Tb Again

[Dakhar]

Well folks some time back I wrote a post about TB exposure.

Long story short, I tested positive, we are not sure if it was due to that exposure or a possible past exposure. I had a chest x-ray done 4 months post exposure & it is fine.

Issue currently at hand is that I developed a sore throat and it has been with me for a month, I think I have to go have this checked out. I have small white spots, that appear to be under the skin in the back of the throat, and some of the dots almost look like blisters.

any advice?

[Mossfinn]

By what method have you tested positive?

Moss

[Dakhar]

1) tested montoux 2 days (estimated) post exposure (negative)

2) tested tine test 3-4 weeks post exposure (negative)

3) tested montoux 8 weeks post exposure (positive >15mm)

[Sheryl]

A sore throat of that duration (or even half that duration) and any sore throat with visible lesions needs to be cultured. See a doctor ASAP and insist on a throat culture. Its OK to start on antibiotics pending the culture results (which will take 2-3 working days) but the culture must be taken before the antibiotics start. Make sure yolu see a doctor in a hospital of reasonable size, otherwise he may not have culture facilities and the tendency in Thailand is to tell a patient he doesn't need tests that the doctor isn't able to perform, even though he does (I think the loss of face bit).

If you can get hold of Zinc thrat lozenges they are very helpful. Lacking that (they seem not to be available in Thailand) could just take zinc supplements, will work better if you can stand the metallic taste enough to let them dissolve in the back of your throat. In the US palatable sweetned zinc lozenges make that easy but they seem not to be available here.

It could be many things and may not be related at all to your TB exposure, but it certainly needs treatment.

[FBN]

1) tested montoux 2 days (estimated) post exposure (negative)

2) tested tine test 3-4 weeks post exposure (negative)

3) tested montoux 8 weeks post exposure (positive >15mm)

Please get a Quantiferon test done before assuming active TB.

Current sore throat is very unlikely to be related to previous TB exposure.

Be sure to have throat swabs done for culture and treat specifically.

[Dakhar]

I went to Synpaet "Sin Pat" (sp) today & saw the ENT he told me I have gerd.... I am so relieved! (That is sarcasim)

So that was a waste of time and money.

So I will go to Bumungrad where the doctors are eager to order tests (more money). But it is the tests that I want, I trust the lab more than I trust the doctors.

Any how, the quantiferon is a neat diagnostic tool, but it does not indicate active TB. Thus far I think Bumungrad is the only hospital that offers that test?

But I may get the QFG done and combine that with the skin test.

Any how, like I said I will go to Bumungrad and get the throat swabs done.

Health care is so frustrateing, especially when trying to communicate with a doctor in horrible English.

Good luck to everyone.

[Dakhar]

Went to Bumungrad. Met with a older female doctor that stated she was an instrutor at "jurat" (sp) hospital.

She stated:

1) that my chronic sore throat was due to an infection, even though there I have no fever or swollen glands. (I thought that was strange)

2) that the QFG is not as accurate as the Skin Test... (kind of contrary to what I have read)

3) A DNA studdy on a throat culture or any culture of my throat would be a waste of money.

(I told her I have money to waste, but she would not order the test)

4) Stated I should begin INH for 6 months, and not to worry about liver issues and normally she does not test liver functions because people panic when they see their liver go on the blink.

5) Stated the WHO consisted of a bunch of falangs that have never seen or treated or experienced TB patients, thus Thai doctors are more qualified.

I stated I want the QFG, such that I can verify that I do have TB before I take a toxic drug.

She sold me some ZithroMax for the throat....

I go back on Tuesday to have blood drawn for the QFG

Follks.... wish me luck

[Goldenbead]

Sounds frustrating indeed. Good luck and all the best.

[Sheryl]

Went to Bumungrad. Met with a older female doctor that stated she was an instrutor at "jurat" (sp) hospital.

She stated:

1) that my chronic sore throat was due to an infection, even though there I have no fever or swollen glands. (I thought that was strange)

2) that the QFG is not as accurate as the Skin Test... (kind of contrary to what I have read)

3) A DNA studdy on a throat culture or any culture of my throat would be a waste of money.

(I told her I have money to waste, but she would not order the test)

4) Stated I should begin INH for 6 months, and not to worry about liver issues and normally she does not test liver functions because people panic when they see their liver go on the blink.

