Is it fine to start treatment for TB before the test report comes positive?

Patient's Query

Hi doctor,

My father aged 62 had undergone the kidney stone removal on both the kidneys. But, after one week of removal he suffered frequent urination with heavy pain. We have tested urine culture report and result is negative. Again we took an UV scan and come to know that the bladder size is reduced in size. He has frequent urination for 30 minutes once but only little that too very pain while releasing. I would like to know the reason for reduction in bladder size. Doctor suspect that this could be due to TB and he said we continue the treatment with TB medicines. We gave AFB urine stain and culture for confirmation, but we will receive the result only after 6 weeks. Since my dad suffered with severe pain he told us to start TB tablets. I have attached the tablets he gave. Please provide your suggestion. We are so confused regarding the treatment. Shall I start giving those medicines? If AFB result comes negative what are all the side effects? Please clear my doubts.

Answer

Dr. Gopinath

Urology

Hi,

Welcome to icliniq.com.

I went through the reports and prescription (attachment removed to protect patient identity).

From the report he has a decreased renal function with increased serum creatinine levels as well as urinary infection seen as increased pus cells.

Whenever the culture is negative we have to presume that urinary tract tuberculosis is a possibility. Let us wait for the AFB culture (acid-fast bacteria).

I would better suggest urine PCR (protein creatinine ratio) for tuberculosis; three early morning samples to be collected before starting on anti-TB drugs (anti-tubercular).

He can be given anticholinergic drugs like Tolterodine as well.

I need to know the previous USG (ultrasound sonography) scan report, which is done before kidney stone removal to look for the bladder capacity.

The Probable causes:

Urinary tract infection.

Investigations to be done:

1. Urine PCR for TB (tuberculosis).
2. Need MCU (micturating cysto-urethrogram) if bladder capacity continues to be low

Treatment plan:

1. Capsule Terol (Tolterodine) 4 mg at night.
2. Tablet Urispas (Flavoxate hydrochloride) 200 mg twice a day.

Regarding follow up:

Revert back with the investigation reports to a urologist online.---> https://www.icliniq.com/ask-a-doctor-online/urologist

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Patient's Query

Hi doctor,

Thanks for the reply. I have attached the scan reports made before operation. Because of frequent urination they inserted tube with urine bag and asked to keep it for two weeks and provided TB tablets to continue (attached the prescription). How can we identify whether my father is suffering with TB without test and symptoms? Today he had vomiting after taking those tablets. Is this normal after TB tablets?

Answer

Dr. Gopinath

Urology

Hi,

Welcome back to icliniq.com

I went through the old reports (attachement removed to protect patient identity).

He had ureteric as well as renal calculus which was cleared. The present symptoms are not related to the stone disease and are suggestive of urinary tract infection in the bladder.

Since the urine culture report is negative we have to think and evaluate for urinary tract TB. This particular disease is difficult to diagnose.

Options left are urine AFB culture and Urine PCR for TB. However, anti-TB drugs based on symptoms alone is not advisable. We start ATT (anti-tubercular treatment) only after a laboratory evidence of the same.

Anti-TB drugs do cause gastritis which could be the reason for vomiting, for which you can add tablet Pantocid D (combination of Pantoprazole and Domperidone) twice a day before food.