Dr. Kaushal Bhavsar
Pulmonology (Asthma Doctors)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I was diagnosed with tuberculosis of lymph node two days ago and started with four first-line tuberculosis drugs. And now my intensive phase finished last week. In the previous two weeks, I gained weight. But I feel tiredness and my legs feel tired all the time, and when I drink or eat anything cold, I start feeling soreness in my throat. I get normal after two or three days. I have no other medical conditions. Is it normal to feel tired and allergic to cold? Please advise.
Hello,
Welcome to icliniq.com. I understand your concern. I have gone through the images you have attached (attachment removed to protect the patient's identity). It is improving for sure. You also have gained weight, so no need to worry. Just finish six to eight months of treatment. Regarding cold allergies, this is not related to TB (tuberculosis). It might be an altogether different thing. Regarding fatigue, this can be due to anti-tuberculosis drugs. I suggest you to take good Multivitamin tablets containing Vitamin B6. Let me know if you take any other pills other than TB medicines. I hope this helps. Thank you.
Patient's Query
Hello doctor,
Thanks for your suggestion. Yes, I am taking Vitamin B6 25 mg per day, Vitamin D tablet once a month, and anti-tuberculosis drugs.
Hello,
Welcome back to icliniq.com. I suggest you get a blood test done for you to rule out the cause of tiredness, or may I know if you have any recent blood reports? Is CBC (complete blood count), thyroid, electrolytes, liver function test done before? Please follow up with the above reports. Thank you.
Patient's Query
Hi doctor,
Thank you for the response. I have attached my blood test report, which says everything is normal. But last week, I was feeling cold and sweaty, which got better in two days. My lump stopped discharging pus three weeks ago, but it again started discharging pus last week. Is this normal? By this month, I will complete three months of treatment. What can I do about this? Please help.
Hello,
Welcome back to icliniq.com. I can understand your concern. I have gone through the reports that you have attached (attachments removed to protect the patient's identity). All reports are normal. Regarding discharge, Please answer the following to guide you better, 1) Is it clear discharge? 2) Is the discharge foul-smelling? 3) Is there any pain present in that area? 4) Can you send me a recent picture of that area? 5) Which anti-TB drugs are you taking? Please reply to these questions so that I can guide you better. Thank you.
Patient's Query
Hello doctor,
I am taking the tablet Rifamate (Rifampin 600 mg and Isoniazid 300 mg) and Vitamin B6. And I also checked with a doctor. They did gene testing when I was diagnosed; no Rifampicin-resistant was found. And the discharge is very little in amounts like two or three drops in a day, and there is no smell. The consistency is thick yellowish. There is no pain, sometimes slight itchiness on top. What can I do? Please help.
Hi,
Welcome back to icliniq.com. I have gone through the image you have attached (attachments removed to protect the patient's identity). It is almost healed. There is no need to worry. I suggest you continue the same treatment, tablet Rifampicin, and tablet Isoniazid, with Vitamin B6. If possible, get a new ultrasound done to document improvement. Thank you.
Patient's Query
Hi doctor,
I went for a check-up today, and the doctor said it could be a paradoxical reaction. I am currently in another country, and they do not allow ultrasound straightway. My problem is that I have a persistent low-grade fever and chills with fatigue from more than a week, and I also lost around 2.2 lb weight, and my lump is discharging little pus around 2 or 3 drops a day. But my concern is if it is a paradoxical response, why I am feeling fever and chills day and night with sweating? I was getting better and gained around 11.02 lb of weight in the first two months, and my lump completely stopped discharging by the end of the second month, but why are my symptoms coming back now in 3 months? Is it possible to develop resistance during treatment? Or it could be due to a paradoxical response. I have never missed any dose or anything, and no resistance was found during the treatment. I am sharing the image of the lump with you. Please advise as I am worried.
Hello,
Welcome back to icliniq.com. I can understand your concern. I have gone through the images you have attached (attachment removed to protect the patient's identity). I do not think it is drug-resistant tuberculosis (TB) because improvement would not be seen if it is drug-resistant TB. It can be a paradoxical reaction. Usually, drug-resistant patients deteriorate from the beginning. But weight loss is not seen in paradoxical responses. In my opinion, this can be a secondary bacterial infection, other than TB. We need an ultrasound, pus culture, and CBC (complete blood count) to diagnose secondary bacterial infection. Please share the following details so that I can guide you better. 1. Is it possible to get these tests done? 2. Any other medicines (antibiotics) given after your last doctor visit? 3. Any antiseptic cream prescribed?
Patient's Query
Hello doctor,
I am sharing the reports with you as an attachment. I got the blood tests done yesterday. My doctor suggested that the reports were normal, and there was no need for antibiotics. Is it possible to have a secondary infection even if the report is not showing any abnormalities in complete blood count (CBC)? Also, I continuously feel weakness, feverish, and chills with mild sweating, and my appetite is also affected.
Hello,
Welcome back to icliniq.com. I can understand your concern. Yes, infection is possible even with normal blood reports. In my opinion, we should try a broad-spectrum antibiotic tablet Amoxicillin plus clavulanic acid for a week. It would be best if you continue your tuberculosis medicines and multivitamin tablets. If possible, get the ultrasound done. Hope I have solved your query. I will be happy to help you further. Wish you good health.
Patient's Query
Hello doctor,
I am sharing the image of the scar with you. What should be the further treatment? Please share your suggestion.
Hello,
Welcome back to icliniq.com. I can understand your concern. I have checked the image you shared (attachment removed to protect the patient's identity). It looks like healing scar only. However, I want to know more detail about you. 1. Is there any pain or discharge? 2. Are you experiencing any weight loss at present? 3. Are you stressed? Please reply to the above-asked questions so that I can guide you better. Wish you good health. Thanks.
Patient's Query
Hello doctor,
For the last couple of weeks, I have felt uncomfortable inside my neck lump area with minor soreness. However, there is no discharge, but it feels soft and cystic to touch, and I have had a weight loss of around 2.2 lb to 4.41 lb in the last two months. No other stressors, only worried about my health and treatment. Few things I want to mention. I also feel muscle weakness and low-grade fever at night and am sometimes sweaty, weak, and tired. I have attached a month-old picture that looks flat, and my today’s picture now feels like there is something like cystic tissue behind, which is increasing slowly from the last few weeks, which you see looks puffed out a bit. I am concerned about why my culture did not grow initially? Please share your suggestions.
Hello,
Welcome back to icliniq.com. I have gone through the images you have attached (attachment removed to protect the patient's identity). The best answer to your question is an ultrasound or CT (Computed tomography) scan to see the exact size, consistency, infection. 1. Is it possible to get an ultrasound or computed tomography (CT) neck done? 2. Regarding culture, you did not have drug resistance; your TB bacterial were drug-sensitive. 3. Do you have a culture report with you? 4. Can you send me your culture report? Please reply to the questions mentioned above so that I can guide you better.
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Pulmonology (Asthma Doctors)
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