Tuberculosis Culture Results: Misdiagnosis and Treatment Options

Q: Tuberculosis Culture Results: Misdiagnosis and Treatment Options

Hello： The diagnosis of pulmonary tuberculosis does not necessarily require two or three sets of sputum culture and mycobacterial identification results; abnormal infiltrates may also be observed on X-ray. <br>This aspect can be discussed with the attending physician. <br>As for

Regarding the culture of Mycobacterium tuberculosis?

Hello Doctor, my grandfather is 89 years old.
In August of this year, he was taken to the emergency room due to health issues and later transferred to the intensive care unit.
After being discharged, he gradually regained his health.
Last month, we received a notification from the hospital that my grandfather is suspected of having tuberculosis.
He underwent an X-ray and a bacterial culture, which showed a positive result only on the first day of the three-day culture.
Other family members who also had X-rays at the hospital showed no signs of infection.

I would like to ask the doctor, since my grandfather does not have a cough or any similar symptoms, and only one out of three cultures was positive, is there a possibility of misdiagnosis? He is currently in an isolation room, and last week, due to elevated liver enzymes from tuberculosis medication, the treatment was temporarily halted.
His condition slightly improved, and the medication was resumed, but his consciousness and mental state have been deteriorating, even showing signs of dementia.
Is it possible to pause the medication or are there alternative treatment options? Can we seek a second opinion or further testing at another hospital or facility? Thank you, Doctor.

Xiao Xie, 20~29 year old female. Ask Date: 2016/10/15

Dr. Yang Wenda reply Pulmonology

Hello: The diagnosis of pulmonary tuberculosis does not necessarily require two or three sets of sputum culture and mycobacterial identification results; abnormal infiltrates may also be observed on X-ray.
This aspect can be discussed with the attending physician.
As for individuals who experience hepatitis as a side effect of anti-tuberculosis medications, treatment can be resumed gradually after liver function improves.
If the final medication used is not a standard prescription, the duration of treatment must be extended to achieve successful treatment outcomes! Best wishes!

Reply Date: 2016/10/15

More Info

When dealing with a potential tuberculosis (TB) diagnosis, especially in an elderly patient like your grandfather, it's crucial to approach the situation with a comprehensive understanding of the disease, its diagnostic methods, and treatment options.
Firstly, the fact that your grandfather's sputum culture was only positive on the first day and negative on the subsequent days raises a valid concern about the accuracy of the diagnosis. Tuberculosis cultures can sometimes yield false positives or false negatives due to various factors, including contamination or the presence of non-tuberculous mycobacteria. Additionally, the absence of typical symptoms such as persistent cough, fever, night sweats, or weight loss further complicates the diagnosis. It is not uncommon for elderly patients to present atypically, which can lead to misdiagnosis or delayed diagnosis.
Given that your grandfather is 89 years old and has recently experienced a decline in his overall health, including liver function issues due to TB medication, it is essential to weigh the risks and benefits of continuing treatment. The standard treatment for active TB typically involves a combination of antibiotics over a prolonged period (usually 6 to 9 months), but this can be adjusted based on the patient's overall health, the presence of side effects, and the specific strain of TB.

In cases where the patient is experiencing significant side effects, such as elevated liver enzymes, it may be necessary to temporarily halt the medication to allow the liver to recover. However, this decision should be made in consultation with a healthcare professional who can monitor liver function and assess the risk of TB progression. If the TB diagnosis is confirmed, it is critical to manage the treatment carefully to avoid complications, including the development of drug-resistant TB.

If there is still uncertainty regarding the diagnosis, seeking a second opinion or further testing at another facility can be a prudent course of action. Additional tests, such as a repeat sputum culture, bronchoscopy, or imaging studies, may provide more clarity. It's also worth considering that if your grandfather's condition continues to deteriorate, palliative care options should be discussed to ensure his comfort and quality of life.

In summary, while the initial positive culture raises concerns for TB, the lack of consistent positive results and the absence of symptoms suggest that further evaluation is warranted. The management of TB in elderly patients requires a careful balance between effective treatment and the potential for adverse effects, particularly in those with pre-existing health conditions. Consulting with a specialist in infectious diseases or a pulmonologist may provide additional insights and treatment options tailored to your grandfather's specific situation.

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