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How to do confirmatory test for ankle TB
My daughter has swelling in her foot for a month.as x-ray came out normal so doc suggested MRI..MRI reports show enhancing marrow infiltration in calcaneus with adjacent enhancing soft tissue thickening suggesting like osteomyelitis...so doctor done soft tissue biopsy and trucut biopsy of calceneum...both biopsy give result for necrotising granulomatous inflammation of soft tissue consistent with mycobacterial etiology
- no evidence of malignancy
- stain for AFB- negative
Advice - AFB culture
Based on above report our doc suggested to start anti TB medication without AFB culture as this culture is done with pus n there was no pus during surgery...but other doc suggested not to start medication without culture...kindly elaborate what's going on and how culture can be done? Should we start medicine or not...we r very confused n tensed
Answers (2)
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Dear Sir,
your child is of two years age, and in this age group, one has to be sure of TB, before giving drugs, simply because, the treatment continues for a period of almost 1 year in bone TB,
Second thing is regarding confirmation, you have gone for a biopsy, but you fail to mention what are her ESR and CRP levels, as they have a great significance if we think of TB, moreover, the culture for AFB does not need pus, any tissue can be given, but i suspect now that we would be having any tissue left. There is one another investigation that can be done from blood which can be done its called TB gold. Based on all these we have to start drugs, Moreover I would like to mention here, since TB is endemic in our country, many physicians start it on trial basis,this was quite acceptable in the past when we had no sophesticated methods of diagnosis, but now a days this is not practiced any more
Next Steps
Send ESR, CRP levels, and Get TB Gold done from childs blood.
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Possibility of TB is high as per the findings that you have mentioned.
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In tuberculosis of bone..many a times there is no pus for culture..so even if stain is done it shows negative as the bacteria may be present in another field..
The tests which are done in case of tuberculosis of bone are mri which has already been done..along with that mantoux test and complete blood count.
A sample can also be sent for PCR of TB which is polymerase chain reaction where a segment of the infected bone is taken and amplified in a dish to check. If it shows mycobacteria then she needs to be started on medications..
It is not necessary to specifically see a mycobacteria tuberculosis as there are 100 sub species of atypical mycobacteria..
Hope she gets well soon..
Next Steps
get her blood tests done and mantoux done.
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Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.