Tuberculosis Recurrence: Symptoms, Testing, and Follow-Up Care

Q: Tuberculosis Recurrence: Symptoms, Testing, and Follow-Up Care

Dear Peipei： Regarding your questions, 1. Abdominal tuberculosis indeed requires a pathological and microbiological diagnosis for confirmation. 2. It is recommended that TB patients undergo a chest X-ray (CXR) annually for monitoring. 3. Currently, the diagnos

Pulmonary tuberculosis may relapse after treatment?

Hello Doctor: Thirteen years ago, I was diagnosed with asymptomatic pulmonary tuberculosis and completed a two-year treatment course as directed by my physician.
I did not have any follow-up afterward.
In January and February of this year, I experienced pain during deep breaths, similar to a sensation of not being able to regulate my breathing after running, with the pain located around the diaphragm.
This was accompanied by abdominal pain, and my menstrual flow was heavier than usual, lasting over ten days.
After consulting a gastroenterologist, it was thought to be a gynecological issue.
I then visited an obstetrician-gynecologist who found an ovarian cyst.
Due to a significantly elevated CA125 tumor marker level above 500, I was referred to a gynecologic oncologist.
However, the gynecologic oncologist, after reviewing the ultrasound (including Doppler ultrasound and CT scan), did not find it indicative of a malignant tumor and suspected a recurrence of TB infection in the abdominal cavity.
I was then referred to an infectious disease specialist, who ordered a chest X-ray, which showed no abnormalities in the lungs.
In March, I returned for a follow-up blood test, and my CA125 levels returned to normal, my menstrual cycle normalized, and the pain during deep breaths resolved.
I feel much better compared to January and February.
After reviewing the blood tests and X-ray results, the gynecologic oncologist believes that the issue is more likely related to a recurrence of TB.
However, the infectious disease specialist stated that a surgical procedure is necessary to diagnose a recurrence of TB, as the INF gamma test will always be positive in someone with a history of TB, making it impossible to determine if there is a recurrence.
I am feeling a bit anxious because my health has inexplicably improved, yet the cause of my previous discomfort remains unclear.
I have looked up symptoms of TB recurrence, but at that time, I only had pain during deep breaths and a poor appetite, without coughing or chest pain.
I am uncertain if these qualify as symptoms of recurrence.
(I had COVID-19 last September.) I would like to ask the doctor: 1.
Are there any tests to check for TB recurrence besides surgery? 2.
After completing TB treatment and a two-year follow-up, is further monitoring necessary? 3.
Is it possible that the infection response was triggered by a temporary decrease in my immune system during those two months, potentially inducing a TB recurrence? Thank you, Doctor, for taking the time to clarify my concerns.

Peipei, 30~39 year old female. Ask Date: 2023/03/07

Dr. Huang Yiwen reply Pulmonology

Dear Peipei: Regarding your questions, 1.
Abdominal tuberculosis indeed requires a pathological and microbiological diagnosis for confirmation.
2.
It is recommended that TB patients undergo a chest X-ray (CXR) annually for monitoring.
3.
Currently, the diagnosis cannot be confirmed; please continue to monitor and observe.
Changhua Hospital cares about you.

Reply Date: 2023/03/07

More Info

Understanding tuberculosis (TB) recurrence is crucial for anyone with a history of the disease. Your situation raises several important points regarding symptoms, testing, and follow-up care after TB treatment.
Firstly, it’s essential to recognize that TB can indeed recur, especially in individuals who have had the disease previously. However, the likelihood of recurrence is relatively low, estimated at about 5-10% over a lifetime for those who have completed treatment. The symptoms of TB recurrence can vary widely, but common signs include a persistent cough, weight loss, fever, night sweats, and fatigue. In your case, the deep breathing pain and abdominal discomfort could be indicative of various issues, but they are not classic symptoms of TB recurrence.

Regarding your specific questions:
1. Testing for TB Recurrence: While a surgical biopsy is one method to confirm TB recurrence, there are other non-invasive tests available. For instance, a sputum culture can be performed if you are producing sputum, which is a common method to detect active TB. Additionally, a chest X-ray is a standard initial test, but it may not always show early signs of recurrence. A CT scan can provide more detailed images of the lungs and may help identify any abnormalities that a standard X-ray might miss. Furthermore, the QuantiFERON-TB Gold test or T-SPOT.TB test can be useful as they measure the immune response to TB proteins, although they cannot definitively diagnose active TB.
2. Follow-Up After TB Treatment: After completing TB treatment, routine follow-up is generally not required unless symptoms develop. However, if you have risk factors for TB (such as immunocompromised status or exposure to active TB), your healthcare provider may recommend periodic evaluations. Given that you experienced symptoms this year, it would be prudent to have follow-up assessments to monitor your lung health, especially since you had a history of TB.

3. Impact of Immune Response: It is possible that your immune system was temporarily weakened, leading to an increased susceptibility to infections, which could explain your symptoms. Stress, illness (like COVID-19), or other factors can impact your immune response. However, the absence of classic TB symptoms such as a persistent cough or significant weight loss makes it less likely that you are experiencing a TB recurrence.

In summary, while your symptoms warranted thorough investigation, the improvement in your condition and normalization of your CA125 levels are encouraging signs. It’s essential to maintain open communication with your healthcare providers, as they can guide you through further testing if necessary. If you remain concerned about TB recurrence, discussing the possibility of additional imaging or tests with your infectious disease specialist would be a prudent step.
Lastly, remember that while TB can recur, many individuals who have been treated successfully do not experience recurrence, especially with proper follow-up care and monitoring.

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