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Tuberculosis

Am I cured of TB

07/23/2008

Question:

I am a 38 year old female. I have been experiencing recurrent urinary tract infections since my first pregnancy in 2005 which was through surgery. I was prescribed antibiotics during such infection, after the completion of the course of antibiotics the infection used to go, but it recurred after 1-2 months. The agent was always E.Coli. I took all types of antibiotics then a stage reached where I had developed resistance to most of antibiotics.

Last year a doctor advised me to go for a test (urine for PCR). The result of which confirmed TB. The CT scan report conducted read as right kidney is normal in position, size and contour with normal contrast excretion, a calclus in right kidney 10mm size in lower pole calyx and left kidney is normal in position, size and contour with normal contrast excretion, no evidence of renal calclus, in plain section, multiple tiny subcentimeter sized hyperattenuating foci (attenuation 70-90 HU) in the renal cortex in upper and mid pole regions, suggfestive of punctate hemorrhagic foci. Few tiny subcentimeter sized cortical systs are also noted in left kidney. Besides Hepatomegaly is present with liver span of 20 cm. A small calcified nodule is seen in right lobe of liver, suggestive of old granulomatous lesion and a small subcentimeter sized cyst is also noted in lateral segment of left lobe of liver.

The doctor advised that I had tuberclosis in my left kidney and put me on on medication i.e. 1. RCINEX (900mg), 2.PYRIDOXIN 40mg, 3.PZA-CIBA (750mg). After 3 months I was advised to continue 1 & 2 only, and have been taking the medicine since 10 months. In my latest urine reports E.Coli still persisted. Now the doctor has advised me to discontinue the medicine as there is no need to continue. He also advised me to go for laprascopic surgery for removing the stone in right kidney.

I want to know whether I had the TB in my left kidney, and how have I contacted the disease because I have been living under good living conditions since my childhood and also the stone has been persisting in my right kidney since lthe last 8 years. Has the medication actually cured me of the disease. Is there any test to confirm that I have recovered. Should I go for laproscopic surgery for removing the stone in the lower pole calyx of the right kidney? Is the recurring UTI because of the stone in right kidney? Please advise.

Answer:

I am not able to comment specifically on your case, except in very general terms. The test (PCR) which you had performed to diagnosis tuberculosis is a good test and a positive result is considered diagnostic of active tuberculosis. The treatment which you describe is standard tuberculosis treatment used throughout the world and would be considered curative for tuberculosis. There is no test to be completely sure that the TB is gone and will not come back. However, the 10 months of treatment you used is curative in about 98% of people.

The persistence of bacterial infection in your urine (E Coli) is concerning and likely requires more aggressive treatment. I am not a urologist or an infectious disease specialist and therefore cannot comment on the recommendations for surgery.

Thank you.

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Response by:

Catherine A Curley, MD, MS Catherine A Curley, MD, MS
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University