Q: My 24 years old wife is suffering from tuberculosis (TB) for the last 2 months. She has enlarged lymph nodes in the neck and fine needle aspiration cytology (FNAC) report of the left supraclavicular node stated scanty aspirate showing few areas of caseous necrotic material and scattered lymphoid cells in the background. IMP: Koch’s adenitis; left supraclavicular region. My wife is taking AKT-4. We have a 2.5 years old daughter. Is there any chance of infection transmission to our daughter? When can we plan for the next child? For how many months does she have to take medicine?

A:Tuberculous adenitis or Koch’s adenitis (also called scrofula) is a form of extra-pulmonary TB, caused by the infection of the lymph nodes by the bacteria Mycobacterium tuberculosis. However, a small proportion of cases could be caused by non-tuberculous mycobacteria or NTM (such as Mycobacterium scrofulaceum).

Most TB lymphadenitis cases are secondary to a primary infection elsewhere, usually, the lungs. The disease may manifest as a swelling of the lymph node (in this case of the supra-clavicular region), which is characteristically painless in majority of cases. On histological or cytological examination (such as fine needle aspiration cytology - as in this case) caseating (or cheese like) necrosis or degeneration of the affected tissue is observed, along with infiltration of the affected area with chronic inflammatory cells (lymphocytes). Sometimes, the skin over the lymph node may ulcerate revealing a sinus (a tract) through which infectious or degenerated tissue debris may get discharged to the exterior. The condition is amenable to treatment, which generally lasts for a minimum duration of 6 months. Most patients on effective anti-tuberculous therapy become non-infectious by 2 weeks of starting treatment. However, it must be remembered that TB of the lymph node is much less infectious than the TB affecting the lungs. So the chances of your wife transmitting the disease to other members of the family are quite low if no co-existing lung TB is present.

It would be important to know if any sample from the FNAC was sent for Mycobacterial culture and susceptibility test. In case of drug resistant TB (which occurs in about 3-15% of patients in India), the standard first line treatment may not work. Most experienced clinicians are able to make an assessment of the risk of drug resistant-TB from history of previous TB treatments (if any), adherence to current TB medications and clinical response to current therapy.

Physicians treating TB may do certain tests routinely in order to plan treatment or the monitor response to therapy. These may include: a chest X-ray, a full blood count, a liver function test, urea/electrolytes, ESR/CRP, and an HIV test. I would advise you to be alert but not alarmed by the possibility of TB transmission within the family. TB is a common disease in the Indian context, and with regular and appropriate treatment, most cases are cured. BCG vaccination helps in providing some immunity against this disease especially against the conditions like miliary (disseminated) TB and TB meningitis (both of which are found to occur more commonly among children). Since, BCG vaccination is part of India’s national immunisation programme, I hope that your child is already vaccinated with BCG. This will give her immunity against TB and help her to fight the organism if she is exposed to it. It would also be important to see if there are other members of the family (or even among visitors) who have got signs or symptoms of TB (such as fever, cough, bloody sputum, weight loss). Individuals with these symptoms or signs should see a doctor to rule out TB. My best wishes for your family.