Q: My son reported throat pain with a small lump on left side of his neck. We got him examind by a physician who first advised various tests like blood, chest X-ray, etc. Since nothing unusual was noticed in these reports, he further advised cytology test of the lump. After this, he prescribed standard 4D Medicine,which my son took continuously for 4 months. After seeing the progress and disappearance of the lump, the medicine was reduced and he was advised: 1. R-cinox(600 mg) once daily; 2. P-Zide(750 mg) two tablets; 3. Benadon(40 mg)once daily. This treatment continued for three more months. But recently in August 2002, my son reported sudden pain on the left side of abdomen with slight temperature in the evening (varying between 98-101 degrees F) with complete exhaustion/total tiredness. The fever used to be occasional with a gap of about 4 to 5 days. The matter was reported to the treating doctor who again did blood & urine tests and chest X-ray. Nothing came out in these test and everything was normal. Then the doctor advised CT scan of chest and upper abdomen. The same was done and the only observation was as under: Left moderate pleural effusion is seen to layer the dependent aspect of pleural space. No accompanying pleural thickening or enhancement seen. Some basal resultant passive collapse is on right suspicious anterior basal focal lung opacity is there--Otherwise lungs are clear. Opinion--: Left moderate amount pleural effusion. Tubercular aetiology needs first consideration. Various queries which obviously bother us are as follows for which I seek your advise and guidance: 1. Are we on right track of treatment or anything else is to be done for our son to fully recover from this ailment? 2. Is there any side effect of these medecines, if any, what should be done? 3. What diet should he take? 4. Any precautions to be taken by my son or other family members? 5. We do not have any family history of this problem. 6. Normally, what will be time span for treatment and can this reccur? Please advise as we are very emotionally involved and my son is a young boy of 25 years who is just starting his career. He has to attend to his daily office jobs also. Sorry for the lengthy letter and the details.

A:Your son obviously has a resistant form of tuberculosis. This needs aggressive management by the physician, with need to use as many drugs as neccessary which the body can tolerate, with monitoring of other blood and liver parameters, so that drug dosage can be monitored to not cause too many side effects. As long as repeated sputums for AFB are negative, there is no worry of infectivity. This can happen to anyone in any socioeconomic status in India (and for that matter in UK also) so the concern that this has not happened before or to anyone else is unfounded. Just treat aggressively, and all should be well.