Q: I am a 78 years old male with an elevated ESR (110-140) and had a heart stroke last year. Now, I am suffering from cough, irregular episodes of fever, loss of appetite and weakness. Some abnormal findings such as mild prostatomegaly, mediastinal lymphadenopathy and slight thickening of pleura were reported in my tests. Are these the symptoms of TB? Currently, I am on ATT (anti tuberculosis treatment). My Mantoux test result is negative. What line of further treatment should I take?

A:The symptoms of cough, irregular fever, weakness and loss of appetite along with an elevated ESR and X-ray findings of mediastinal lymphadenopathy and pleural thickening suggest tuberculosis. The initial evaluation should include X-ray chest and sputum examination for TB bacillus (AFB stain and culture). The role of Mantoux test is very unclear in endemic regions and in individuals who have received prior BCG vaccination. A CT scan is sensitive in the identification of lung, pleural or lymph node involvement. Rapid automated culture techniques are readily available for identification and antibiotic sensitivity. Serologic tests (testing for TB antibodies) are neither sensitive nor specific for diagnosing TB routinely. It is advisable to consult a good chest specialist who can examine the patient and exclude the possibility of other diseases, including malignancy.