Concluded Case

A 23yr old male presents with fever for 3 days, cervical lymphadenitis since a week and generalised weakness. No history of loss of appetite or weight loss.No history of cough or any other symptoms. On examination vitals are stable. FNAC and excision biopsy of the lymph nodes were suggestive of acute inflammatory reaction and was negative for TB. Even GeneXpert was negative. Patient was discharged on antibiotics. After 4 weeks TB culture report was positive. What's the probability of TB lymphadenitis in this case? What's the further management?

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Concluded answer

Smear.. negative Genxprt.. negative HP...and fnac..acute inflammatory reaction Mycobacterial culture.. positive. Culture report appears dubious. Go by clinico imaging correlation. Do not start ATT..solely on basis of this culture report. Periodic follow up with a course of broad spectrum antibiotics..is suggested.

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All related test like smear negative, Lymph node biopsy negative Xenexpert negative 3. Sputum test negative Xay chest normal no sign of tuberculosis Only culture came positive Very difficult to take up as tuberculosis Go CBNAAT. Keep watch for 3 months the repeat to make any conclusion.

I agree sir
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Smear.. negative Genxprt.. negative HP...and fnac..acute inflammatory reaction Mycobacterial culture.. positive. Culture report appears dubious. Go by clinico imaging correlation. Do not start ATT..solely on basis of this culture report. Periodic follow up with a course of broad spectrum antibiotics..is suggested.

Thank you doctor
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Excision biopsy HPE would be GOLD standard diagnostically. But if culture report is positive for TB, start 1st line drugs as per body weight. May give 6to 9 months therapy. Evaluate for HIV status. Also see for atypical mycobacterium complex.

It is tubercular adenitis and to be treated by ATT.

Thanx dr Dinesh Gupta
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Case of tuberculosis ad X-ray chest CBNAAT & sputum exam then start AaTafter reports are available

Thank you doctor, chest X ray was normal and 3 sputum samples were negative for TB.
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IT'S A..CASE OF.. ? TUBERCULOS LYMPHADENOPATHY.. NEED'S.. ANTI TUBERCULOS TREATMENT.. FURTHER INVESTIGATIONS..

Usually criteria for TB Such as x ray chest Sputum AFB Cytosmear Geexpert All negative Only culture positive It is doughtful Repeat it Clinicopathologic also correlation

TB Lymphadenitis Rept FNAC again Start ATT

Yes sir I do admit your opinion, I think repeat culture before going for any further specific treatment.

ADVISABLE.. CLINICO. IMAGING.. CORRELATION PERIODIC. FOLLOW. UP.. BROAD. SPECTRUM. ANTIBIOTICS

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