T.b.

[seonai]

Thanks mate Moss, little people under bridges will be washed away and hopefully Seonai will be able to be damaged but drug free... YIPEE on both counts

[Sheryl]

Great news Seonai, and hopefully getting off the meds will give you a boost. Take care.

[Ijustwannateach]

That IS great news! Take it easy on EVERY count, Seonai, get yourself back up to speed slowly!

[seonai]

Thanks all. Still got another 4-6 weeks to wait for cultures (not) to go :D

[Mossfinn]

Yup, that's right, if they don't grow in 49 days, you are home and dry,

so 49,48,47,46.......... and counting

Moss

[seonai]

Really Moss... seriously so 49 days... but I haven't handed them in yet - the hospital is dead slow at getting me in for an app. God I am so scared and yet so excited. Moss were your last cultures when you were on meds or off?

[Mossfinn]

Thanks all. Still got another 4-6 weeks to wait for cultures (not) to go :D

If they haven't taken the cultures, are you saying you have to wait 4-6 weeks just to see you, why didn't they try and take them when you saw your Specialist the other week?

... seriously so 49 days...

Yes, that is the max they will generally grow them for, that I know of, but they often know beforehand, they grew mine in a couple of days.

were your last cultures when you were on meds or off?

Off, I only did the nine months, when I had relapses, they never put me back on the meds, until they were sure what I had got, last cultures were for Renal TB, results tomorrow.

Moss

[seonai]

Good luck Moss. Your doctors sound more switched on than mine. Let me know what your results say

[Mossfinn]

Let me know what your results say

Yes, they do appear to be, excepting that they have lost my last results/specimens, have to go through them all again.

But because of all previous results and tests, all pretty promptly done, I might say, (this waiting for long periods, is quite outrageous!!) but it would appear that I am clear as long as the my next set don't show anything untoward.

There is something wrong, but they can't quite put there finger on it, I had a lengthy consult today with a Registrar and he went through everything, piece by piece, but had quite a few longish medical terms thrown in, so I have asked for a copy of the letter so I can go through it, slowly and in my own time.

He did mention something about a possible high GA? count, but the only way to find out for sure was a kidney biopsy, and if they found this out to be correct, they wouldn't treat me any different anyway. I politely declined.

Liver and kidney function doing well, no grown cultures from blood, cough or urine, so all appears largely optomistic.

Good Luck

Moss

[seonai]

Well let's hope that this is a good sign Moss What is GA? The kidney biopsy thing souns horrid!!!

[seonai]

Of course Girdhar Don't be serious, I get a bit hot about TB as I have had such a bad experience and Mossfin has too. Thanks for saying sorry in public

[seonai]

Moss... you okay ???

[Mike45]

The skin test said Tb. The x-ray said "nothing there".

Start the 9 months of drugs they said.

We read and learned. We told them "we hear there is a blood test that will tell us for sure. We want it."

They said "sure no problem"

Blood test results result

" Negative- No TB - Perfectly healthy"

It pays to ask questions and learn rather than just take the drugs blindly. We were lucky.

All my best to the rest of you and thanks for the relevant information and thought provoking dialog.

[seonai]

Wow !!! Well done and congratulations Mike45

[Mossfinn]

It pays to ask questions and learn rather than just take the drugs blindly. We were lucky.

This is true and yes it would appear you were lucky, taking the meds for an unnecessary reason is not good, they are quite unpleasant.

The skin test said Tb. The x-ray said "nothing there".

A possible reason and I am only suggesting a possible reason here, is that a high proportion of people carry latent TB, however, if so, this shouldn't have been their only test and x-rays will only high-light Pulmonary TB, I believe.

Start the 9 months of drugs they said.

Did they ever explain why they were kicking you off on a 9 month campaign?

We read and learned. We told them "we hear there is a blood test that will tell us for sure. We want it."

God on ya for reading, it is sometimes very important, but can you remember in your reading what name they gave the blood test, because I have never heard of a one stop shop blood test, unless it is positive and they have grown a positive culture from it? This is important for my research, because I passed the blood test and I was eventually confirmed as positive.

Thanks for the post, but I would like to hear more if poss.

Good Luck

Moss

Edited January 27, 2008 by Mossfinn

[Mossfinn]

I want like to know if patients can expect to have the same kind of problems with the "one Isoniazid a day for 9 months" regiment which is frequently prescribed for latent TB and a clear X-Ray.

