Tuberculosis: Symptoms, Diagnosis, and Treatment Insights

Pulmonary tuberculosis

Hello Doctor: My mother had tuberculosis, and my second brother died of lung cancer, so I undergo regular chest X-ray examinations every year.
In August of this year, I experienced slight chest discomfort and a mild cough.
In September, I went to the health bureau for a chest X-ray and sputum test (the health bureau's sputum test results were normal).
The doctor immediately referred me to the hospital for a CT scan and another sputum test (the results were also normal).
The scan showed some grayish areas in the left lower lung lobe and a black spot (1.5 cm).
The doctor then referred me to a teaching hospital for further examination.
I was hospitalized for six days, during which I had four X-rays, three CT scans, an endoscopy, a bronchoscopy, a nuclear medicine scan, a lung biopsy, blood tests, and sputum tests over three days.
The doctor said it was tuberculosis, but could not be 100% certain.
However, the doctor advised me to take tuberculosis medication for six months.
Today is my second day on the medication, and I have no appetite, feel weak, can hardly stand or sit, and can only lie down.
My vision is almost gone (due to shingles affecting my right eye, leaving me with only 0.1 vision).
I also have persistent diarrhea (I have a history of gastrointestinal issues and kidney stones).

I have several questions:
1.
Why did both the health bureau and the hospital find no issues with the sputum tests, but the teaching hospital diagnosed tuberculosis? The time difference is only one month! How reliable are these tests?
2.
Are my symptoms after starting the medication normal? How long will they last? Should I change my medication?
3.
Is tuberculosis contagious? What precautions should I take to avoid transmitting it to others?
4.
What should I pay attention to during the medication period? What dietary considerations should I have? How can I improve my appetite? Should I supplement anything in particular?
5.
Do I have a chance of recovery? How long will it take to see results?
6.
Since the doctor is not 100% certain it is tuberculosis, are there any tests I have not undergone? If not, how long should I monitor myself before needing further tests to confirm the diagnosis? Thank you.

A-Hua, 60~69 year old female. Ask Date: 2003/11/01

Dr. Zhou Ziguang reply Pulmonology

(1) It is indeed possible for some patients with pulmonary tuberculosis to have normal sputum tests (i.e., non-open cases), and diagnosis requires other clinical evidence.
(2) Common side effects of anti-tuberculosis medications include liver function abnormalities, impaired vision, gastrointestinal discomfort, allergies, and gout; if any of these occur, medication adjustments should be made by a qualified physician.
(3) Open pulmonary tuberculosis is contagious, but adherence to medication, maintaining a well-ventilated environment, and wearing a mask or covering the mouth when coughing can significantly reduce transmission.
(5) Pulmonary tuberculosis is treatable; please cooperate with your physician's management.
(6) If 100% certainty is required, consideration may be given to pulmonary resection.

Reply Date: 2003/11/01

More Info

Understanding tuberculosis (TB) is crucial, especially for individuals who may be at risk due to personal or family medical histories. Your concerns regarding the diagnosis, treatment, and management of TB are valid and important. Let’s address your questions systematically.

1. Testing Reliability: The discrepancy between the sputum tests at the health department and the teaching hospital can be attributed to several factors. Sputum tests for TB can yield false negatives, especially in the early stages of the disease or if the bacterial load is low. Additionally, the sensitivity of the tests can vary based on the method used and the sample quality. The teaching hospital likely employed more advanced diagnostic techniques, such as PCR testing or cultures that can detect TB bacteria more reliably. Therefore, while both tests are valuable, the latter may provide a more accurate diagnosis.

2. Medication Side Effects: It is not uncommon to experience side effects when starting anti-TB medication. Common side effects include loss of appetite, fatigue, and gastrointestinal disturbances like diarrhea. These symptoms can vary in duration; some may subside as your body adjusts to the medication, while others may persist. If your symptoms are severe or worsening, it is essential to consult your healthcare provider. They may consider adjusting your medication regimen or providing supportive care to manage side effects.

3. Transmission of TB: TB is an airborne disease, meaning it can be transmitted from person to person through respiratory droplets when an infected person coughs or sneezes. To prevent transmission, it is crucial to follow your healthcare provider's recommendations, which may include wearing a mask, ensuring good ventilation in your living space, and avoiding close contact with others, especially vulnerable individuals. Informing close contacts about your diagnosis is also important so they can monitor their health.

4. Medication Management and Diet: During your treatment, it is vital to adhere strictly to your medication schedule. Regular follow-ups with your healthcare provider are essential to monitor your progress and adjust treatment as necessary. Regarding diet, focus on a balanced intake rich in proteins, vitamins, and minerals to help boost your immune system and improve your appetite. Foods like lean meats, dairy, fruits, and vegetables can be beneficial. If you struggle with appetite, consider smaller, more frequent meals or nutritional supplements.

5. Prognosis and Recovery: With appropriate treatment, the prognosis for TB is generally good. Most patients begin to feel better within a few weeks of starting therapy, but it is crucial to complete the full course of treatment (typically six months) to ensure the infection is fully eradicated and to prevent drug resistance. Regular follow-ups and imaging studies will help assess your recovery.

6. Further Testing: If your doctors are uncertain about the diagnosis, they may recommend additional tests, such as a bronchoscopy, biopsy, or more advanced imaging techniques. It’s essential to communicate openly with your healthcare team about your concerns and any symptoms you experience. They can guide you on when to return for follow-up evaluations based on your treatment response and any new symptoms.

In summary, while the journey through TB diagnosis and treatment can be challenging, understanding the process and maintaining open communication with your healthcare providers can significantly improve your experience and outcomes. Remember, you are not alone in this, and there are resources and support systems available to help you through your treatment.

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