PROLONGED FEVER DURING THE TREATMENT OF PULMONARY TUBERCULOSIS

A study was carried out to investigate the causes of prolonged fever or onset of fever, after starting anti-tubercular treatment (ATT) in sputum smear positive, HIV negative patients admitted in a Tuberculosis (TB) Sanatorium for directly observed therapy (DOT). A total of 40 patients were studied. All were males with age ranging from 22-55 years (mean 43 years). There were 22 (55%) patients with radiological extensive disease, 12 (30%) of whom had toxemia of TB (any three of the following, <90% body weight, hypoalbuminemia, hyponatremia, severe normocytic anaemia, <5mm response on tuberculin testing). Radiologically, moderately extensive disease was seen in 9 (22.5%) cases, whereas focal disease was present in another 9 (22.5%) patients. There were 28 (70%) patients who had evidence of dissemination of disease to extra pulmonary organs. It was found that fever occurred because of direct complications of TB in 22.5%, TB hypersensitivity (cold abscess) in 12.5%, drug resistance in 10% and drug reactions in 22.5%. Other diseases were the cause of fever in 32.5%. These included superadded lung infections in 15%, malaria in 7.5% anaemia in 5%. Filariasis and amoebic liver abscess in another 2.5% each. It is concluded that such fevers require a systematic and detailed investigation rather than attributing fever to drug resistance or TB toxemia alone.