my doctor diagnosed after having done a MANTOUX TEST,X-RAY in chest & FNAC in neck.Is this the right way to diagnose TB? after one month of taking this medicine my swelling in neck is getting bigger. now doctor rx be injection for 2 months "STREPTOMYCIN INJECTION IP AMBISTRYN-S 0.75GM"? why this injection has been rx.
Infectious Diseases - 2 Answers
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1 :
cdc.gov + TB, or go to your local public health clinic info site, seems you are getting the best treatment, if neck swelling bothering you breathing/swallowing /pain/pressure/ears, etc. see MD stat or go to ED , call first. You're lucky you've been diagnosed and treated and not spreading to others. It is a serious health problem. If you smoke, quit. Anyone else in family/relatives/traveling been exposed, untreated?
2 :
Hi Rahul, do you have TB of the neck (cervical TB or scrofula), also known in general terms as extrapulmonary TB? If so, there's an important article on cervical TB at: http://emedicine.medscape.com/article/858234-overview Go to http://emedicine.medscape.com/ and sign up for the site in order to read the article (you have to log in for access). I'll paste a few excerpts about cervical TB here from the eMedicine site, but please check out the article online. There are two types of cervical TB according to the article and particularly important is that the treatment for M. tuberculosis appears to be different from NTM. "Today, approximately 95% of mycobacterial cervical infections in adults are caused by Mycobacterium tuberculosis and the rest are caused by atypical mycobacterium or nontuberculous mycobacterium (NTM)." Clinical history helps doctors to differentiate the two: * M tuberculosis o Patients report a painless, enlarging, or persistent mass. o Systemic symptoms include fever/chills, weight loss, or malaise in 43% of patients. * Nontuberculous mycobacterium (NTM) o Chronic cervicofacial mass o Clinical progression of the disease o No constitutional symptoms o Poor response to conventional antibiotics o No history of tuberculosis (TB) exposure Physical signs: * M tuberculosis o Any cervical node, although anterior cervical chain is more common o Firm rubbery node becoming more firm and matted as disease progresses o Infrequently, fluctuant with draining fistula o Multiple masses in two thirds of patients o Bilateral nodes in one third of patients * Nontuberculous mycobacterium o A nontender slightly fluctuant mass is present with the overlying skin obtaining a violaceous hue. This is referred to as a cold abscess because of its lack of calor, or warmth. o As the lesion progresses, the skin can become adherent to the underlying mass. This stage may progress to rupture and sinus formation. "NTM generally occurs in immunocompetent hosts." (not generally in those who are immunocompromised) The histological findings of the two types of cervical TB are different. The treatment of the two types is very different. See the article: http://emedicine.medscape.com/article/858234-treatment Read the Medications section too. If you don't have cervical TB, there is an article on pulmonary TB at the eMedicine site: http://emedicine.medscape.com/article/230802-overview. Look for other online resources by searching for "TB standards of care" (without the quotations marks). For example, http://www.who.int/tb/publications/2006/istc_report.pdf is the International Standards for Tuberculosis Care and gives diagnosis and treatment plans. (Search on the word "extra" if you want to find comments specific to extrapulmonary TB, if you have this). For medications, see ISTC Standard 8, pages 30-32 in the ISTC report. Standard 8 is below in part, but read Standards 12-15 as well. "Standard 8. All patients (including those with HIV infection) who have not been treated previously should receive an internationally accepted first-line treatment regimen using drugs of known bioavailability. The initial phase should consist of two months of isoniazid, rifampicin, pyrazinamide, and ethambutol. The preferred continuation phase consists of isoniazid and rifampicin given for four months. Isoniazid and ethambutol given for six months is an alternative continuation phase regimen that may be used when adherence cannot be assessed, but it is associated with a higher rate of failure and relapse, especially in patients with HIV infection. The doses of antituberculosis drugs used should conform to international recommendations. Fixed-dose combinations of two (isoniazid and rifampicin, three (isoniazid, rifampicin, and pyrazinamide), and four (isoniazid, rifampicin, pyrazinamide, and ethambutol) drugs are highly recommended, especially when medication ingestion is not observed." Re: ethambutol: "1) Streptomycin may be substituted for ethambutol. and 2) Ethambutol may be omitted in the initial phase of treatment for adults and children who have negative sputum smears, do not have extensive pulmonary tuberculosis or severe forms of extra-pulmonary disease, and who are known to be HIV negative." You should look at the medication tables in the document too. A good infectious disease specialist could help you sort through your concerns. Have you tried this direction yet? Best wishes to you
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