Q. What are the chances for TB to recur after completion of medicine?

Answered by
Dr. Amolkumar W Diwan
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Apr 20, 2019

Hello doctor,

I had pulmonary TB and undergone six months of continuous medication as suggested by the doctor. There was blood in sputum few times and sputum test showed negative but based on CT scan doctor suspected pulmonary TB. I was recommended medicine for six months. I gained 3 kg weight and there was no blood in 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 a significant improvement but still some suspicious nodules that may be active in a rare case of 1 to 2 percent. He suggests extending medicine for another three months.

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

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

2) Whether should I take TB medicine for another three months?

3) Is there always 1 to 2 percent chance of TB recurring even after 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 resistance TB right now?

#

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 treatment in spite of the sputum test being negative. Even though the sputum test for AFB 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 cannot decide whether this is active TB at present or not just on the basis of CT scan report.

For that, we have to consider, if there are any symptoms at present or not, second now what is the status of sputum AFB test whether positive or negative and if sputum test is negative then we should do induced sputum test after nebulization with saline or perform bronchoscopy test, a kind of endoscopy of lungs and collect sputum sample through the scope.

Regarding extension of treatment, it is always the decision of treating doctor to extend the medicines for extra three months, based on 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 Bactec test of sputum to find out whether it is drug-resistant TB or not and decide the appropriate medicines based on the Bactec test report.

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. All the best and take care.


Investigations to be done:

Sputum AFB test, bronchoscopy to collect sputum directly from the lungs.

Treatment plan:

It should be based upon the results of fresh sputum test.


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