5) Stated the WHO consisted of a bunch of falangs that have never seen or treated or experienced TB patients, thus Thai doctors are more qualified.

I stated I want the QFG, such that I can verify that I do have TB before I take a toxic drug.

She sold me some ZithroMax for the throat....

I go back on Tuesday to have blood drawn for the QFG

Follks.... wish me luck

This doctor is practicing substandard medicine.

The Zithromax stands a good chance of curing your throat since it is very broad-spectrum, but if it doesn't, it will be hader to culture the organism now. You should have had a throat culture done first. If you haven't strated on the antibiotic, go to another doctor and get one. But if you have, continue it for the full course.

Now, in respect to the culture she was wrong but not unusual, this is pretty common among Thai docs. Her advice re INH on the other hand is utterly beyond the pale. INH should NEV be given without baseline liver function tests and periodic checkes therafter. There is a very real risk of harm and even death otherwsiase and it would totall qualift as malpractice.

As we have discussed by PM, taking the INH at all is a personal choice with pros and cons both ways.

[Nampeung]

Right, well you ought to see your doc pronto and discuss all this with him/her now. I learned the hard way and am up for a chat if u need it... please PM me about this ...

[Nampeung]

Anyway OP please PM me so we can chat as this is serious stuff

[Nampeung]

Hi Dakhar,

Well I suggest that you do have a positive TB result but many people test positive with TB and do not have active TB. In that case the hospital would recommend a 3 month preventative drug taking to stop your TB becoming active. The most important test is to have cultures grown from your sputum. This takes more than a month to get results. If they cannot grow cultures from your spit you are okay. But... sometimes people with high AFB levels of dead bacteria show positive in an AFB test but they may not actually have active TB. That's what happened to me and it took hospitals in UK and Thailand nearly two years to understand. I am also going to post this in the main forum as it's not private and may help others

Nampeung

[ronz28]

A relative had TB 30+ years ago. TB came with a cough and fever that the first doctor in US misdiagnosed as the flu and gave meds for that. Second doctor in another city did a skin test and when it was positive put the patient in the hospital for more tests, antibiotics and TB meds. After brief hospital stay, TB meds were taken for several months to fully encapsulate the TB germs. Relative was cured and it never returned. I don't know what the treatment is now but I would visit another doctor for a second opinion and keep on going until you are confident that you are on the right meds because it can be cured.

[Nampeung]

Hi Ronz28, you are absolutely correct... TB can be cured. But only if diagnosed early. If it goes for a long time undiagnosed the person will end up with severe suffering and disability

Edited May 22, 2008 by Nampeung

[Dakhar]

Hi Ronz28, you are absolutely correct... TB can be cured. But only if diagnosed early. If it goes for a long time undiagnosed the person will end up with severe suffering and disability

Trouble is, how long is a "long time." I am trying to get things done ASAP, but I have to depend on others, including doctors that give this process the "mai pen rai" attitude.

[moldy]

Well folks some time back I wrote a post about TB exposure.

Long story short, I tested positive, we are not sure if it was due to that exposure or a possible past exposure. I had a chest x-ray done 4 months post exposure & it is fine.

Issue currently at hand is that I developed a sore throat and it has been with me for a month, I think I have to go have this checked out. I have small white spots, that appear to be under the skin in the back of the throat, and some of the dots almost look like blisters.

any advice?

Yes go back and have some more tests done, hardly conclusive evidence, and many tests are not definitive anyway.

[geriatrickid]

That is a disturbing story about the physician, even more so because you gave a good summary. I strongly suggest you consider another physician. Personal bias can sometimes interfere with how a case is handled. In fact, I would insist that if you have the financial means to get another opinion.

There are chronic TB patient populations in the USA, Canada and parts of Europe. As such, there is significant medical expertise and treatment experience with which to derive treatment guidelines. The recommendations of "farangs" cannot be dismissed. Anyway, as usual sheryl and others gave you great advice and I hope you listen to her.

[Dakhar]

I went to Bumungrad & met with another doctor. It seems as though he happened to be a former student of the original doctor I met the first time.

He stated:

1) He never heard of the QFG so he could not make a call on the value of the test

2) He had never heard that the TB skin test could give a false positive due to Mac. Avium & wanted to discount that fact. He also asked how I knew I was positive for Mac Avium. I told him a lab in Thailand did a DNA study and they stated I had it. He stated he doubted that was really the case.

