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What does a positive IGRA test result indicate?

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Posted on Thu, 28 May 2015
Question: Hi mam
In continuation with my previous chat(I had a cesarean deivery in nov 14 and was suspected of tb) would like to have further queries to be guided by u

Have strted empirical att 23 days back.mantoux was 11 mm at 72 hour
Igra was o.81 positive
Ada 9.2
Usg..hypoechoucctrack of 14 mm
doctor
Answered by Dr. Ramadevi Wani (2 hours later)
Brief Answer:
Positive IGRA test is a marker for tubercular infection.

Detailed Answer:
Hi XXXXXXX
Welcome back to Healthcare Magic.

First tell me how are you feeling now? Have you started feeling better now?
Your ADA levels are normal.
Positive IGRA test is a marker for tubercular infection though not diagnostic of disease.
Since you were not willing for diagnostic tests it is good that based on this test you have started ATT.

Do you have any queries, do write to me. I will be happy to answer.
Best wishes,
Dr Rama

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ramadevi Wani (2 days later)
Thanls mam
Based on igra usg and mrithat was doubtful of pid i have been put on empirical att for last 25days.
1
Mam pls detail ,e evrything about att,wen it is to be taken ,how is to be taken ,diet to be followed and how to encounter the side effects.
2
Doc i have also taken tayo 60 k once weekly six times till now,but while taking this att medicines i feel very weak tired and feverish during the day as if so eone has extracted all my power.is it common,with ceackling sounds feom my bones and body and headache too withblurred visison
3 mam how long does att take time to show its effects,right now i m given akt 4 witbevon folvite sorbilin and hifinac p or xinase d sos and rabonik plus or pan d softeron z and montair lc and soventis dc
I weigh 66 kg ..i take rifampicin beforebreakfast and rest of medic8nes post breakfast

Do theyneed to be taken same time exact daily or theybecome drug resistant
Is tht so..u have also seen the attached list of medicines taken by me sofar have my become drug resostant

4,doc if i have the soft tossue track,lesion or adhesion (whether tubercular or not as i m still confused )will att work on that.or will that track needs to be excsied sugically
5..if a surgical intervention is neccesary am i the right candidate for rhat ,(given a history of lscs 5 months back,allergic asthma,weak abominal wall strength,low immunity,malnutrotion and if there is tb infection inside).WILL IT BE SAFE TO GET DIAGNOSTIC LAPRPSCOPYDONE and will it help in tht track removal or ,may be it will settle from att
6.can u suggest me some iron and calcium supplement if i need to take them..i have taken cipzen forte for 1.5month..should i continue or fiscontinue its use(if there is a scar yossue teack
7.i have difficulty passing motions too..what should i do

Mam pls guide i m very scared

doctor
Answered by Dr. Ramadevi Wani (19 hours later)
Brief Answer:
Detailed answer below.

Detailed Answer:
Hi XXXXXXX
Welcome back. Sorry for the delay in replying.
1 & 3.I presume you are taking INH, Rifampicin, Pyrazinamide and Ethambutol. All these need to be taken on empty stomach, daily in the morning one hour before breakfast. If you wish you may take Ethambutol after breakfast. Your doctor has already prescribed Rebonic to counter the gastric acidity side effect.
Take a 25mg of Pyridoxine daily along with INH. I know you are taking Bivon. But the Pyridoxine content in it is not sufficient. Eat food rich in protein (dal, eggs, milk chicken etc). Eat nuts, fresh fruits and vegetables daily. This will help reduce the side effects of INH. In some patients cheese and fish can cause reactions while taking INH. So please avoid them. Taking them at the same time helps you avoid missing the tablets. If you miss the tablets drug resistance can happen.
You have not become drug resistant. Don’t worry.
To improve your immunity exercise is very important.
Take Hifenac-P only if you have fever.
It is important to monitor for side effects by monthly blood tests ( complete blood count, liver and kidney function tests). The side effect of blurred vision is worrying. Please consult your doctor for examination
2. Take two more doses of Vitamin D
4. I don’t think the track will need excision.
5. Let’s see how you respond to medicines. You may start feeling better after 2 months of treatment. Later we can think about laparoscopy.
6. Take iron and calcium only if you have deficiency. Iron tablets are known to cause constipation which can compound your problem. Any calcium and iron preparation is okay.
7. Take lots of fresh fruits and salads in your diet to counter constipation. How long you can take Sorbilin? Consult Physician to find out the cause for constipation.
You may stop cipzen forte.
Finally XXXXXXX be positive. No need to have undue anxiety. That will make you feel more sick. XXXXXXX I am not a specialist to deal with tuberculosis. I have written here based on my limited knowledge. Right people to consult regarding tuberculosis are physician/chest physician.

