[MERGED] Tuberculosis

[nytowlmom]

to give you a background, last january 10 2012 I have undergone wide excision of left breast mass which had a histopath - granulomatous mastitis with abscess formation. than last April, I experienced same symptoms then develop a mass this time on my right breast and i again had excision of right breast mass with the same biopsy result - granulomatous mastitis with abscess formation.

I'm relieved knowing that the side effects will subside with time. cause I'm about to call my doctor tom and let him know. Thanks!

[nytowlmom]

The effects of anti-TB drugs can subside with time.There are no "replacements" or alternatives except maybe for switching brands which sometimes works with medications (the so-called "mas hiyang" for a particular brand though they're supposed to have the same components).

I don't know your case but PPD is a really poor way of diagnosing TB. In fact it is almost useless in adults. A positive test only means you were exposed to TB sometimes in the past.

what if I was really exposed to TB in the past is it possible that I was infected and the bacteria lies dormant for sometime (and I'm not aware and was not treated) then it only manifests now that I'm older?

[Les]

Yes, it is established that TB can lie dormant in the body and reactivate, especially when there is a decline in the immune system's activity. Thus in people who develop TB, the bacilli could have been acquired at any time in the past (a process called infection), and these people are the ones who become PPD positive.

[kanlat16]

Normal lang po ba yung tingling sensation sa legs while taking myrin forte? Hassle kasi, hirap matulog, ano po ba gamot nito? May vit.b naman akong iniinom

[cyberniz]

Hi, Po sa lahat ng doctors and users here:

Share ko lang po yung experience ko sakit ng PTB ..

Last March 27 2012, i was diagnosed na my sakit daw ako na PTB before kc complain ko na di na ako nawawalan ng ubo at sipon for almost 1month so i decided na pa check na dun sa MMC , then my pulmo doctors advise me to get an X-RAY: e2 yung request sample:
Request for chest x-ray
- PA
- Apicolordotic view

e d un na x-ray na ako dun sa PHIL-CARE kc covered kami ng philcare or HMO, then after 3 days result was released and e2 *** findings ng radiologist..
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Apicolordotic view in correlation with chest PA study date 3/27/12/ confirms the presence of the fibrotic densities in the left upper lobe.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

So un pinabasa ko un sa in house doctors ng PHILCARE then sabi nya my history daw ba ako ng TB dati? , sabi ko wala nmn kc last year lang din ako nag pa xray para sa pre employment den wala nmn silng nakita, then next question nya ano daw ba ang nararam daman ko now.

sabi ko my onting whizzing sa pag hinga ko and di ako nawalan ng ubo at sipon for almost a month.
any others symptoms :
Fever: wala
night sweats: wala
lost appetite: normal lang
previous weight is 56 kg & 5"8 height
23 yrs old
current weight after 2months: 58.6kg

so un sabi nga ng doctor meron daw ako TB pero minimal lang daw, and then di nala ko agad *** xray result dun sa PULMO ko dun sa MMC then d rin siya satisfied dun sa findings ng radiologist *** pinabasa nya dun sa radiologist nila. so confirmed nga daw meron akong PTB.. sympre d ako maka paniwala kc sa dinami dami ng sakit un pa . so un nga nag start nko ng take ng medicine e2 *** t n take ko..

FIXCOM 4 for 2months ..
BITAMIN: POLYNERV 500
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

then e2 na sympre tapos na ko sa 2months ko sa wakas! ready for follow up check up .. last May 29 2012 nag pag xray ako ulit then nakuha ko *** result nya today May 31 2012.

then e2 result.. ng x-ray
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Apicolordotic view in correlation with chest PA study date 5/29/12 shows no indicating parenchymal infiltrates or nodules .

Conclusion: No significant chest findings..
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

So Pagka basa ko palang first lines it looks good news na, in fact na happy dance pa nga ko pag kabasa ko eh.. ahaha.

anyway un nga dina la ko agad sa pulmo ko then sabi nga nya ok na daw clear na daw for PTB .