3) Stated the AFB studies would be a waste of money along with DNA PCR for TB based on sputom.

(I told him that is was worth the price for peace of mind, he said doctors love this kind of patients)

4) I was supposed to receive the QFG results today, but like typical Thailand... they were not there & had no idea where they were... so I was told to check back with them on Monday.

5) He said my sore throat was probably due to a viral infection. (A virus for 4 weeks?)

After I know the QFG results then we move on from there.

All that, for 1300 baht and around 500 in transit fees.

On the way home I stopped at a pharmacy and picked up a round of Zrytec, maybe this is all allergy?

I have been concentrating on getting a good amount of sleep and drinking lots of water... In general I am feeling better, but still no apetite to speak of.

Wishing us all good luck

Edited May 24, 2008 by Dakhar

[Dakhar]

I got the QFG results back, & it was positive.

I have been on Zyrtec for 2 days and I have to say my apetite is back, and I have a lot less congestion. Sputom color is white, and I only have sputom in the morning and not much to speak of. Phlegm same story.

Anny suggestion?

I kind of want to call this an allergy issue and move on...?

[Nampeung]

Dakhar, you don't have an allergy. For god's sake will you treat this seriously, if your test was positive you have TB

You need to sort it out

[Sheryl]

First of all, need to confirm that prior exposure to M. avium would not cause a positive QFG. I think it wouldn't but am not sure. You could try PM to FBN to see if he knows. Or consult a good ID specialist, or email the CDC.

If that can be settled and it is the case that the M. avium cannot cause a positive QFG then it is confirmed that at some point in your life you encountered the TB bacterium. If I understand correctly, Chest films are negative for active TB so it is most likely latent and unrelated to your current symptoms (which could indeed be allergy), but as long as you have sputum you may as well have a sputum AFB test, they are inexpensive and if negative, together with normal chest film, give all the more assurance that you do not have active TB.

Then you have to decide whether or not to take INH prophylaxis. There are pros and cons both ways. A history of adverse drug reactions and/or liver disease or elevated liver enzymes would all argue against INH. Any weakness of the immune system would make INH prophylaxis esssential. If ylike most people you fall into neither of those groups, it really becomes up to you. Most docs would probably still advise it but it is not off the wall to skip it in favor of regular chest films. Ultimately, your call.

But straighten out the M. avium issue first. Because if the QFG can react due to prior M. avium exposure the fact that you are positive is of no diagnistic meaning one way or the other.

[Dakhar]

Earlier studies using skin testing with sensitins from atypical mycobacteria, such as M. avium or M. scrophulaceum, indicated that about half of the positive TST reactions in military personnel following return from missions were false positive (3). New diagnostics like QuantiFERON-TB Gold in-tube (QFT-GIT) have been developed using the TB-specific antigens ESAT-6, CFP-10, and TB7.7 (1, 7, 15). The advantages of these new assays over the TST are the higher specificities (excluding false-positive results due to BCG or environmental mycobacteria), logistic simplicity, and need of only one patient visit (9, 14, 15, 17). In this study, we used QFT-GIT for screening military personnel.

Every thing I have read indicates the QFG is not the gold standard of TB testing, due to the higher specificity. I do feel a lot better, since using Zyrtec. My apetite has come back in full bloom! So yes, I have TB, but I do not think it is active. I plan on getting another x-ray in 12 weeks.

If I take INH and then get exposed to TB 2-3 months post torture of the meds, I will be just as likely to aquire the bacteria all over again. Unfortunatley this is the one of the many "gifts" Thailand has to bestow on it's people.

[FBN]

Earlier studies using skin testing with sensitins from atypical mycobacteria, such as M. avium or M. scrophulaceum, indicated that about half of the positive TST reactions in military personnel following return from missions were false positive (3). New diagnostics like QuantiFERON-TB Gold in-tube (QFT-GIT) have been developed using the TB-specific antigens ESAT-6, CFP-10, and TB7.7 (1, 7, 15). The advantages of these new assays over the TST are the higher specificities (excluding false-positive results due to BCG or environmental mycobacteria), logistic simplicity, and need of only one patient visit (9, 14, 15, 17). In this study, we used QFT-GIT for screening military personnel.