Ah, this explains part of my questions, however, if their observations were suggesting latent TB, why prescribe Isid', I just do not understand this, my Daughter showed a positive reaction to the skin test, but their assumption was that it was latent TB showing and just decided to do a follow up, nothing showed.

Any ideas anyone, on the different approaches?

Moss

[Mike45]

QuantiFERON®-TB Gold test (QFT-G)

[Mossfinn]

Thanks Mike,

I have never heard of this, just done a quick search, many hits, so some good reading when I have time, also a few phone calls to be made as well.

Thanks for the prompt response

Moss

[seonai]

Shit this is all really interesting. My son tested positive in UK 2006. They decided to put him on 3 months 'preventative' rifampacin and Izoniazid - made hime have severe mood swings. The more I read this thread the more I reckon the medics don't know what they are doing

[seonai]

So what is this QuantiFERON®-TB Gold test ?? I Googled and got loads on Immunosuppresed stuff. Are you saying that you can tell from a blood test whether or not someone has TB??? That seems new to me but I will ask my Consultant next week

[seonai]

Mike45 are you sure they said just one Izoniazid per day? It wasn't combined with Rifampacin?

[cali4995]

So what is the current recommended treatment for this? Izoniazid?

Rifampacin? in combinations with others? for 6-9 months?

I have a friend-girl and I know this is what she has. Incessant,

prolonged coughing for at least the last 2-3 months. After griping

at her about it she did go to the hospital and I guess they took

an x-ray and indeed, that seems to be what they told her but

she's still not on the meds? I told her I'd take her to the pharmacy

and buy the stuff because she will end-up with permanent lung

damage right? and if she isn't taking the antibiotics she's that

much more likely to pass it on to someone else? I don't know

what it is with Thai girls and doctors. These antibiotics aren't always

a magic wand and I'm certainly not an MD. What do you do?

[Mossfinn]

Seanai,

This is a web-site by the manufacturer!! Cellestis which gives a higher % success rate than other information I have found.

This is Another there %'s differ widely, however there is no mistaking its high success rate as opposed to the mantoux skin test.

How about TB-Alert, can you get info from them, regarding it?

Moss

[Mossfinn]

So what is the current recommended treatment for this? Izoniazid?

Rifampacin? in combinations with others? for 6-9 months?

Cali,

This is the current approved meds for TB TB meds but maybe not in Thailand, I am not sure.

It is usually a 6 month course but can differ depending on the course of treatment.

Mine kicked of with Ison, Rifa and Ethambutol for two months and then for the remaining four, the Ethambutol was stopped, I really can't remember if I was on the Pyraz as well.

Can't quite understand all of your content Cali, did they confirm that she had TB, just from an x-ray, did they take any other tests?

If she is coughing for a prolonged time and they have confirmed it is TB, it sounds pretty iffy to me, did they mention cost of the meds to her and she decided she'you couldn't afford it?

If it is active TB, it is still not easy to catch, close proximity for a prolonged time, children and low immunity thresholds are the most at risk.

Can I suggest that you go the Hospital with her and ask questions, then ask some more, until you are satisfied with the diagnosis, the treatment regimen and any long or short term outcomes.

Good Luck

Moss

Edited January 28, 2008 by Mossfinn

[Mike45]

Mike45 are you sure they said just one Izoniazid per day? It wasn't combined with Rifampacin?

They offered two courses of treatment:

Nine months of Izoniazid

OR

Four months of ( I think it was Rifampacin but not sure)

They pushed hard for the 9 months treatment.

[cali4995]

Mossfinn, thank-you for the thoughtful reply. She is like an aquaintance,

and not very forthcoming with the information she gives me. I noticed

she had a very bad persistent cough. More than a smoker's cough or

a head cold. And that was about the only other thing I could think of.

Our communication is far from 100%. I read you can get some kind of

skin test, or maybe an x-ray would help determine. From what I could

figure out she went to the hospital on that 30 baht scheme and from

whatever occurred, she seemed to accept that yes, she was sick.

I suppose that would be ideal if we all met with the doctor but I'm not

sure how likely that is to come about. I tried reading about the antibiotic

regimens and it seemed like a combination for 6-9 months was preferred.

It really does sound pretty horrible and a lot more complicated than I

realized. I'll try to talk her into going back to the hospital and if she needs

help with the meds I can do that. No idea what this stuff costs in Thailand.

This wiki page (below) seems to explain the difference between short course

and long course treatments, particularly with antibiotics involved.

http://en.wikipedia.org/wiki/Tuberculosis_treatment

Edited January 28, 2008 by cali4995

[Mossfinn]

skin test,

Info on the Mantoux Test or the Heaf Test there is a Gold Test, but apart from what I put in an earlier thread, I know little more for the moment.

or maybe an x-ray would help determine.

This is from Wiki, there are others, but I found them a little studious

x-ray

seemed to accept that yes, she was sick.

I suggest to check it out further,

I suppose that would be ideal if we all met with the doctor

That would be the ideal, is there a reason why not?

Good Luck

Moss

[seonai]

I don't actually know what to say on this thread anymore and maybe Sheryl can give some form of middle man stuff. My experience of TB is of just about being dead, really, and then trying to understand it all via the doctors etc. So the first thing we all have to understand is TB does not go in straight lines ... it is complicated and each person's experience of it is different. Currently for me, if it's any help, I saw a chap who said that maybe the bugs that were showing 'positive' in a smear were actually dead so I was not positive at all !!!!! Go Figure !!!!! I am now stopping all medication because I don't believe the medics in UK know what to do... India maybe the most prominent in TB care ... but UK ... forget it

[cali4995]

Yes, I suspect that's true also. That Thai medical professionals probably have far

more experience treating this than doctors in my own country. My friend-girl had

relayed to me that she had got some type of chest x-ray, which I see now is only

(1) of many determining tests. This looks far too complicated for just a quick trip

to the pharmacy. Reading about it certainly helps but I can only suggest she goes

back to the hospital and gets on whatever regimen course the doctor prescribes.

[Sheryl]

Both the skin test and the blood test detect only whether or not the person has, had some point in their life, been exposed to the TB bacteria and formed an antibody response. NEITHER alone can detect whether or not the person has an active case of TB.

The majority of people who have been exposed to the TB bacetria form an effective immune response and never develop TB. Others develop TB at a later date, often at a time when their immune system is depressed (eg from HIV infection, age, poor nutrition, stress etc). And a smaller unlucky number develop TB after initial exposure. Many of these are people with weakened immune systems but some are just plain unlucky. There may be other factors (size of the initial exposure and virulence of the particular bacterial strain) too.

It is common practice in HIV negative persons to test first for exposure (skin or bllod test) then, if positive, to follow up with Xray, sputum test etc. The skin test is much cheaper than the blood test but also more likely to give a false positive. False positives do occur with the skin test, and false negatives may occur with both if the person's immune system is compromised.

Since false positives are more common with the skin test, it makes sense for a positive skin test to then have the blood test if the person is otherwise asymptomatic, and can help avoid unnecessary treatment.

People with antibodies to the TB bacetrium but no sign of TB infection are descrobed as "latent"cases. In some developing countries these represent a significant part of the population, and in those settings it is neither feasible not customary to treat it except in people with compromised immunity.

In developed countries, "latent TB"is much less common and it is thus feasible to treat all cases, and from a public health standpoint, desirable. Every country's own public health service has its own recommendations on this; I know that in the US ir recommends treating and suspect this is so in most iof not all developed countries.

However, since the drugs do have adverse effects (especially on liver function), each indiviudal case must be evaluated on its own merits. For some people, the risks of the treament exceed the risk of eventuiatlly developing TB. The risk of a person with "latent TB infection"(LBTI) ever developing TB has been quantified and varies considerably by the presence or absence of factors such as poor nutrition, IV drug use, high risk sexual behavior, current HIv status, and how reecently the TB exposure was. If it is known to have occurred more than a year prior the risk of developing TB is much higher than if it is a recent "conversion"(i.e. positive TB test in someone known to have been negative previously).

In terms of treatment, there are several approved regimens. One is INH alone for 9 months. Others involve combinations of drugs for shorter time periods. One of the reasons these were developed is that there was poor patient compliance with the long course of INH. However, these shorter regimens are more expensive.

For an individual faced with the decision of treating or not treating "LTBI", questions to ask your doctor are:

- what is my specific risk of developing an active TB infection?

- what is my specific risk of developing serious complications from (1) INH treatment (2) the shorter course treatments?

The answers to these will be different for different individuals.

In some ocuntries you may not have much choice in the matter, i.e. public health reguilations may require that you be treated unless there is a clear medical contraindication.