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Tuberculosis

Right Term for TB Scar

06/29/2010

Question:

after being diagnosed with minimal ptb, i underwent a 6-month treatment, but later on realized that i was not cured at all.i consulted different doctors and i was started at category II and finished my 8-month treatment with tropical disease foundation. it has been a year but pulmonologist`s xray readings still states that i still have "small cavitary". i had my sputum tested and turned negative. i even had my xray plates to be read by the tb diagnostic committee wherein they said that i no longer need further medication. they even issued med certificate. however, im having problems justifying to other doctors that im cured already. they said "small cavitary" is not the term for scar and i might still have "it". i feel very healthy now and haven`t had cough since i completed my treatment.

am i still sick or i would have to deal with that "small cavitary" and never pass pre-employment medical examinations my whole life??

please help me, im desperate.

thank you!

Answer:

It is often very difficult to determine how long to treat a patient diagnosed with pulmonary tuberculosis (TB) to be sure that they are “cured.” The guidelines state for drug susceptible Mycobacterium tuberculosis, treatment of 6 to 9 months is sufficient to kill the slow growing mycobacteria. Clinically, we will use 3 different factors to determine how long to treat a patient: clinical improvement (patient feels better and no more signs or symptoms of pulmonary TB), radiological improvement (Chest X-ray [CXR] has improved and becomes stable), and microbiological improvement (sputum smears and cultures have become negative). Even using all three factors to decide when to stop the TB medicine, it is not a 100% guarantee that we have “cured” the patient. However, treating patients with the best drugs to which the bug is susceptible for the proven duration should cure the majority of the patients (90-95%).

The definition of “minimal” pulmonary tuberculosis (TB) may vary. However, patients with minimal TB usually have milder symptoms and a shorter duration of symptoms, with minimal disease on CXR. The CXR may continue to remain abnormal despite adequate treatment.

It appears that you are feeling well and no longer have any signs or symptoms consistent with TB. In addition, the pulmonologist and the TB committee have stated that you have completed treatment and are now “cured” and have provided you with a letter to support this. Your only concern is the persistent abnormal CXR.

Many employers have regulations that require further medical work-up. In a person with previous history of pulmonary TB, that may require a CXR. If the CXR is abnormal, they may then require further work-up to rule out active TB disease even though you have a treatment completion letter. If you can show that the abnormal area on the CXR is stable (not changed in the last two years) that may help to support that you do not have active infection. I am sorry you have to go through this frustrating process, but employers are required to this because they need to ensure that you are “not infectious” and cannot transmit the infection to others. Usually, you only need to do the extensive work-up initially as a new employee. We are very happy that you have been cured of your TB disease and have made a complete recovery and hope the pre-employment process will get easier.

For more information:

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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