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Tuberculosis

Tuberculosis With No Symptoms

02/19/2009

Question:

My friend went for a chest xray. There is as spot on the lungs. The doctor skipped the tests since there has been a spots in 2 consecutive xrays in a week already (2 were done because she wanted a second opinion). My friend is on medication (rifampicin, isoniazid, pyrazinamide and ehtambutol) for almost a month already and is due for an xray for her PA. Is there a possibility that on her xray after a month there wouldn`t be a trace?

Answer:

It is difficult to comment on your friend’s case without knowing more details. However, I will try and give some general comments that may help answer your question.

Currently, your friend is being treated for active tuberculosis (TB) disease with the 4 drug medication regimen. You mention that your friend does not have any symptoms. The most common symptoms of TB disease of the lung are cough, fever, chills, night sweats, and fatigue but rarely, patients may have no lung symptoms and have an abnormality on CXR. I am not sure if your friend only has the CXR abnormality or other evidence to suggest TB such as a history of positive skin test, history of TB exposure, sputum culture positive for TB, or symptoms initially but now with TB medications the symptoms have resolved.

Usually patients with active TB disease of the lung are treated with 4 drugs for the first two months, then the medication is decreased to 2 drugs (rifampin and isoniazid) for 4 more months. A follow-up CXR is usually taken at 2 months and at the end of treatment. The duration and medication choice vary depending on drug susceptibility testing, clinical improvement, length of time a patient remains culture positive, and the type of CXR abnormality (cavity or hole in the lung is more severe).

To answer your question, “Is there a possibility that on her xray after a month there wouldn’t be a trace?” It depends on the “spot”. I am not sure how big the spot is, whether it is solid or cavitary, and how long the spot had been there. It is especially helpful to have an old CXR to compare it to. With TB treatment, the spots can decrease in size, completely resolve, or stay the same size. That is why we take a CXR at the end of 2 months, to see if there is any improvement and make sure the spot does not get bigger. Another CXR is taken at the completion of TB treatment so that the doctors will know what the lungs looked like at the end of therapy. Spots on the lung should generally be followed by a doctor for one to two years to make sure they do not get bigger. Such spots can be due to several causes apart from TB.

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Response by:

Shu-Hua   Wang, MD, MPH&TM Shu-Hua Wang, MD, MPH&TM
Clinical Assistant Professor of Infectious Diseases
Clinical Assistant Professor of The Division of Epidemiology
College of Medicine
The Ohio State University

Larry S Schlesinger, MD Larry S Schlesinger, MD
Professor:
Molecular Virology, Immunology and Medical Genetics
Microbiology Administration
Environmental Health Sciences
College of Medicine
The Ohio State University