infectious diseases - Infectious diseases
Under Category :  Infectious diseases
Posted By :  Dr.  SUNDEEP NIGAM
Posted On : 3/31/2013 12:45 AM
contact child having lymphadenopathy ?
a 5 yrs old child having weight 13
kg his weight was 11 kg around 6-8
months back, having cough and fever
off and on for last 6 months, chest
xray is wnl, montoux is 15mm,
he have enlarge lymphnode of 1.5-2.5
cm in axillary and cervical region non matted,no organomegaly fnac of lymph node is inconclusive suggesting a query on atypical mycobacterium tuberculosis, the boys father has MDR TB,please suggest how to reach correect diagnosis_?_?_?_?
 
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In medicine there are certain situation where you should not wait for hundred percent proof....
Here there is no justification for withholding antituberculous treatment because you dont have lab investigation support...
There is positive house contact with father , who is sputum MDR positive.
The patient is five years only ,,grade two malnutrition , symptomatic with fever cough of six month ,, FNAC shows AFB ..............it is foolish to go for CT , CT guided biopys..

Fully agree with Dr.Pramod.. Do and Excision biopsy of LN. Do an HIV, high chance of resistant TB..if at all any further investigation needed is line probe assay .
Put the patient on ATT ,.. CAT I for the time being ....You may do the sputum , gastric aspirate for program purpose.. ignore the normal xray ...
Only point of doubt in this case is there was a weight gain of two kg in the inital perod .. from gross inaduate state to a fair position.....
One important point is how to judge the MDR status....after two months...One may argue ,, there was weight gain even before puting on ATT. so can you take the weight gain as a sign of response... Agree to that point
And sputum or gastric aspirate positive state to negativity is not practicable in children..
Lymph node once removed.. you are not in a position to recheck bacillary status..
So only judgement of response is based on symptom status..
Here is the role of line probe assay ..
Dr. PURUSHOTHAMAN says,
5/9/2013 7:40:33 AM
Dr. achinta mallick says,
5/4/2013 12:16:09 PM
tissue biopsy is diagnostic
biopsy of the cervical, axillary lymph nodes recommended
FNAC many a times may be inconclusive
CT scan Chest with CT guided biopsy of mediastinal LN if present and also rule out disseminated TB in this child. As MT is positive, it means child is having good immune response so dissemination may be less likely
Dr. zainul Gagan says,
4/19/2013 11:08:27 AM
Dr. shanthi shanthi says,
4/18/2013 7:34:05 AM
CT scan of chest can be done to detect pulmonary focus
PEM, atypical mycobacteria and inconclusive lymphadenitis. this patient requires excision biopsy and line probe assay for diagnosing TB conclusively as well as HIV testing also requires. a strong candidate for MDR TB case, I suppose.
Dr. Pramod Paharia says,
4/18/2013 7:04:57 AM

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