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TB,CERVICAL LUMPH NODES
Sep 29, 2008

I AM MALE 30 YEARS OLD. I HAVE DEVELPOED LUMPH NODES. I GOT MY FNAC DONE TWICE IN APR 2008 AND JUL 2008. REPORT SAYS 'LEFT CERVICAL LUMPH NODES'. I ALSO GOT MY MONTOX TEST WHICH WAS 20mm POSITIVE. MY ESR WAS 24. REST ALL REPORTS INCL CHEST CT SCAN, ABDOMINAL ULTRASOUND,BLOOD CP, SUGAR FASTING, URINE RE, LFT, AND CHEST X RAY WERE NORMAL. MY DOC HAS PUT ME ON ANTI-TB. I NEVER HAD FEVER, NOR ANY WAIGHT LOSS AND NO OTHER ABNORMALITY. MY LUMPH NODES ARE ON LEFT SIDE OF NECK ABOUT 5 SMALL SIZA UNDER AND NEAR MY LEFT EAR AND 3 SMALL LUMPH NODES ON LOWER SIDE OF NECK. COULD YOU PLEASE ADVICE ME WHAT I SHOULD DO. ONE THING MORE I AM GETTING MARRIED IN DEC COULD YOU PLEASE ADVICE ME IS IT SAFE FOR ME TO GET MARRIED IN DEC. WHARE AS MY TREATMENT HAS STARTED ON 9 SEP. LOOKING FWD FOR YOUR REPLY.

Response from Dr. McGowan

TB is a very common infection depending on where you live. Having HIV would put you at increased risk of having disease caused by TB. Your positive skin test for TB indicates that you have been exposed to TB and likely have the bacteria in your body. The test measures your immune system's reaction against the infection. TB, like HIV, can present in many ways. It is a great mimic. Swollen lymph nodes is a common presentation for TB. HIV can also cause swollen glands but they are usually symmetrical (which means balanced between the right and left side). You would have to be treated for your TB exposure to prevent disease spread anyway since you are young and have a positive skin test. The risk of not treating for active disease (with 4 drugs instead of 1 for prevention) would be to risk development of drug resistance (just like with HIV). TB can take weeks to grow in the lab, especially if there are only a few bacteria and your body has made a strong reaction against it. Sometimes the cultures never grow. An FNA may not be as successful as an open biopsy to get enough tissue for the diagnosis. It sounds like your doctor is being conservative, and I would agree that that is likely the best approach. You should not be infectious to others with a negative CT scan and no cough, especially after you have been on treatment for a couple of weeks.

Best,

Joe


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