Is my husband infected with TB?
Q: My husband is 34 years of age and weighs around 74 kgs. Since the last one year, he is suffering from fever. Though he feels feverish, but this doesn't show on the thermometer. He feels weak. And also gets throat infections very frequently. He had undergone open heart surgery in childhood. He has got his initial test done in November for Widal, Blood sugar, CBC, ECG, ECHO, etc. All were OK. Now the doctor has suggested for a second round of tests. The results show that his CBC count is okay, but ESR is 20. He has under gone Mantoux test which has shown 8mm. The blood culture record for 48 hours is negative, TB IgM is 0.18 but TB IgG is 272 (which is positive). What does this signify? Is he infected with TB? If yes, will it be curable and will it affect our baby, who is expected soon? Should he go for a CT scan also?
A:It is unlikely to be fever if the temperature has been recorded between 36.7 and 37.1 degree C. Have different thermometers been tried to confirm if he actually has fever? The feverish feeling along with weakness for nearly one year could be due to many factors including diet, exercise, workout, occupation, etc. ESR of 20 mm is slightly raised but does not have much significance since it is an acute phase reactant and is non-specifically elevated in a large number of conditions. Also, blood for this test has to be collected in the fasting state to minimise false positives. Mantoux reading of 8 mm is negative from the patient's perspective in endemic countries like India, though would be considered positive for epidemiological reasons, and can be explained on the basis of BCG vaccination. TB ELISA is a non-specific test with poor diagnostic accuracy, sensitivity and specificity. A negative IgM with a positive IgG may indicate exposure in the past, and that would be true for the majority of population in endemic countries like India. An x-ray of the chest is definitely indicated and a CT scan may be done if the x-ray is inconclusive. It might be worthwhile to re-evaluate the symptoms in detail by a physician, keeping diet, exercise, occupation, psychosomatic features, etc in mind. It could also be initial phase of myopathy, myasthenia gravis or post-viral fatigue syndrome.