TB medicine before confirming

Patient

Q: I am from India. My Mom was recently taken sick fevers, chills, cough and was on antibiotics for about 3 weeks without much improvement. On Jan 20th, she was diagnosed with Pneumonia Diagnosed through Chest xray, WBC count 19,400, Higher Eusenophils and was hospitalized. While in hospital she was given Zubacef and Moxicip intravenously. She was discharged after a week but continued to receive antibiotics. On Feb 3rd, the doctor found fluid in her lungs. The fluid was drained around 600ml and examined. Pleural Fluid ADA count 18 Pleural fluid for culture and sensitivity No growth after 48 hrs incubation at 37 deg C. My Mom still has slight cough, apetite loss and fatigue. However she has neither had weight-loss she is obese, non-diabetic or night sweat through out this period. She has not had fevers, chills since she was realeased from hospital. Yesterday, she was referred to a specialist, who is suspecting TB. He has asked for the following tests to confirm his suspect Mantoux test HRCT Chest plain without contrast SOS Bronchoscopy USG guided theraupetic tapping However, he has prescribed Rcinex 600, Cambutol 1g, Pyzina 1g, Benadone even before the test reports come in. My question is from her symptoms does it seem TB? Is it prudent to prescribe TB medicine before confirming TB?

Doctor

A:   Certainly the symptoms might appear to be similar to some of those found in TB. In my opinion, due to the plural effusion with ADA of 18 which is suggestive of TB plus the symptoms, her physician might have suspected of TB and started the treatment before confirming the diagnosis. ADA has been used
in the diagnosis of tuberculous pleural effusions and if required, certain physicians might start the treatment without confirming the presence of TB with a sputum culture. I would suggest her to continue with the treatment and follow up to rule out TB definitely. She will also need to have follow up visits to check her liver if the treatment continues. I wish her a prompt recovery.

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