Brief Answer:
Rule out reactivated Tuberculosis.

Detailed Answer:
Hi,
I have read your query and understand your concern.

As per the symptoms there should be an high index of suspicion for the development of pulmonary tuberculosis in patients treated with BCG therapy for papillary carcinoma of the bladder with 6+3 regimen.

Such patients are also at high risk developing rapid onset sepsis if not promptly treated with anti tuberculous treatment or broad spectrum antibiotics.

I strongly recommend you to have a urine culture with a sputum examination with or with out sputum culture to rule out tuberculosis.

I hope this info is helpful to you.
Thank you

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Brief Answer:
Lets await culture report

Detailed Answer:
Hi,Sir
i have gone through your Sputum AFB report.It came out normal.That's fine.
Lets wait for sputum culture.
I also recommend you to get urine culture and sensitivity and digital XRAY chest PA view meanwhile.
Review with reports.
Thank you

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Brief Answer:
Moxifloaxin plus TMP/SMZ is needed

Detailed Answer:
HI,Sir,
I have gone through your reports.

She seems to have non tuberculous chest infection and an asymptomatic urinary infection(asymptomatic bacteriuria).

The right choice of antibiotics in her case would be a 3 day course of Moxifloxacin and Trimethoprin/sulphamethoxazole9TMP/SMZ) each.

This would be absolutely clearing all her infection if any.

Note these drugs have to be taken under strict medical supervision.

Any chest or urinary symptoms have to treated aggressively with required antibiotics in future.

Post your queries if any.
Thank you

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Brief Answer:
These antibiotics microorganisms specific.

Detailed Answer:
Hi XXXXXXX

The antibiotics which I prescribed act strictly against the cultured ECOLI and not against the Mycobacterium bovis of intravesical BCG vaccine therapy.

Hence the efficacy of the intravesical therapy is not altered.

I request you to post your mother's discharge summary again as it is not visible on my home page.
Or you can send to YYYY@YYYY and subject as ATTN:Dr. Suresh Heijebu

Thank you

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Brief Answer:
Relapsed and resistant form of TCC bladder.

Detailed Answer:
HI XXXXXXX

I have carefully gone through the entire case summary of your mother.

I Find few interesting and delayed management options in this case.

1.This is a definite case of a relapsed form of bladder cancer.

2.It has converted form low grade to high grade TCC insipte of 3 TURBTS and one 6+3 regimen of BCG immunotherapy.

3.In my opinion the basic cause for relapse would be;

a)Failure to detect early invasive component by TURBT.
b)Delayed initiation of BCG therapy.
c)No use of intravesical chemotherapy at any stage.
d)BCG immunotherapy should have been used for one full year.
e)left sided urethral orifice on visualisation has not been attended for a long time until HDN develop


The antibiotics mentioned in my earlier answer can be safely used in this case in times of urinary tract infectons.

THANK YOU

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