DOC : QUESTION ko **

1: *** spot kc na pinag hihininalaan nila nung una nandun parin nmn sa second x-ray , naka circle kc *** unang x-ray *** ma compare mo tlaga.
2: possible po ba na nag kamali lang talaga *** first reading ng xray ko, or *** spot na nakita nla nung una is normal lang talaga?
3: tama po ba fixcom3 pang maintenance for for months , kc advise nya e2loy ko parin daw un gamot eh..
4: possible po ba un within 2 months all cleared na lahat pati yung scarring na tinatawag?

Doc Les or Doc Kram

pasencya na po medyo napa haba yun kwento sana masagot nyo confused lang talga ako
but of course thankful kc cleared nko ..

Huge Thanks in advance.

BTW. napaka helpful ng thread na to..

[K_r_a_m]

kanlat16: Yes it may be due to your anti-PTB medicines. It is important to inform your physician regarding your complaints. He/she may revise your medicines.

cyberniz: Good on you! Having a clear chest x-ray to a person diagnosed with PTB truly is great news.
1. I'm sorry, I cannot understand the question because of the ****. Maybe you can rephrase or change the spelling of the words.
2. Though radiologists can also make mistakes, it is not common for them to misread a finding, especially a "spot" in the lungs as normal.
3. Yes I agree. You have to take it for 4 months.
4. Yes it is possible. No one knows how long the lesions disappear but the important thing is it has disappeared.

[Nelissa_sanchez]

Hi! Iam a med student and my dad also is currently treating for Tuberculosis. Medicines for TB includes a package :

For two months of treatment you have to take:
RIFAMPICIN
ETHAMBUTOL
ISONIAZID (INH)
PYRAZINAMIDE

For the next 4 months (maintenance) you only have to take:
RIFAMPICIN
ISONIAZID

SO the treatment period will last for 6 months.

Remember to take VIT. B6 together with ISONIAZID or INH because VIT. B6 forms a complex with ISONIAZID

Can I precribed this to my 29yo Brother? kahapon lang namin nalaman na may TB sya.. *** *** pumayat sya.. pero magana namang syang kumain.

thanks thanks sa sasagot

[K_r_a_m]

^^ It would be best if you let him seek a physician first. Let the physician give the medicines because they are computed by weight.

[gumer123]

Hello Doc. Im a newbie here. ask ko lang po kung pwede pa rin ba magstart sa work while curing PTB? because nung nag undergo ako ng pre-employment medical examination, May nakita raw silang spot sa Lungs ko. There will be a possibility na I have a TB. BTW I'm working in a call center. Thanks

[K_r_a_m]

^^ Usually, one is allowed to work 2 weeks after starting the anti-PTB medicines, since in theory they are not contagious anymore. A spot in the lungs seen on chest x-ray can be anything from an active PTB to a granuloma and etc. It would be best to undergo further tests to ensure that you have PTB.

[Einaphet]

Hi, my husband has been diagnosed with tb pleurisy 3 weeks ago and before that his main complaint was fever that doesn't go away and back pain. He was confined for almost a week due to pleural effusion and was started on anti-tb meds, quadtabs 4x a day. When he was discharged, he felt a lot better and akala namen tuloy tuloy na but on his 3rd week of medication he just feels as though the condition is getting worse, I know there are side effects but isn't it suppose to make you atleast feel a little better? First week of taking quadtabs he had rashes and some loose stools, on the 2nd week the fever came back again he has low grade fever every night and the back pain came back again and 3 days ago he started to experience nausea and vomiting. Anyone here who share the same experience? It really breaks my heart seeing him almost always in pain and he is just too weak. When do we see improvement in his symptoms after taking the meds? Any inputs would be greatly appreciated. TIA!

[Les]

Those symptoms are not necessarily related to TB (or its worsening) but could be side effects of the medications. Please have him follow-up with his doctor if the symptoms persist and/or worsen.

[starlily]

Hello! Last June 2 I had my pre-employment medical exam. I got my xray result suggesting to have an apicolordotic view bec i have a suspicious density in my left upper lung field. Then when i got my 2nd xray the impression was pulmonary tb. I was really shock bec i dont have any symptoms like cough, fever and weight loss. The doctor advised me to have afb but my problem is i can't expectorate sputum instead i spit saliva. I did it so many times trying to cough hard but i just can't. I'm frustrated and sad . Pls. Help me. I what should i do in order to expectorate a sputum instead of saliva. And is it possible that the result of the xray could be wrong or just wrong diagnosis? Thank you in advance.

