Dr. Prabhu Prasad N. C
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,
Tuberculosis (TB) lymph node recurrence was detected for the second time after a gap of two years. I got one lymph node removed surgically. Gene X pt report confirmed positive, and bacteria show no resistance to Rifampicin. A culture test with a sensitivity test will take over two months. I need consultation for the best line of treatment. I was given standard anti tuberculosis therapy (ATT) medication given for an extended period of 2 years before three years. Symptoms like fever and pus discharge from the neck lymph node disappeared after the Rifampicin dose is increased two times the normal. I need guidance for the future course of action, medication, and one to one chat to understand and address the concerns.
Hello,
Welcome to icliniq.com. It looks like a relapse of your TB (tuberculosis) lymph node. As Rifampicin is sensitive, you can start on presumptive TB treatment for sensitive TB infection. The recommended regimen is category 2, according to revised national tuberculosis programme (RNTCP). And ask for DST (drug susceptibility testing) on culture and also send the pus for gram stain and c/s.
Patient's Query
Thank you doctor,
Since earlier Rifampicin anti tuberculosis treatment (ATT) did not eliminate bacteria, how can the same treatment do the job this time? How serious is this relapse? Will it be possible to eliminate bacteria this time? Considering that earlier treatment was for two years. We want to consult you on the phone. Shall we do it now? What is RNTCP and gram stain, and c/s? How and where is it done?
Hello,
Welcome back to icliniq.com. I think it needs proper discussion and understanding. revised national tuberculosis control programme (RNTCP) is a Government system for tuberculosis (TB) treatment and gram stain, and c/s is the test you need to send after collecting the pus discharging from the node in any of the labs. I can share a consultation slot.
Patient's Query
Thank you doctor,
We went to the hospital for the removal of stitches. Mycobacterium tuberculosis (MTB) detected low, is the Gene Xpert finding. Please advise. What is the treatment prescribed for it?
Hello,
Welcome back to icliniq.com. First, you need to ask for lipoprotein a (LPA), mycobacteria growth indicator tube (MGIT), tuberculosis (TB) culture, and first and second-line dexamethasone suppression test (DST) on the sample, MTB-detected low sample, and start on second category treatment. According to body weight, you need to start on HRZES, Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and injection Streptomycin. And please take any infectious disease specialist opinion also.
Patient's Query
Thank you doctor,
We have started on all drugs except Streptomycin. Is Streptomycin necessary? Is it alright until other test reports come? Please tell me how long this second category treatment will have to be continued?
Hello,
Welcome back to icliniq.com. Streptomycin is very important for tuberculosis relapse. It is better to start as early as possible. Usually, tuberculosis (TB) treatment for the first time is given for a maximum of one year, but I could not understand why you were given for two years, and for the second time like your case will range up to one year.
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Pulmonology (Asthma Doctors)
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