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What Do My Lab Test Reports Indicate?

Posted on Tue, 25 Aug 2015

Question: Dear Doctor : we did CT guided biopsy and culture report for the abcesses before starting the treatment for spine tb. Recently we got the culture report on 16th july which was after 3 months of treatment of spine tb with akt-4 medicines. Culture Report says Resistant to 1st line drugs of tb i.e.(isoniazid,Rifampicin,Pyrazinamide,Ethambutol) and sensitive to second line medicines (ciprofloxacin,Levofolxacin,Ofloxacin,Amikacin,Kanamycin,Amino Salicylic Acid). Currently My husband is still on AKT -4 and doc has suggested to start taking Akurit-4. When we shown this sensitivity report to doc and asked him if my husband tb was resistant to 1st line medicines than how he responded well to 1st line medicines and ESR and CRP was reduce, 9 kgs weight gain and pain relief in 3 months . He did not had any answer to this and suggest to consult infection specialist. My Questions 1> Is it possible 1st line dosage work on MDR tb. if no how come my husband infection reduce with 1st line tb medicines. 2> Is it possible that my husband actually got inffected with MDR tb bacteria but because he did not had history of tb previously, he actually got with primary line infection and hence the 1st line tb medicines are working. currently his ESR readings are 25(reduce from 91 in 3 months) and CRP is 9.71 ( reduces from 107 in 3 months).

Answered by Dr. Divakara (25 hours later)

Brief Answer:
Seems he was infected with MDR TB from the beginning.

Detailed Answer:
HI

Thanks for the follow up.

Question 1 : NO first line drug will not work totally on MDR TB but it works partially giving some partial improvement . But once the course of 1st line medications are over within few months the TB will relapse.

Question 2 : See either your husband got infected from the beginning with MDR TB bacteria or initially he was infected with Non MDR TB bacteria ( usually TB bacteria ) and later it might have got changed to MDR TB due to improper medications. ( not in your husband's case )

Hope this answers your query.
Any clarifications feel free to ask.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Divakara (11 hours later)

Thanks for the answer.But with 1st line medicines which are resistant, will it improve/bring down ESR and CRP so much?Also is immune system has any thing to do to bring down ESR and CRP at this level.

Also if person is having MDR tb but he is not aware of it or do not have any symptons. dose that mean his immune system is fighting with it internally and is it something to do with WBC count.

can person affected with TB can get pregnant and deliver a healthy baby without any issue

Answered by Dr. Divakara (7 hours later)

Brief Answer:
If Tb is controlled she can get pregnant.

Detailed Answer:
HI

See ESR and CRP are very non Specific tests. They are increased in al most any disease , from simple viral infection to cancers. Actually they represent the body's immune reaction to the disease.

Well as said earlier 1st line medications do have partial effect on MDR TB Bacteria and hence can bring down ESR and CRP.

Well as of my knowledge human body's immune system is not competent enough to fight and cure MDR TB, but all said and done there can be exceptions for my statement where the body's defence can fight MDR TB and heal it.

If the persons TB is under control then definitely she can get Pregnant.

Hope this information was useful to you.
Any clarifications feel free to ask.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Divakara (3 hours later)

Dear Doc,

Thanks a lot for answering the queries. I have few more queries.
1>When you say under controlled tb, what does that mean, how much under controlled?
2>As you have seen the Culture report. what you suggest depending on report.
which sensitivity medicines should my husband start along with first line.
3>Appreciate if you could refer any infection specialist from XXXXXXX any contacts.
whom we can meet and take opinion.

Regards,
XXXX

one more - Is potts spine contagious, what precautions should we take?

Answered by Dr. Divakara (4 hours later)

Brief Answer:
No its not contagious.

Detailed Answer:
HI

Pott's Spine ( TB Spine ) is not contagious .

TB under control means --

1. Most important is the symptoms by which the TB was diagnosed has to come down. If cough was the symptoms then cough has to subside , if headache was the symptom then headache has to subside....

2. General well being of patient.

3. Absence of fever, improvement in appetite and weight gain .

Coming to treatment , I would recommend you redo the test in a RNTCP certified laboratories or meet your district Tuberculosis Officer, if the repeat test also confirms that it is MDR TB then treatment will be initiated.

Treatment includes a combination of 6 drugs for 6-9 months followed by combination of 4 drugs for 18 months ( So a total of 24-27 months treatment )

Sorry I don't know any Infectious disease specialist in XXXXXXX but I recommend you meet your District Tuberculosis Officer. He is the right person.

Hope this information helps.
Any clarifications feel free to ask.

Regards

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar