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Pleural effusion and CBNAAT

Dear Seniors and friends, I want your help in regard to Pleural effusion and CBNAAT for TB. In my practice I have observed so many cases which are having consolidation in the lungs and yet their sputum and CBNAAT are negative. These people are having typical symptoms of cough with sputum and fever with chills, weight loss and decreased appetite. A lot of patients have pleural effusion but their pleural fluid does not have any abnormalities. I wanted to ask that how much reliable these investigations are and whether we should start ATT or not and if not then should we leave the patient in deteriorating condition? Your opinions will be valuable for me. In the area where I am practicing Pulmonary TB is very much prevalent so all your suggestions will be of great help. Regards, Dr Himanshu Bansal

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DOCTORS CLINICAL EXPERIENCE IS ABOVE ALL REPORTS YOU CAN START THE TRATMENT EMPERICALLY IF PATIENT IS HAVING TUBERCULOSIS PATIENT WILL START FEELING WELL WITH IN 15 DAYS
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DOCTORS CLINICAL EXPERIENCE IS ABOVE ALL REPORTS YOU CAN START THE TRATMENT EMPERICALLY IF PATIENT IS HAVING TUBERCULOSIS PATIENT WILL START FEELING WELL WITH IN 15 DAYS
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Pleural fluid analysis. Straw colored turbid fluid with prominent lymphocytes on microscopic examination with cob web in the bottle after some time of storage of aspirated fluid .its protein content is high ( exudate) the clinical features of pt fever cough pleural chest pain loss of wt These things are sufficient to start AKT.in haemogram raised ESR.pleura fluid can be sent for TB gold/ gene expert test
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IF SPTUM EXAM FOR 3 DAYS MORNING SAMPLES ARE - VE CBNATT IS NEGATIVE PL FLUID ADA NEGATIVE IT IS NOT TUBERCULOSIS OTHER INVESTIGATIONS MAY BE DONE BRONCHOSCOPY & BAL FLUID MAY BE EXAMINED FOR AFB CULTURE FOR AFB SPTUM FOR CULTURE FOR AFB MAY BE DONE BLOOD CULTURE DD 1SARCOIDOSIS BLOOD ACE 2ATYPICAL PNEUMONIA SPTUM = C& S 3 TO RULE OUT BRONCHOGENIC CA WITH SECONDARY INFECTION
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Generally pleural fluid CBNAAT -sensitivity and specificity is low,if you having doubt you can do interferon gamma levels,if it’s >3.7 suggestive of tuberculosis and Do ADA1 /ADA 2 ratio,if it’s more than 0.7 suggestive of tuberculosis However sputum CBNAAT sensitive and specificity is 99%
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Though clinical experience is superior we still shouldn't start ATT without hard evidence in most cases. If pleural fluid is non suggestive, Sputum CBNAAT is negative, then most likely its not Tuberculosis. Still we can give a trial of ATT if TB cant be ruled out.
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Though clinical experience is superior we still shouldn't start ATT without hard evidence in most cas If pleural fluid is non suggestive, Sputum CBNAAT is negative, then most likely its not Tuberculosis. Still we can give a trial of ATT if TB cant be ruled out.
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In such situations u can start "Therapeutic test of AKT" Will show result in 15 days by improving the health of pt,u should continue for full period course. At least u can save few pt, not all.
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ADVISABLE PLEURAL. FLUID ...ANALYSIS AND CULTURE. AND. SENSITIVITY

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