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how we can differentiate TB vs pneumonia in CXR?
Dear Parsa,As you know CXR changes in TB are not specific. One needs to consider age, clinical signs and patient's symptoms as well. The following website provides a good overview of four pattern approach to reading abnormalities.http://www.radiologyassistant.nl/en/p50d95b0ab4b90/chest-x-ray-lung-disease.html
Also, is important to consider contact or no with TB patientDear Masoud,Thank you very much for this precious information2016-01-04 9:08 GMT+02:00 Masoud Dara, MD via GHDonline <:
Dear Parsa,Tuberculosis, MDRTB and some of the radiological presentations of pneumoniamay mimic each other at the radiological examinations. ( Chest x.ray,Thorax CT etc.) The key element is bacteriological examination of sputumfor AFB. If it is negative, diasease history, physical examinationfindings, laboratory results and radiological features may help todifferentiate tuberculosis or pneumonia. ( not for MDRTB versus pneumonia)Best Regards,Haluk Çalışır M.D.2016-01-04 9:04 GMT+02:00 Masoud Dara, MD via GHDonline <:
Differentiating between pulmonary TB and pneumonia can be difficult even with the use of the best imaging techniques like chest CT, especially if microbiologic tests (smear, NAAT, culture) are negative.In these situations, a strategy of treating for pneumonia with using a short course of antibiotics that has little activity against TB can be helpful. Some examples of these medications are beta-lactam antibiotics like amoxicillin/clavulanic acid or macrolides like azithromycin. Medications in the fluoroquinolone class should be avoided though because they have activity against TB.If the patient responds clinically and demonstrates radiologic improvement to treatment with antibiotics that have no activity against TB, it increases the likelihood that the diagnosis was bacterial pneumonia rather than pulmonary TB. If the disease progresses despite the empiric antibiotics, it makes TB more likely.
Thanks Dr Dylan, How long should one persist with non-mycobacterialantibiotics to see the response? Would 2 weeks be a reasonable time period?Here's<http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1213> oneof our recent patient's online record where we resorted to the samestrategy (you will need to scroll down to the bottom once the link opens).regards.rb
Antibiotic therapy for bacterial pneumonia is usually given for five to ten days, with the exact length determined based on the severity of disease. It should be noted that radiologic resolution of bacterial pneumonia can lag, sometime for weeks. I would probably re-image four to six weeks after treatment (assuming that smear positive pulmonary TB has already been exonerated with negative AFB smear microscopy).
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