Question: My wife is 24 years old. She weighs abt 45 kgs with height of 5foot 5 inches. She complained of neck pain, weakness, low appetite

She got diagnosed with pulmonary and multifocal skeletal tuberculosis involving spine with paravertebral access around c2, l2.
Her esr was 98, lymphocyte count 11, platelets 5.2 and Manton negative(post tb drugs usage)

We started 3weeks back with rcin 450, isokin300, patina 1000, combustol 800

For 1st week we also used zerodol. She showed increased appetite and reduction in pain
Post withdrawing above(paracetmol) , we notice fever between 99 and 101 after abt 4hoyrs of taking drugs lasting till 8_10 hours. There is also weakness drowsiness, lot of sleep and preference to lie down


Is this normal response to drugs or any cause to worry

1. Haven't ruled out mdr

2.flam test was ordered but since there was no cough, we couldn't do it.
We thought about taking sample from lung, but they said not too much fluid is there

3.right from the start, our doctor(pulmo) has been suggesting steroids. However, spine doctor dint agree. It was agreed to review it after a month of treatment

4. Weight has been constant or marginal rise since treatment started. Only thing noticed is weakness and sleepiness particularly post drugs. Also doesn't prefer to walk much or sit for a very long time

Hi Sir,

Uploaded XRAY, CT, Blood Haemogram at start of treatment. Plz go through it. Also have taken mri of entire spine

Xray says-left pleural cavity is obliterated , increased bronchial vascular markings

CT says
destructive lesions involving c6,c7 with preverterbral abcess extending drom c4 to d2
lytic lesion seen involving L1, with paravertebral abcess from d12-L1

centrilobular nodules in tree in bud pattern in both upper lobes, right middle lobe, left lingual with minimal pleural effusion and mediastinal adeopathy

Currently she is taking the following in addition to tb drugs

1. Becouseles

2. Shelcal

3. Nuroday h

4.d rise

Apart from this milk with protein ex and high protein diet

Sir,

Answer to above questions
1. First episode of tb. Her mother had spine surgery due to tb 3 yrs back
2.No check made for diabetes

Post our discussion,
1. Fever reduced completely
2.her neck pain etc got much better
3.Nausea,vomiting in evening, reduced appetite and sensitivity to smell
We did a LFT and blood test post completing her 1 month treatment
1. Due to high levels of ast/alt, one opinion is to remove rcin,isokin,pyzima and introduce mycloxin and streptomycin injection (prescription attached)


2. Other line is not to stop drugs as she is responding very well. For aiding liver, uniliv 300 mg prescribed 2 times a day

3. Moved treatment from day to night

Post taking Rcin,isokin,pyzina,combutol yesterday morning, today she took all in the evening

1.she had no symptoms in day
Increased energy
2.increased diet
3. After taking rcin at 7.30 pm, checked temperature at 9.30 pm. It was 100 F. At 11.30 it came down to 98
4.craving for food in the nught
5. Took isokin at 9.30,pyzina-10pm, combutol 10.30pm

Extremely scared that she wil develop resistance to first line. That's why resisting changing treatment. If we can manage it for 1 month. Bilirubin levels are changed

Also scared seeing the change today after changing time of drugs.

Attaching all prescriptions. Please suggest on course, any doc u know in XXXXXXX is it beneficial to admit her

Sir,

What are the risks of continuing with the current line of treatment?
How common is it?

Can we continuously monitor LFT and carry on same treatment?

Is there any absolute level in LFT beyond which we can in no circumstances continue and have to change drugs?

Seeing the response only, we are disinclined to change

Also is streptomycin effective? Is it the right dosage suggested?

Sir,

Attaching reports for your reference

1. Bilirubin level is unchanged at 0.6

2.sgpt/sgot was done at start of treatment and wee normal at 21,20

She was having nausea and vomiting. Appetite reduced as a result. She was having lunch and breakfast. Around dinner time she used eat fruits only and vomit if taking milk

Not using any other drugs

We shifted to drugs to night from day. She is finding it better. Is treatment in the day more effective