[atom05]

Hi po i was diagnosed with PTB BUL last march 6, 2012 tpos niresetahan ako ng rimactazid 450 mg. take ko daw ng 3 months then have another CRX natapos ko na yung 3 moths with rimactazid and nagpaCRX na din ako at ang result ay retrogressive right na *** clear na ang left at ituloy lang daw ang pag inom same med rimactazid 450mg din. Ask ko lang po Doc is diba dapat ang pag gamot ng TB is with RIFAMPICIN, ETHAMBUTOL,
ISONIAZID (INH),PYRAZINAMIDE pero yung gamot ko is with rifampicin and isoniazid ok lang po ba yun?

[Les]

Hello! Last June 2 I had my pre-employment medical exam. I got my xray result suggesting to have an apicolordotic view bec i have a suspicious density in my left upper lung field. Then when i got my 2nd xray the impression was pulmonary tb. I was really shock bec i dont have any symptoms like cough, fever and weight loss. The doctor advised me to have afb but my problem is i can't expectorate sputum instead i spit saliva. I did it so many times trying to cough hard but i just can't. I'm frustrated and sad . Pls. Help me. I what should i do in order to expectorate a sputum instead of saliva. And is it possible that the result of the xray could be wrong or just wrong diagnosis? Thank you in advance.

You should have sputum induction done. This is just nebulization with saline solution. However I'm not sure which places offer this.

[Les]

Hi po i was diagnosed with PTB BUL last march 6, 2012 tpos niresetahan ako ng rimactazid 450 mg. take ko daw ng 3 months then have another CRX natapos ko na yung 3 moths with rimactazid and nagpaCRX na din ako at ang result ay retrogressive right na *** clear na ang left at ituloy lang daw ang pag inom same med rimactazid 450mg din. Ask ko lang po Doc is diba dapat ang pag gamot ng TB is with RIFAMPICIN, ETHAMBUTOL,
ISONIAZID (INH),PYRAZINAMIDE pero yung gamot ko is with rifampicin and isoniazid ok lang po ba yun?

Are you sure that was what was prescribed to you? The standard anti-PTB regimen consists of 4 drugs (INH, rifampicin, ethambutol, pyrazinamide) taken for 2 months (called the intensive phase) and 2 drugs (INH, rifampicin) taken for 4 months (called the maintenance or continuation phase) for a total of 6 months. Using just 2 drugs for initial therapy is unacceptable as this might lead to treatment failure, or worse, development of drug-resistant tuberculosis.

If this what was really prescribed to you then I suggest you switch to another doctor, preferably a pulmonologist, so that the error can be rectified somehow.

[starlily]

Thank you doc! I will visit a pulmonologist and i will ask/tell him your suggestion. Doc, is it possible that the result of the x-ray could be wrong? Or misdiagnosed? Thank you again!

[atom05]

Are you sure that was what was prescribed to you? The standard anti-PTB regimen consists of 4 drugs (INH, rifampicin, ethambutol, pyrazinamide) taken for 2 months (called the intensive phase) and 2 drugs (INH, rifampicin) taken for 4 months (called the maintenance or continuation phase) for a total of 6 months. Using just 2 drugs for initial therapy is unacceptable as this might lead to treatment failure, or worse, development of drug-resistant tuberculosis.

If this what was really prescribed to you then I suggest you switch to another doctor, preferably a pulmonologist, so that the error can be rectified somehow.

