Persistent low-grade fever in between TB treatment

[ManuKaushik]

Hi
I am a working professional in New Delhi. Back in Dec last year, I got this big lump on my neck. The doctor diagnosed it, and it turned out to be swollen thyroid. Since the swelling was huge, the doctors suggested surgery. They removed part of my one thyroid gland (lobectomy) during the surgery and it was sent to biopsy. The biopsy report said that it was Hurthle cell adenoma. The surgeon told me that it is not dangerous. Along with thyroid gland, one of my lymph nodes was also removed since it was swollen. In the biopsy of removed lymph node in the neck, the doctor detected TB in that node. Following the report, a general physician started a 6-month TB course for me. It started in December last year with 5 tablets of Akurit-4. Two months later, Akurit was stopped and the doctor prescribed RCINEX 600 once a day. Ten days after starting RCINEX 600, I got fever. I consulted another GP who suggested me to have Mycobutol 1200mg daily. The fever didn't go for 4 weeks after which I decided to consult a TB specialist in Apollo. He asked for different tests:
#Mantoux test - Less than 2mm induration with 5 T.U. tuberculin. The doctor says it show TB but the result also shows that my immunity is low.
#HIV I and II - non-reactive
#GenExpert - TB not detected
#FNAC of two swollen lymph nodes - Reactive lymphoid population are present a few epithelioid cell granumolas. ZN stain for AFB (Negative)
#Blood rests which includes CBC,LFT and KFT are mostly normal. Monocyte and Lymphocyte counts are slightly high (10.4 Monocyte) (46.5 Lymphocyte)
#Chest X-ray - Skiagram shows fibro-calcific opacities in both the upper lungs. Could be ? old healed lesions.
#Abdomen ultrasound - doctor says that it is OK.

After these test, he asked me to take RCINEX 600, Mycobutol 1200, Moxicip 400 once a day, Claribid 500 twice a day.

For the past 4 weeks I have also developed breathing problem. It happens at any time of the day for hours or minutes. The doctor asked me to go for PFT for which the results are normal.

So even after three weeks of starting the new course, my fever is not going. My body temperature varies between 98.6 to 99.6 at any time of the day. It usually stays between 99-99.2 Celsius. The doctor says that fever is normal and I am not required to take any medicine to reduce the fever because my body is fighting infection. The fever has not gone for a single day for the past eight weeks. Although my two swollen lymph nodes in the neck have shrunk, the fever persists and it is troubling me. My body weight has gone down by about 4 kgs in one month. My current weight is around 83. I feel hungry sometimes and sometimes I don't feel like eating. I feel full after eating a small amount of food. I am also getting 4-5 bowel movements in a day.

Can someone please suggest me the reasons why my fever is not going. Is my current treatment OK? Do people get persistent fevers during the TB treatment?
Regards,
Manu

[caregiver222]

Fever is part of the immune system. TB bacteria can only replicate within a narrow rage of temperatures. The fever is a natural means of fighting the infection. You need to have the specific strain of bacteria positively identified. Then evaluate the specific antiobitics that are effective. Unfortunately tb mutates and many drug resistant strains are developing. This is a very nasty disease.   You might try taking lipitor, in addition to other medications. This is an unapproved use.  This medication dissolves cholesterol, and tb bacteria hide out in biofiuloms which are cholesterol. Good luck.

[ManuKaushik]

Thanks. What are the ways to identify specific strains? Please suggest some tests. Also, do we have antibiotics for most TB strains?

[caregiver222]

That is a complex question. I studied tb under a contract for almost a year during the 1990's (can 20 years go by so quickly?), however most of what I learned in terms of tests are now obsolete. Apparently there are some new strains that are resistant to all antibiotics. TB can be killed with what are called bacteriophages, which seek and kill specific bacteria, but  the protocol is not accepted. I had lunch years ago with Dr. Watson (who discovered DNA) and he was originally working on bacteriophages. Discover magazine had an article. Do a search. They are an alternative to antibiotics. There are very few labs that can differentiate beween the different strains. During the 1920's protocol was to paint over all walls in the home of a tb patient to seal the bacteria in. They can remain capable of causing an infection for up to eight months.  The library of tb treatments during the 1920's is at Columbia Medical School, and there are forty feet of studies (on shelves) there and I am probably the only one who has looked at them. It seems we must rediscover the wheel.