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Posted On : 11 Aug 2024

I have a 10-year-old patient who was admitted to us 2 months back with a fever, on investigation and examination he was found to have Rt effusion which was therapeutic and a diagnostic tap was done, it was tubercular with Mountoux 20 mm positive, he was started with 4 drug ATT after 1 mth he came to me with absolutely no fever, healthy life xray done revealed blunting of angle, I continued on the same treatment, now he came after completing 2 month of intensive TT by ATT and no complains, adequate weight gain is there, but x-ray shows blunting still present.
How much time does it take to clear, any role of steroids if the effusion persists TB effusion is a hypersensitivity reaction to protein, Do I need to continue intensive treatment for 1 month more, I was unclear as there were no symptoms I put him on 2 drugs now?

Expert Answer :

Answer Discussion :

A

Abhinav Peerdiwal

0

Thanks for the query
You might have to send CBNAAT and liquid cultures if not already send.
Get a CT scan or good lung USG to see what is the underlying pathology there -fluid or fibrosis or atelectasis.
But seems reasonable to continue with whatever treatment you are giving

1 month ago

D

Dfsa Ata

0

3month

1 month ago

A

Ashish Dutta

2

No role of extending the intensive therapy.
Ideally Gene Xpert should have been done to check for Rif sensitivity.
XRay clearing can take 2-3 months also.
If the child is clinically better, weight gain is present then don't need to chase the X-Ray findings.
If you are still worried then can do a CT chest, it might be just pleural thickening but always keep in mind the radiation exposure component.
No role of steroids.

1 month ago

F

Fahad Iqbal

1

Pleural effusion in tb needs steroid cover, do the gene xpert if its negative start continuation phase with 2 drugs if positive look for rifampicin resistance

1 month ago

D

Dr. Akshay

1

Pleural effusion is the most commonest cause as you told pt had effusion I think go for bronchoscopy to rule out empyema or hemothorax as these two are the complications

1 month ago

Answer 1

Minimal effusion may persist for a few months. If the child is putting on weight and is otherwise well, he can be continued on regular ATT regime.

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