What do you think is impact of mis-diagnosing TB on drug-resistance and public health?

[bobby ramakant]

Dear friends,
read the below story, online at: http://StopTB.citizen-news.org

The boy had to take anti-TB medicines due to misdiagnosis, he was actually suffering from cancer. Luckily after two years of mistreatment, he was finally rightly diagnosed and treated - and is safe and recovering.

What is your experience with TB getting misdiagnosed and its impact on drug-resistance and public health at large?

Looking forward to learning from you all,
warm wishes, bobby

Thank God, the boy is safe
Gaurav Saigal
The Hindustan Times
30 January 2010

Wrong diagnosis forced eight-year old Adarsh Kumar Tiwari to quit
studies. 80 per cent of cancer patients are victims of delayed diagnosis
in India, said Dr MC Pant, former medical adviser to Uttarakhand
government.

Suffering with Hodgson's Lymphoma - a type of cancer Adarsh was
diagnosed and treated for tuberculosis by the doctors roughly for two
years. This developed the cancer in him to near fatal stage three.

After roaming in different government and private hospitals for two
years he was admitted to Balrampur Hospital on February 16, 2009. For
next 10-months he remained under treatment here but was compelled to
stop going to school due to treatment schedules. On Friday, doctors of
the Balrampur Hospital, who finally treated the child, declared Adarsh
was out of danger and could lead a normal life. But for the little one,
two years of his life are gone. "When he came to us the boy had
undergone all major tests and treatment for tuberculosis, malaria and
other such related diseases. Our diagnosis fortunately was correct" said
Dr GK Singh, senior paediatrician at Balrampur Hospital.

The case, Dr Singh said, though was not difficult to diagnose for lymph
nodes could be located both in his neck and lower abdomen but was
difficult to treat as the cancer was of stage III (B). This type of
cancer happens to five among 10 lakh children and this was first such
case at Balrampur Hospital.

Till November (roughly 10 months) Adarsh remained under medical
treatment and was given chemotherapy. Finally he has been declared as
treated. "We spent over Rs 40,000 (about USD 850) in two years on
diagnostic tests, medicines and doctors fee" said Adarsh's mother Renu
Tiwari who is now planning to send her son again to school.

 

(Published in The Hindustan Times, Lucknow on 30 January 2010: credit-line: Gaurav Saigal, HT Staff Writer)

[bobby ramakant]

Comment: Cancer patient treated for TB (3)
Dr Rakesh Bharti
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[Mods note: The news online at: http://StopTB.citizen-news.org is about a boy who had to take anti-TB medicines due to misdiagnosis, he was actually suffering from cancer. Luckily after two years of mistreatment, he was finally rightly diagnosed and treated - and is safe and recovering.

Members are welcome to share their experiences with TB getting misdiagnosed in their local contexts, and its impact on drug-resistance and public health at large. Thanks]
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Dear Stop-TB members,

AND THE REVERSE also happens where patients of TB get misdiagnosed as that of cance (Hodgkin's).

I have an HIV patient, age 49, male. This man started having fever and after few months even lost some kgs of weight, may be more than 10% of his original weight. Taken to a reputed medical college in Ludhiana in Punjab and was diagnosed to have cancer--Hodgkin's.

The name of "cancer" scared him--so he sought second opinion and was found to be co-infected with TB and HIV. Anti-TB treatment (ATT) for nine months and ongoing anti-retrovicral (ARV) therapy have made him a healthy looking man now.

The point to be taken care is that-should we not double check before announcing dreadful diseases?

The medical fraternity knows very well (through some published articles, some not) that err is human and we do commit mistakes in our medical life times. There is more wrong, however, if we commit a mistake and do not accept and rectify. Tuberculosis bacilli is one of those, who have many other ailments forging its signatures. So be cautious.

Dr Rakesh Bharti
BDC Research Center
Amritsar
Email: [e-mail]

[bobby ramakant]

Comment: Cancer patient treated for TB (4)
Dr Edwin Mapara
***************************

[Mods note: The news online at: http://StopTB.citizen-news.org is about a boy who had to take anti-TB medicines due to misdiagnosis, he was actually suffering from cancer. Luckily after two years of mistreatment, he was finally rightly diagnosed and treated - and is safe and recovering.

Members are welcome to share their experiences with TB getting misdiagnosed in their local contexts, and its impact on drug-resistance and public health at large. Thanks]
***************************

"QUITE COMMON TO SEE PATIENTS BEING TREATED FOR TB YET THEY HAVE A CANCER"

Dear Stop-TB members,

It is quite common to see patients being treated for TB yet they have a cancer, especially in the world of HIV infections and AIDS. In the twenty years that I have worked on the TB wards in Zambia and Botswana, the most common misdiagnosis was with Kaposi's sarcoma (KS), where colleagues thought that
it was TB, yet it was KS.

Worse still was the fact that the some of the KS patients with HIV infection (100%) of my clients would cough up blood. The sputum was obviously AAFB
negative on lab tests. The diagnostic lesions of KS on the chest or the back or the mouth confirmed KS. X-ray changes for KS can look like mottling or opacities of TB but with a sharp eye, one can see the fine difference.

Secondly there are no crepitations / crackles in severe KS of the lungs. ALWAYS LOOK IN THE MOUTH FOR KAPOSI'S SARCOMA TO CLINCH THE DIAGNOSIS.

In the early days, 1990s, some of the patients with KS and were HIV positive had severe Stevens Johnson Syndrome, due to thiazina. They reacted to the sulphur ingredient in thiazina. That is what made us thoroughly examine patients for TB, before starting the treatment, on a confirmed TB patient.

Dr Edwin Mapara
Community Health Action Trust
London, UK
Email: [e-mail]

[bobby ramakant]

below is another comment to this post:
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Wrong diagnosis eventually brought about a split among the parents of a little child with chronic bronchitis who was diagnosed as suffering from lung TB. The parents accusing each other of having this 'shameful' and 'dreadful' disease in the family, may end up in a divorce.

It might be a "curse" to make CXR of babies and children with bronchitis/asthma: longstanding cough, mild growth retardation and shortness of breath. They are falsely diagnosed as lung TB.

The false TB diagnosis is confirmed because tuberculin reaction (after routine BCG vaccination) or other serologic tests like PCR, Mycodot, etc.) were positive. Often a blood test with increased blood sedimentation rate plus an increase of lymphocytes count are mistakenly thought to support the diagnosis of TB.

As a consequence, without exception, all healthy household members have to have CXR, sputum examination and tuberculin testing, requiring considerably high costs at their own expense.

The child will be given 6 months of anti-TB drugs.

Then a follow up CXR is made with varying results, from a.o:
- no marked improvement,
- lesions remain the same or are somewhat deteriorated
- lesions have cleared almost completely, but apparently are still active.

The poor child will again have another 6 months of treatment. Sometimes after 2 years the treatment was discontinued!

In fact, children having asthma or bronchitis will all have normal CXR's! Minor fluctuations from the norm cause frustration of inexperienced CXR readers.

This serious and tragic problem may occur anywhere (?) in the world, where BCG vaccination is a general procedure, and CXR is routinely used in babies and children with longstanding respiratory symptoms which are simply due to asthma or bronchitis.

In this Year of the Lung, readers may want to share their knowledge and experiences or insight on
1. the signs and symptoms of Bronchitis or Bronchial asthma.
2. primary lung TB
3. post-primary TB in children.

Let us learn together from several contributors from all 5 subcontinents.

With best wishes for the Year 2010.

Dr Muherman Harun
Jakarta, Indonesia