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Old 07-21-2010, 05:27 PM   #3
ashandtherev
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Re: scrofula/lymphatic TB

Quote:
Originally Posted by harka View Post
Hi Ashley!

You've had quite an ordeal this past year eh? So yes, sounds like you have TB lymphadenitis, though technically since your skin didn't bust open and start draining pus, it's technically NOT scrofula.

TB is a very interesting infection because it can infect almost every single organ in the body. The only place it has never been documented to infect is dental pulp. The problem with TB even nowadays is that we don't have the best diagnostic tests to identify it. Much of the time we are relying on culture based methods (i.e. when you actually have to go to the site of the infection and get tissue or phlegm) though there are a few new tests we can do on tissue to make the diagnosis a bit more rapidly (i.e. PCR).

The worst possible test to do to try to diagnose TB is the TB skin test. It is OFTEN negative in active tuberculosis and if someone has symptoms which are suggestive, you should NEVER rely on a negative TB skin test. The fact you had granulomatous inflammation in the lymph node in the context of a lot of exposure to TB, is very suggestive, but not confirmatory of the diagnosis. In Canada, a lot of the time we'll send that tissue sample to the lab so they can do direct PCR on it to try to identify the TB (it's must more sensitive that way).

Unfortunately, in MANY cases of TB, we are stuck having to treat it empirically (i.e. without complete proof). The added clinical difficulty in your case is the fact you were in S. Africa which has a lot of drug resistance (as you know), so choosing a regimen to start you off on would be difficult.

TB can happen when you are first exposed to it (i.e. primary TB), but it can also happen when you are exposed to it...your immune system beats it down and the TB goes to sleep, but then it wakes back up a few years later and causes infection (i..e reactivation TB). Often this happens in immunosuppressed people, but make no mistake, completely healthy, immunocompetent people can get TB.

Working in Toronto, given the number of immigrants here (a huge proportion even compared to larger cities like Los Angeles and New York) we see one of the highest number of TB cases in N. America, so there's extensive experience.

Are you on treatment right now? Have you been in any other places where you could have been exposed to TB?

I have my next appointment at the health department next wednesday. and I guess we will discuss treatment options then? They wanted to review all my xrays and stuff so they were waiting for them to come through to their office. I have spent time also in morocco (north africa) I am not really sure what the issue of TB is there, otherwise I have spent time in Europe. Also do you know of the probability of ovarian TB is? I have had excrutiating pain in my ovary, have been to the e.r. a few times for it and they keep saying its an ovarian cyst. But the pain continues, I've heard of tb in the reproductive organs, how would they diagnose that?? through a biopsy of the ovary/fallopian tube?? THanks so much for your reply, I can't sleep because I can't stop thinking about all this stuff..