thanks for the reply Doc Les, here's my case kasi my previous case na po ako ng PTB last 2009 pa tapos nireseta sa akin is Myrin P forte for 6 months kaso na take ko lang is 3 months nagstop po ako dahil sa nawalan ako ng work nun at kapos sa pambili ng mga gamot ko, nagpunta ako nun sa DOTS kaso sabi nila pag mga patient daw na nagpaconsulta sa mga private clinic di nila tinatanggap, mga new case lang daw ang tinatanggap nila para daw masubaybayan nila. After 3 years ito ngang march 6, 2012 ay nagpaCRX ako at ang findings nga ay PTB BUL. At nagpunta ako sa same doctor ko last 2009 at siya ang nagreseta sa akin ng Rimactazid 450mg. for 3 months daw kasi sabi niya ay scarring na daw ang sa right upper lobe ko at ang mga nakita sa BUL ko ay mga infiltrates daw. ako din nagsabi na dati kong gamot ay Myrin P forte at nagrequest ako sa Doc ko kung may pwede bang ibang gamot kasi baka di na sa akin effective at baka magig DRTB ako kaya rimactazid 450mg. ang binigay nya sa akin. kaya after 3 months ng medication with rimactazid ay nagpafollowup CRX ako at ang findings nga ay Retrogressive ryt na lang clear na daw ang left wala na ang mga infiltrates. Kaya sabi sa akin ng doctor ko ay continue lang daw ang paginom ng gamot xe effective naman daw sya sa akin at pagaling na daw ako. Kaya lang curiuos po ako xe Rifampicin at Isoniazid *** ang combination ng gamot ko pero naging OK naman ang conditon ko. Mali ba ang iniinom kong gamot? Thank again...

[Les]

thanks for the reply Doc Les, here's my case kasi my previous case na po ako ng PTB last 2009 pa tapos nireseta sa akin is Myrin P forte for 6 months kaso na take ko lang is 3 months nagstop po ako dahil sa nawalan ako ng work nun at kapos sa pambili ng mga gamot ko, nagpunta ako nun sa DOTS kaso sabi nila pag mga patient daw na nagpaconsulta sa mga private clinic di nila tinatanggap, mga new case lang daw ang tinatanggap nila para daw masubaybayan nila. After 3 years ito ngang march 6, 2012 ay nagpaCRX ako at ang findings nga ay PTB BUL. At nagpunta ako sa same doctor ko last 2009 at siya ang nagreseta sa akin ng Rimactazid 450mg. for 3 months daw kasi sabi niya ay scarring na daw ang sa right upper lobe ko at ang mga nakita sa BUL ko ay mga infiltrates daw. ako din nagsabi na dati kong gamot ay Myrin P forte at nagrequest ako sa Doc ko kung may pwede bang ibang gamot kasi baka di na sa akin effective at baka magig DRTB ako kaya rimactazid 450mg. ang binigay nya sa akin. kaya after 3 months ng medication with rimactazid ay nagpafollowup CRX ako at ang findings nga ay Retrogressive ryt na lang clear na daw ang left wala na ang mga infiltrates. Kaya sabi sa akin ng doctor ko ay continue lang daw ang paginom ng gamot xe effective naman daw sya sa akin at pagaling na daw ako. Kaya lang curiuos po ako xe Rifampicin at Isoniazid *** ang combination ng gamot ko pero naging OK naman ang conditon ko. Mali ba ang iniinom kong gamot? Thank again...

Frankly, the additional data given by your story makes things worse. Since your original treatment was not finished and you are being re-treated, your status is that of a defaulter (sometimes called Return After Default). Defaulters are those that have taken at least 1 month of treatment and return after at least two months of interruption. For this category the local PTB guidelines advise an 8-month regimen with the first 2 months consisting of 5 drugs (addition of streptomycin, which is given via injection), the next month with 4 drugs, and the last 5 months on three drugs. Thus considering that you are just being given 2 drugs, your regimen is grossly inadequate and there is a high risk of your TB being under-treated, regardless of what changes are seen on the x-ray. You are also at risk of developing drug-resistant TB, which is the thing you were trying to avoid in the first place.

To be very blunt about it, your drug regimen is very wrong. I strongly advise you to seek consultation with another doctor.

[Les]

Thank you doc! I will visit a pulmonologist and i will ask/tell him your suggestion. Doc, is it possible that the result of the x-ray could be wrong? Or misdiagnosed? Thank you again!

An x-ray by itself is just one of the tools in arriving at the diagnosis of PTB. Other factors that need to be considered include presence or absence of symptoms, previous PTB diagnosis and treatment, and of course other labs like the sputum examination. However, since you already had two x-rays and the apicolordotic one confirmed the presence of infiltrates then there's reasonable grounds for considering PTB despite the absence of symptoms. At this point some doctors might start PTB treatment while others might monitor the lesion with serial x-rays (x-rays done every few months). Both approaches are reasonable, the former being justified by the high prevalence of TB in the country while the latter is justified by the possibility that the patient might not have active PTB (lack of symptoms) and the lesion seen is just a scar from previous PTB.