Every thing I have read indicates the QFG is not the gold standard of TB testing, due to the higher specificity. I do feel a lot better, since using Zyrtec. My apetite has come back in full bloom! So yes, I have TB, but I do not think it is active. I plan on getting another x-ray in 12 weeks.

If I take INH and then get exposed to TB 2-3 months post torture of the meds, I will be just as likely to aquire the bacteria all over again. Unfortunatley this is the one of the many "gifts" Thailand has to bestow on it's people.

Positive skin test followed by positive Quantiferon with negative chest X-ray usually indicates latent TB. The regular, accepted management for this is INH for 6-9 mths. According to some papers, given the above test scenario (latent TB) you have about 10 - 15 % chance of developing active TB. This can be avoided by taking INH.

The choice is up to you (given the potential side effects of INH) but it is strongly recommended that you protect yourself. At this stage, it can still be considered preventative rather than curative treatment. There are a few excellent posts from OPs that have gone, and are still going through the ordeal of resistant TB treatment; this is all valuable knowledge, read some of those.

Best of Luck!

[Dakhar]

Earlier studies using skin testing with sensitins from atypical mycobacteria, such as M. avium or M. scrophulaceum, indicated that about half of the positive TST reactions in military personnel following return from missions were false positive (3). New diagnostics like QuantiFERON-TB Gold in-tube (QFT-GIT) have been developed using the TB-specific antigens ESAT-6, CFP-10, and TB7.7 (1, 7, 15). The advantages of these new assays over the TST are the higher specificities (excluding false-positive results due to BCG or environmental mycobacteria), logistic simplicity, and need of only one patient visit (9, 14, 15, 17). In this study, we used QFT-GIT for screening military personnel.

Every thing I have read indicates the QFG is not the gold standard of TB testing, due to the higher specificity. I do feel a lot better, since using Zyrtec. My apetite has come back in full bloom! So yes, I have TB, but I do not think it is active. I plan on getting another x-ray in 12 weeks.

If I take INH and then get exposed to TB 2-3 months post torture of the meds, I will be just as likely to aquire the bacteria all over again. Unfortunatley this is the one of the many "gifts" Thailand has to bestow on it's people.

Every thing I have read indicates the QFG is not the gold standard of TB testing

Correction:

.... is NOW the gold standard

[FBN]

http://www.cdc.gov/TB/pubs/tbfactsheets/LTBIandActiveTB.pdf

Useful article and reference for my post #23 above.

[Sheryl]

FBN,

He has history of MAC. I have been unable to get definitive info as to whether this could cause a positive QFG. Do you know?

[FBN]

FBN,

He has history of MAC. I have been unable to get definitive info as to whether this could cause a positive QFG. Do you know?

Dear Sheryl,

The QFG test is specific for the M. tuberculosum complex but not other mycobacteria..

[Sheryl]

Thanks FBN.

So, Dakhar, you have latent TB.

If you opt to not take INH, you are counting on your immune system to contain the bug. You can help it do so by taking proper care as follows:

-- regularly get enough sleep

-- eat a healthy balanced diet

-- don't drink or only in real moderation

-- avoid/learn to manage stress

A good vitamin/mineral supplmenet probably not a bad idea. Make sure it contains zinc.

If you have any co-existant chronic diseases, are under-nourished or are HIV positive, your risk is higher than average and you shouldn't chance it.

Good luck

[Nampeung]

Quite amazing as I just went to a meeting about disabled people, from all disabilities ... of which i am now one. Going undetected ... TB can cause enourmous problems in your life and not many people understand that

[Dakhar]

Thanks FBN.

So, Dakhar, you have latent TB.

If you opt to not take INH, you are counting on your immune system to contain the bug. You can help it do so by taking proper care as follows:

-- regularly get enough sleep

-- eat a healthy balanced diet

-- don't drink or only in real moderation

-- avoid/learn to manage stress

A good vitamin/mineral supplmenet probably not a bad idea. Make sure it contains zinc.

If you have any co-existant chronic diseases, are under-nourished or are HIV positive, your risk is higher than average and you shouldn't chance it.

Good luck

I do not dring, and I do try to get the right amount of sleep.

I have a genetic issue of hypertension and high cholesterol. Even if I were physically svelt, and looked like Bruce Lee, it would still be there. I am about 20 lbs over weight at the moment. I have occassional boubts of cholitis, but I would say it is about 1 boubt a year.

Thus far I take 1 tab of zyrtec a day and my throat is doing better.