Is A CT Scan Advisable For Diagnosis Of Tuberculosis?

Posted on Tue, 9 May 2017

Question: Hello

My daughter is detected with tb positive today.
Montoux reading : 25mm and x ray report says mild prominence of bronchovascular markings in bi lateral lung zone - s/o LRTI.
On the basis of this doc gave her anti tuberculosis drugs.
Do i need to go for second opinion..? A pediatric friend mentioned that I need to take her for CT SCAN as well...? What should I do

Answered by Dr. Deepak Patel (1 hour later)

Brief Answer:
CT scan should be done

Detailed Answer:
Hi,

Can understand your concerns.

In tuberculosis, there is history of chronic cough or low grade fever, or contact with a person of tuberculosis. Montoux test is positive that is more than 10 millimetre, X ray chest has prominent bronchovascular markings, ESR is raised, and sputum for AFP is positive.

If montoux test reading is more than 10 millimetre and x-ray is suggestive of prominence of bronchovascular markings then there is strong chance of tuberculosis. But I suggest you to do ESR levels also, and do a CT Scan because CT Scan will tell us that whether any lymph node swelling is present or not.

Montoux test is positive in most of the XXXXXXX population, because it denotes exposure to a person with tuberculosis. So, we also need some other evidence in addition to MT test for starting antitubercular drugs like increased ESR levels, lymph node swelling, and contact with a person with tuberculosis.

CT scan of chest will be helpful in diagnosis and should be done if there is any doubt.

I hope this will help you.
Wishing your child good health.
Take care.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Deepak Patel (22 hours later)

Hi.. so I went to another pediatrician today and she also mentioned that if the child was in contact with tb infected person so in that case also we start the medication and since she has skin test positive it is better to start. So i am doing the same BUT her regular pediatrician prescribed r cinex (100mg) + combutol (200mg) each to be taken 1 and a half tablet each day. But today another doc told me that for such small kids she doesnt give combutol instead she gives pyrizine 500 ( half tablet each day). So what's ur prefernce of medicine for 2.5 years old girl. Attached her reports as well.

Answered by Dr. Deepak Patel (18 minutes later)

Brief Answer:
All 4 drugs needs to be started

Detailed Answer:
Hi,
Welcome once again.

R-cinex contains isoniazid and rifampicin, combutol contains ethambutol and pyrizine contains pyrazinamide.

In case of 2.5 year old child, all 4 drugs should be started in intensive phase that is for 2 months, and after that 3 drugs are given in continuation phase for 4 months. This is according to dots regime followed in XXXXXXX

There is no protocol to stop it etambutol or pyrazinamide in a 2 year old child.

You can meet pulmonologist who can guide you in a better way. According to dots regime all 4 drugs should be given in intensive phase.

There no reports attached. Kindly attach the reports once again.

Take care.

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Vaishalee Punj