a big mess

[shina]

i have problem that ,i m suffering from lymph tuberculosis and problem is that i have two nodes on neck left side in which one node is disapear and the second one is still same and no changes.this is 5th month now taking antituberculosis medicine .so plz tell me what should i do now?
I M Lil Worried.that,y Its Not Shrinking?one Is Completly Vanished And The Second One Is Still Same No Shrinking Sign ,,nighther Increasing Nor Decreasing.plz Tell About That How Long Should I Take This Medicines.and How Long Time It Will Takes To Remove And I M Still 20years Old And I Cant Raise My Arm Up I Feel So Heavy Ness.due To That Node.and Problem In Mensus Too.not Comes Monthly.

[flirt]

continue your full drug course. Don't be anxious. I think it will disappear too after completing the full drug course. If it is getting smaller then the treatment is working. If the node becomes larger then immediately get medical care by visiting your doctor. Prevent other infectious disease. Have a follow up checkup and consultation with you care taker. Have a healthy diet.

[Soul]

I agree flirt, continue ur drug course. i think steroid is also prescribed for lymph node TB.

[JNUS]

Absolute indication for Steroid is for TB meninges,ureters,eyes,pericardial effusion,adrenal :::: Relative and also most frequently prescribed on TB ascites, larynx, pleural effusion.

Most of the time steroids are not prescribed for TB lymph Nodes.

[Walrus]

Suggestion - Follow the DOTS and physician's assessment.

LN will take time to disappear; may be years but the important thing is to know if there is evidence of infection or not.

[Soul]

Most of the time steroids are not prescribed for TB lymph Nodes.

I don't agree you. I still remember the pnemonic (PUMP LO) for indication of steroid therapy in TB.
1. Pleural effusion
2. Ureter
3. Meningitis
4. Pericardial effusion
5. Lymph nodes
6. Ocular

[Walrus]

Soul, That is not a reasonable argument you have given. I don't know the pneumonic but I feel you are being mislead by it.

For Cervical Tubercular Lymphadenopathy like one described here has no indication of Steroid. If you know any indication, please give a rational statement that can be understood.

I agree with JNUS, ''most of the time, steroids are not prescribed for TB LN''

One place I will consider giving sterod in Lymphadenopathy is Hilar Lymphadenopathy if it is compressing the mediastinal structures.

Instead of relying on the pneumonic, please try also to understand why steroids are indicated in TB. Patient on steroids are at increased risk of TB flareups; so why would anyone want to prescribe steroids without a strong reason. Please give it a thought and share your view. We shall discuss more.

[hydatidcyst]

The fact that one of your lymph nodes has disappeared is most probably that the ATT you are taking is working properly and if you read the texts, lymph nodes take time to disappear.

Most probably, you have started the ATT after ascertaining the diagnosis of TB lymphadenopathy. If there is any doubt, you may opt for an excisional biopsy, but one thing you must be careful is that the wound healing is poor if it is a tubercular lymph node. If the situation is scaring you, you may once visit a doctor for an evaluation.

[JNUS]

PTB, Pleural Effusion and TB Lymph Nodes are the most common one that we encounter in our country since the first day of the medical school. And we see it through out. From the time i was posted as medical student on Hospital exposure to internship and on my practice till now, i had never seen any physicians prescribing steroid for LN that's why i wrote most of the times.. And also i checked few books and i don't find it as an relative indication also.
Soul :::: could u please re-check it with some references. Cause there are still many small things that we don't know, correct me if i m wrong.

Regarding original topic of the TB gland, not disappering, it might be duty secondary infection on it ( tenderness, increased local temp ) or could be due to cold abscess formation. If not then no need to worry cause disease will be wiped out and so it will regress and if won't it can be Excised (resent for biopsy).

[Soul]

Obviously steroid is not a definite treatment for TB, but it is prescribed for lymph node TB (scrofula) coz it helps for regression of nodal enlargement. I don't think steroid in scrofula can flare up the infection , it is an extrapulmonary TB. I am not talking about chronic steroid use, but some still consider a combination of steroid (for 1 to 2 month) plus ATT an effective treatment strategy for lymph node TB. I agree with you JNUS, most of the time steroid is not prescribed for nodal TB..my mistake.