How can tuberculosis diagnosis be confirmed?

Q: My 62 years old mother suffered from persistent cough for over three months. My father took my mother for treatment to a chest specialist. The specialist tried a variety of drugs over a month and referred my mother to an ENT specialist. The ENT specialist asked for a chest x-ray and the radiologist diagnosed the infiltrates as pneumonic. My father took my mother to another general physician who asked for a Mantoux test, which came positive. The physician saw the report and told that she is not suffering from tuberculosis. He then started treating her for pneumonia. Then we consulted another physician who after seeing the Mantoux, diagnosed my mother with pulmonary Kochs and started multi-drug therapy (MDT). For the last one month, my mother is taking MDT and has become really frail and weak. She weighs just 35 kg now. To add, she is taking medicines for seizures. Is there any other definitive test for diagnosing her disease? Right now, she is living away from the main city and we are thinking of taking her to Hyderabad for further treatment.

A:It appears that your mother has a chronic cough with an abnormal chest x-ray. It also looks like the cough has slightly improved with multidrug therapy for tuberculosis. However, your question is very good. While TB is the most likely diagnosis in the situation you describe other diseases are also possible. Sputum is helpful to see if a patient is infectious and to also analyze any AFB that grows for drug sensitivity since resistant TB is also known to occur. In my view confirming the diagnosis with repeat sputum evaluation possibly three early morning specimens for TB by a certified lab would be ideal. Also another chest x-ray or CT chest may be needed if cough does not improve. Ideally your mother will need to wear a mask when in public or at home while coughing and until it is clear that she is not infectious. Hand washing with soap and water is also important. Since your mother is on many other drugs make sure that they check for drug interactions and adjust doses. This is very important because your mother takes medicine for seizures.

Make sure the complete white blood count and the AST and ALT are monitored periodically. A definitive test to confirm TB would be mainly from sputum but there are a few blood tests that may help. A TB specialist such as through the Chest Hospital would be a good resource locally since they see a lot of TB cases. Some patients may need a procedure called induced sputum production or a bronchoscopy to confirm the diagnosis. I would suggest that she gets regular checkups with a chest specialist and if you are moving her to a city there will be many choices. Also in terms of quarantine follow the precautions we mentioned and you have to be sensitive about it since you do not want to socially isolate her either. Once treatment for TB is initiated patients will become noninfectious so things will improve. Make sure your mother has a good diet and takes a multivitamin also.

In summary it appears this may be TB according to local doctors but other diagnoses are possible and if she can get a confirmatory test, it will help such as repeated sputum evaluations and blood tests for TB like the Quanti-FERON test. Please make sure drug interactions and labs tests for side effects are monitored.