I hope this helps.
If you have any further queries do write to me. I want you to get back to normalcy at the earliest.

Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Ramadevi Wani (9 hours later)
Thank you so much for the detailed reply

I have been put on empirical att..but doc i still have some confusion regarding my correct diagnosis that whether mybproblem is because of pid ,tb or soft tissue track ,adhesions.

I know my question can bother u but pls i m very confused as despite taking medicines for last 25 days i m not getting much of relief.if my trck was indeed tu ercular( or not dont know)why the medicines are not showing effect,in fact the side effects are even bothersome

Is that possible mam that my track has turn necrotic after such a period of time as it was delayed in diagnosis and surgical excision is the only option left and if it t is so pls answer my point no 5 of erlier query.mybsurgeon has asked to wait for six weeks else will g0 for cect or diagnostic laproscopy

Mam plslet me know if it canbe cancerous problem like thing that has been missed off..how can i clear my dileema that if it is some cancerous lesion or not,had 8t been cancerous would it have been possible to see it on mri or usg or amyblood work..pls guide doc..my health is not getting better ..i wanr to ensure that it is not cancerous.is there any non invasive procedure to ensure that it is not cancer

I takeduplaac and sos naturolax forr motions for a long time is it safe nd for calcium can i take supracal and for iron orofer xt..pls suggest me some gud pre and probiotoc that can be taken with att

Can ayurvedic herbal med like liv 52 immunocare and herbocalcium also be taken with att..pls guide
doctor
Answered by Dr. Ramadevi Wani (13 hours later)
Brief Answer:
Detailed answer below

Detailed Answer:
Hi XXXXXXX
Welcome back.

Answer to number 5 question-- In my opinion the track should settle on its own. After 2 months of ATT treatment if there is no improvement in your health you can go for diagnostic laparoscopy. There is no problem with it. I would advise you to have laparoscopy with the endoscopic surgeon. In case there are mild to moderate adhesionsn she/he can deal with them.
The effect of treatment is appreciated usually after about 8 weeks of treatment. Probably that is the reason you are not seeing improvement now. Moreover the side effects of medicines are bothering you. Is the pain better now?
I also want to know whether you are doing normal day today activities or not. Have you started some sort of exercise/yoga? This is important for recovery.

Since the IGRA test was positive it is good that you have started ATT.
In my opinion your problem is most likely due to adhesions.
It is a very small track. I do not think it will turn necrotic. It is hard for me to believe that it is tubercular track. XXXXXXX I really cannot figure out why your mind is preoccupied with cancer. It is DEFINITELY NOT cancer.
The only confirmatory test is biopsy. There is no non invasive procedure to confirm or refute the diagnosis of cancer. Again I repeat it is NOT cancer.

Did you have constipation before pregnancy also? The problem with the laxatives is that if you continue to use laxatives your intestine may get accustomed to it. The cause should be found. Consult physician/surgeon.
As regards iron and calcium I have already answered before.
Take curds and butter milk regularly in your diet. Take Soy suppliments. These also have probiotic properties. Any pri and probiotic can be used after consulting your physician.
I am not an authority to comment on ayurvedic medicines.

I hope I have answered all your concerns. If you have any further queries do write to time.
Take care


Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Ramadevi Wani (34 hours later)
Thanks doc.

The pain is bit better now.for a day i feel its getting better,other time tht comes out to be same..apart from pain doc its the heaviness in my lower abdomen that is bothering me now the lower abdomwn feels heavy while coughing sneezing or laughing or turning as if somerhing is pushing or m8ving inside the morw discomfort is on left lower quadrant below navel and above scar.till the time i take meals it feels as if things are getting accumulated there and wen motions arevpassed that sweelling and discomfort reduces a bit ,but after some time wen again i take meals that bump forms again,,for this reason not able to take my diet properly
Can that be starting of incisional hernia(as told by one of my radiologist)
Yes doc i have started doing yoga.not able to do much exercise ,,doing daily activoties also,but feels lot of backache and bodyche like crackng sound from my body,
I was also siggested hifenac p or mr sos if there is severe pain.mam what pain killer or muscle relaxant is safe with att is hifinac mr safe.i feel i have become a godown of medicines

I didnt have constipation before or during pregnancy very much.just had problem of asthma before and during pregnancy and yes twice or thrice i had uti in pregnancy

Mam i have heard regarding a blood test of ca 125 ..what does that test denotes..may be that track is not cancerous,but i want to clear my doubta

Does these side effects of att happens with everyone or its with me only

Does taking att will help in the pelvic adhesions also whether tubercular or not
Have i took a right decision by starting att..i doubt might beproblem is somethong else and i m taking medic7nes for something else

Pls guide..does taking probiotics like darolac or sorbiline creates c8nstipation.for how long sorbiline can be taken
.
doctor
Answered by Dr. Ramadevi Wani (13 hours later)
Brief Answer:
The track is not cancer.

