Can TB recur despite taking a complete course of medicines?

Question

Hello doctor,

I had pulmonary TB and underwent six months of continuous medication as suggested by the doctor. There was blood in the sputum a few times, and the sputum test showed negative. However, based on the CT scan (computerized tomography), my doctor suspected pulmonary TB. I was recommended medicine for six months. I gained 6.61 pounds weight, and there was no blood in the sputum during this period.

The medicine was completed last week, and I visited the doctor. This time again CT scan was done and the report is attached. The doctor says there are significant improvements, but still some suspicious nodules that may be active in a rare case of 1 to 2 percent. He suggests extending the medicine for another three months.

I consulted another doctor based on the same CT scan, and he said there was no need to extend the medicine. There will always be a 1 to 2 percent chance of TB recurring, even after taking medicine for another three months. He says that since TB was detected early and sputum was negative, there is no need to extend medicine. I have attached the first and last CT scan reports for your reference. These are some queries in this regard.

1) What does the current CT scan report say about TB?

2) Should I take TB medicine for another three months?

3) Is there always a 1 to 2 percent chance of TB recurring even after the completion of medicine?

4) Is there any chance of TB getting drug resistance if it happens again?

5) Can I be sure that I do not have drug-resistant TB right now?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through both the CT scans and reports (attachment removed to protect patient identity). It is good that you have completed six months of TB (tuberculosis, an infectious disease that most often affects the lungs) treatment in spite of the sputum test being negative. Even though the sputum test for AFB ( acid-fast bacillus) was negative, the symptoms and CT scan were suggestive of active TB before six months. Now, the CT scan is showing signs of healed fibronodular shadows, but we can not decide whether this is active TB or not at present, just on the basis of the CT scan report.

For that, we have to consider:

1. If there are any symptoms at present or not.

2. What is the status of the sputum AFB test now, whether positive or negative?

3. If the sputum test is negative, then we should do an induced sputum test after nebulization with saline or perform a bronchoscopy test, a kind of endoscopy of the lungs, and collect sputum samples through the scope.

Regarding extension of treatment, it is always the decision of the treating doctor to extend the medicines for an extra three months, based on the sputum report or if any active symptoms, as there is always a chance of some residual infection or reinfection with TB bacteria. Also, we can do a Bactec test (provides a full line of blood culture media developed specifically for the detection of aerobes, anaerobes, yeast, fungi, and mycobacteria) of sputum to find out whether it is drug-resistant TB or not and decide the appropriate medicines.

So, it is advisable to discuss all these things with the treating doctor, and based on the fresh reports, to decide whether to extend the same medicines for three months more or to start new medicines.

I hope all your queries are clear now. Simultaneously you should concentrate on the high-protein diet, and avoid junk food.

Please let me know if you need any help.

Thank you.