TB Chapter – Part 2

I am taking Akurit-2 & Pyridoxine. My regime will be completed by the end of next week at Day 90.

I experienced mild nausea during the first few days on the meds. It reminds me of the bad morning sickness I had in my 2nd pregnancy. My urine did turn a hue of red and orange in the immediate 2-3 hours after swallowing the pills. Initially, I had thought that it would take me a few days to develop that sign. I also had horrible flu-like symptoms which is unpleasant to have during this pandemic. Coincidentally we had staff screening at the clinic that same week using the RTK-Antigen. I tested NEGATIVE for Covid-19.

I noticed I had nightmares too in the first week. I had horrible dreams of Covid-19, dengue fever and other weird disease management. Not sure if it is an after-effect of stress at work or the meds. I did not have insomnia. Instead, I have terrible somnolence. It was as bad as taking Actifed for my occasional runny nose. I did not experience major peripheral neuropathy (so far). My liver function was monitored at 2 weeks and 2 months after starting the treatment. So far, it has been normal.

The paramedic in-charge of my regime allowed me to bring home 2 weeks supply of the medicine. I don’t have to take it at the same time everyday but it would be helpful to stick to one. Akurit-2 is best taken on an empty stomach for better absorption unlike pyridoxine where you can take it at anytime you want. Obviously, I take them together.

I have had people asking me if this would KILL ALL THE TB BACTERIA in my body.

The thing is, Medicine is never 100% guaranteed. There is always a small percentage of patients that will still have active TB one day. On my part, I am doing this for myself, my family and the people around me. I also took my Pfizer vaccine shot whilst on the treatment. I did not experience any major side effects from being on the regime and taking the vaccine. Yes, I did have malaise and a mild fever 24 hours after the 2nd dose of Pfizer but that’s it. Now I feel fine.

Cost of treatment for latent TB

As a Malaysian citizen, I only need to pay RM1 for registration and for every visits to see my attending doctor. I have had two visits. That means on top of the initial RM1, I am paying another RM2. My blood works are FREE. My consultation fee is FREE. My medicine is FREE.

TB Chapter – Part 1

I have Latent TB. This is my story.

The investigation and diagnosis

It started off with a new colleague at my workplace being diagnosed with active pulmonary tuberculosis (PTB). Which consequently led to all her close contacts being screened for it as well. It was normal practice for every new staff to have themselves checked for PTB, a similar process I went through about 2 years ago, with a negative result.

The screening process involved going through the symptoms and sending a sputum sample (if present), doing a chest XRAY and a Mantoux test.

I had no symptoms, my chest XRAY was normal BUT my Mantoux test was glaringly positive this time around. Even I was shocked because I never had this response during my previous Mantoux tests done in my previous workplace and upon entering this new premise.

This was between 24 – 48 hours

Since we had a blood test called IGRA to further confirm the diagnosis, I took the test. Lo and behold, it was POSITIVE. There is no denying of the TB organism in my body- only that it is asleep. It does not have the capacity to give me an infection that manifests the classic symptoms of TB. Now it is my choice of whether I would want to be treated for it or otherwise. Of course in medicine there is no 100% guarantee that it will wipe away the TB and prevent reactivation but it is worth trying.

Initiating Treatment

I first had to do a baseline blood test for my liver function. I ended up screening for my cholesterol and diabetes all. Since my blood works are fine, my doc discussed with me of a few treatment regimes. There are monotherapy treatments which can take up to 6 months and a combination therapy for 3 months. I missed the trial period for a study using a drug called Rifapentine which is to be taken weekly for 6 weeks. Therefore, my choices are limited. My attending Dr and I agreed upon the combination therapy.

My regime is Akurit-2 (rifampicin + isoniazide) 4 tabs daily & pyridoxine 10mg once daily for 90 days. If my weight was less than 55kg, I would have been given 3 tabs instead. It is weight dependent. ha ha ha.

Expected major reactions would be a red-orange hue in my body secretions (tears, urine, sweat) and a degree of peripheral neuropathy. Perhaps also bodily ache and gastrointestinal symptoms. My liver functions will be monitored on intervals and I will personally look out for a tinge of jaundice on myself.

Will update later on how soon I turn orange-red.

Minci, the results came back positive

Apart from a positive UPT, the last thing you want to hear as a patient is that you are positive of something. (for the record, I am not pregnant). Especially now in this pandemic when it is dreadful to be positive of Covid-19. This is because the pathway upon diagnosis here in Malaysia is such that you would be whisked to the hospital and isolated for at least 10-14 days with monitoring in between. It is ugly if you have small children that are dependent on you and that you will have to be separated from them for a while. So yeah, now is not a good time to get Covid-19 eventhough you feel fine.

Anyway, I did the Covid-antibody test a few weeks ago. It was negative. So this entry is not about Covid-19.

The only positive investigation that is pinning on me now is my IGRA test. At the end of last month, a colleague was tested positive for pulmonary tuberculosis (PTB). It was initially just a screening test everyone had to do upon reporting themselves to a new workplace and this colleague coincidentally had symptoms as well. Once the colleague learned of the diagnosis, naturally, all close contacts at the workplace have to be tested including me since we share the same small room for prayers, eating and gossiping during lunch hours.

All the girls did the Mantoux test and chest Xray. Out of 8 girls who did this test, 2 of us had a positive Mantoux test (one of them is me of course) but we are asymptomatic of TB meaning we have no cough whatsoever. In fact, both of us have a really good appetite and a big waistline to begin with. We don’t look like the typical patient with active TB. Or maybe we are atypical? lols.. we could be.

Anyway, all 8 of us were asked to proceed with IGRA – an Interferon Gamma Release Assay blood test. I think both of us were kind of prepared to accept that the results might be positive. Indeed it was.

So, what is next?

Despite being asymptomatic, we still need to make sure that we have no active TB going on. That means reviewing the Chest Xray again with an extra pair of eyes to look for cavitation and taking a sputum AFB sample (if we have sputum to give- which we don’t). Once that has been excluded, then I would need to make a decision on whether I would agree to start on treatment for latent TB.

Latent TB is not infectious.

It means that at one point in life I was exposed to the bacteria which did not have enough capacity (gosh) to launch a full attack on my body to exhibit the TB disease. It’s like I caught the bug and it decided to go to sleep somewhere in my body. Waiting for the time to wake up and become powerful and active. So it will be up to me to try and kill it now before it decides to become evil and create havoc in my body. Anyway, I will only decide once my colleague in charge of TB review my Xray again later. We really need to make sure of this because the type of medicine and length of treatment regime differs.

This TB ball will start rolling next week into the new year. I guess this is the first chapter of my interesting 2021. I guess my WORD for 2021 has a big purpose this year. My word is RESILIENCE. My word for 2020 is THRIVE. Maybe that’s why the bacteria is thriving. lols.

I will give this chapter in my blog a hashtag. It will be #MinciBerTB