosis. Regards Dr. T.K. Biswas M.D. XXXXXXX