Detailed Answer:
Hi XXXXXXX
So happy to know that you are doing yoga/ exercises. Please do back strengthening exercises also. I would also suggest that you have massage twice weekly at least. This improves blood circulation and gives some relief from body ache.
I read your notes. I feel the heaviness what you are experiencing is partly due to belly fat deposited post delivery.
The pain is probably due to adhesions. With regular exercises your body immunity and resistance improves and the pain will subside. It is just a matter of time. Now take Hifinac sos only. You have used it enough.
From your notes I did not feel that it is the beginning of incisional hernia. However get examined from the surgeon.
Are you using salads and fruits in your diet? If yes, then you should not have this constipation. Hope it improves with this ATT. Otherwise you need thorough assessment by physician. XXXXXXX THE TRACK IS DEFINITELY NOT CANCER.
CA 125 is a protein. Its level in blood is measured to look for early signs of ovarian cancer in high risk women ( with family history of ovarian/breast cancer). THIS TEST SHOULD NOT BE DONE IN YOUR CASE. THERE IS NO INDICATION FOR IT. Please note that CA 125 can also be increased in normal conditions like menstruation and in non cancerous conditions like fibroids, endometriosis , pelvic infection etc.
Side effects of ATT occur to many patients. Some suffer even more severe side effects.It is not just you having the side effects.
ATT does not help in resolving non tubercular adhesions.
Since IGRA was positive I think you have done the right thing by taking ATT (Igra suggests infection but does not confirm disease). Don’t keep thinking about it. Complete the course of treatment.
Darolac and Sorbilin do not cause constipation. You may take Sorbilin for long periods without side effects. Infact contents in sorbilin in addition to helping liver also help relieve constipation. My worry is that its prolonged use may make your intestines get accustomed to it.
I hope I have answered all your concerns. If you have any further concerns do write to me. I will be happy to answer.

Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Ramadevi Wani (2 days later)
Thanks mam,

My pain is improving though the heaviness os nothering ,dont feel it is fat,it feels as of something os stuck..one of my radiologost said that because of weak abdominal wall and behining of inciosional hernia i m feeling the bowel movementswen my last usg was done 14 ays back
Doc sometimes i feel tingling and pinching numbness in my left body particullarly hand and my motions are restricting even taking duphalac and soferon ,,i feel dont get defectated properly i had my periods 1 week back.they were normal as in i didnt have much pain but post that above scar area on my left side more i feel something is stuck..can there be bowel obstruction because of this pelvic infection.

Mam i have a doubt of turning this track necrotic

Doc since my treatment was delayed for almost 4 months ,is it possible that if it is indeed tb,it has spread into other organs ,..for last three days my backache has increased and i feel itching and tingling in my body

I have also heard that att might cause hepatitis,,what would be preventive measures to check that earlier before happening

Nd mam if at all i need to go for diagnostic laproscopy(thought i want it to be tha last resort)does that further increaees problem of tubercular infection and further adhesions..and what are the usefulness of ahesion barriers like sprafilm and all.are they really effctive..can they be used in diagnostic laproscopy..do they help in future

Pls guide
doctor
Answered by Dr. Ramadevi Wani (17 hours later)
Brief Answer:
Detailed answer below.

Detailed Answer:
Hi XXXXXXX
Sorry for the delay in the reply. Yesterday was very busy day for me.
As regards heaviness in the lower abdomen please consult Surgeon to see if it is really a beginning of hernia.
Itching, tingling and numbness could be due to due to INH that you are taking. Please consult your doctor. Are you taking Pyridoxine? You must take at least 25-50 mg along with INH.
The track itself is very small. Just 14 mm. In my opinion even if tubercular, it should resolve.
Are you still taking iron tablets? Stop them and see whether constipation improves. Do take salads and fruits. Despite this if constipation is persistent, you need to consult physician.
ATT drugs can cause hepato toxicity in some. Just check your liver function tests every 4-6 weeks.
If it was tubercular disease the doctor during cesarean would have seen some evidence ( tubercles, adhesions etc). So there is no question of it spreading to other organs.
Diagnostic laparoscopy will not worsen tuberculosis or cause adhesions. Seprafilm is definitely effective in preventing adhesion formation. It can be used after releasing adhesions.
I hope this helps. If you have any further concerns do write to me. I will be happy to answer.

Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Ramadevi Wani (29 hours later)
Thanks for the reply and pls dont be sorry

Mam i hav3 gotmy blood work done tday..pls detail the abbrations in lft kftand specially crp,.can increase in crp because of my current health problem or is it because of some other reason like tissue injury or inflammation ..last month on 13 march it was 7.65.wen my esr has come down why there is still high value of crp..arewe still geosslymissing something or will it also settle slowly withatt..

Should intakezinase d, hifinac p again..i took it for 20 25 days in feb and ,arch which was floowed by serraptopeptidase alone for another 25 days cipzen forte..

Mam wen i started att i was taking rifampicin begore breakfast and rest of the thre post breakfast(in a span of 2 .3hours ,butnow i myself have changed it to rifampicn beforebreakfast followed by commim tablet of inh and ethambutol post breakfastamd pyranximide 1500 post lunch for last 1 week ..(i m taking akt4)
Can that causedrug resistance

I hve started feeling vaginal itching also..for that i m using lactacyd twicw a day..is this becauseof antibiotics what can be done..pls guide. Blood reports attached
doctor
Answered by Dr. Ramadevi Wani (2 hours later)
Brief Answer:
LFT and RFT are normal. Stop worrying

Detailed Answer:
Hi XXXXXXX
Welcome back.
I have gone through the reports.
Blood urea nitrogen below the normal range means that your kidneys are functioning very well. It does not indicate a problem. You should worry if it is above normal.
Low normal level of bilirubin again says your liver is functioning normally. A slightly higher level of SGPT does not mean anything. It is worrisome only when there is about three fold increase. So forget worrying about these things.
CRP is a marker for inflammation. It is decreasing. So hopefully it settles down to normal level gradually. Please note that if CRP is measured after exercise it will be increased. However regarding CRP please take opinion of your Physician/Chest physician.
There is no need to take Zinase or Hipanac-P.
Antibiotics can cause vaginal yeast infection. Do you have discharge too? Continue using lactacyd.
I hope I have answered all your concerns.
Do contact me if you have any further queries.
With best wishes,
Dr Rama

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Ramadevi Wani (2 days later)
Thanks mam,

For last two days ,i was having difficulty in passing motions so i took isabgoul husk,
Naturolax softvac 4 spoon simultaneoulsy..nd now feelung lot of discomfort in stomach as wen medicines were started for att..can overuse of laxative cause intentinal swelling tht i m feelung discomfort for last two days XXXXXXX the problem has returned

2.mam i started att on 1 .4.15,for 25 days i took rifampicin before breakfast and rest three post breakfast,.yes i m takung bendon 20 mg with akt 4..but post 25 april since i was having severe side effcects and malsise i adjusted the inrake of dose by takung rifampicin before breakfast and etehmbutol and isonizaid post breakfast and ptrnazimide 750 each after lunch..is that safe mam i know u ansewred this ,becouse i read somewhwre that they neccesarily have to be taken same time ,otherwise it can cause drug resiatance,....is tht really so..do theses medicines really have to be taken exactly at the same time on daily basis

Mam can cect show the reason for my abdominal discomfort,like tuberculosis or adhesions or intentinal sweeling or blockage..i m in my 5th week of att treatment..y do i feel ftereveryy two three days its returning ,,though pain is reduced,,sweeling still persists.more on left side and in a gap of some time it feels something is moving and touching my abdominal wall especially wen i cough sneeze or vomit or even lie straight on my left sid2 below navel..what could this denote..do i feel bowel movements and if yes y could they be so

doctor
Answered by Dr. Ramadevi Wani (13 hours later)
Brief Answer:
Deatiled answer below.

Detailed Answer:
Hi XXXXXXX
Welcome back.
You have used bulk laxatives. These may distend the intestines but with passing of stools you should feel good. Its overuse does not cause swelling of intestines. The discomfort probably is due to the adhesions or the side effect of medicines you are taking. It will settle down slowly.
You are asked to take all the tablets at the same time to make it easy for you to be regular in taking the tablets. As long as you are taking the tablets daily it shouldn’t matter. It does not result in drug resistance.
As of now there is no need to have CT. You probably have developed abdominal wall hernia. Did you consult the surgeon? If not please consult.

I hope this helps.
If you have any further queries do write to me.
I wish you good luck.
With best wishes,
Dr Rama
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Ramadevi Wani

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What does a positive IGRA test result indicate?

Brief Answer: Positive IGRA test is a marker for tubercular infection. Detailed Answer: Hi XXXXXXX Welcome back to Healthcare Magic. First tell me how are you feeling now? Have you started feeling better now? Your ADA levels are normal. Positive IGRA test is a marker for tubercular infection though not diagnostic of disease. Since you were not willing for diagnostic tests it is good that based on this test you have started ATT. Do you have any queries, do write to me. I will be happy to answer. Best wishes, Dr Rama