After exploring the internet for about three/four years about the issue which is given below and still standing at zero and with question mark, i decided to write down some words altjough they may not be very clear and elobrative.i explored the internet but havent yet used this email thing for my problem so any response would be very precious for me.
Following is the brief explanation of the conditions / situations for which help is needed.
Patient's name : Sajid Habib, Age: 42 years, married in 1994 has four children and doing government job in agriculture department.
He had acute fever in August 1995 alongwith severe pain in joints and bones mostly ankles and knees, swelling of bones, rapid weight loss, extreme night sweating while sleeping, reddish spots of about 2cm dia appear scattered on whole body.Couldnt clear this infection with routine conventional antibiotics prescribed by different doctors and specialists for about two months. Responded to anti TB (Myrin-P) and got noraml within two weeks. now some history is as under:
Patient was asymptomatic before August 1995 when the illness started acutely. Initially in the illness patient had high grade fever for a period of 6 hrs daily, starting from 11AM to 5PM with temperatures upto 103-104 F. During the rest of the day the fever decreased to 99 - 100 but never touched basline. Fever was initially accompanied by rigors and chills.
Patient also complained severe pain in joints and bones of feets and ankless with pain intensity corresponding to fever spikes, increasing from moderate to severe. There is history of fleeting arthiritis in the later stage of disease with pain disappearing from one joint completely and reappearing in another joint. Presently patient is also having severe pain in joints and bones of hands whenever he discontinues the anti TB treatment. There is no history of early morning stiffness. Pain in joints is accompanied by joint swelling and limitation of movement.
There is history of severe weight loss, amounting upto 1 kg per day when patient is acutely ill and fever specially when stopping ATT. Patient also complains of night sweats with an intensity that his undergarments feel wet. there is history of redish pink small spots all over the body with warm feeling over it.Patient also complains of severe headache, nausea, belching and retching and swelling during fever spikes now in the later years of this disease again when stoppping medicine.
For these symptoms patient was given following treatment by the physician in August 1995.
Ofloxacin (Tab), ciprofloxacin, augmentin. , But the patient only responded after starting Antituberculosis medicine Myrin-P about after two months of disease which was given to him on trial basis as he had no chest sypmtoms (cough). and since 1996 he is taking ATT with illness relapsing within 5-6 days of stopping the medicine.
Patient is known diabetic (NIDDM) for the last 15 years and takes tab daonil for blood glucose level. Patient had tonsilectomy at age around 10 years. He had a pedressive illness around 20 years of age which was successfully treated with tab Xanax and Tab Sinequam. No history of asthama, Jaundice, rheumatic fever, bronchitis, Hypertension in past. Patient is Nonsmoker, Non addict, Non alcoholic, works as an agriculture scientist on a farm.
No history of asthama, TB, DM, RA in family ,No history of similar illness in family.
Of many laboratory tests done summary of few is as under.
S.No. Name of Test Date Result
i- E.S.R 13-09-1995 95 mm in 1st hour
ii- OX 19 antibodies 13-09-1995 Positive
iii- Widal reaction 13-09-1995 Negative
iv- Blood Test for ANA 16-09-1995 Negative
v- X-Ray 13-09-1995 No active pulmonary pathology
detected uptill now
vi- Montoux Test 26-09-1995 Negative
vii- Blood L.E cells 16-09-1995 Negative
viii- Blood Culture 24-12-1995 No organisms grown
ix- Hepatitis B & C 26-12-2002 Negative
x- HIV Test 26-12-2002 Negative
xi- Mycobacterium 08-02-2003 Mycobacterium TB DNA not detected
detection by PCR
xii- ds DNA 01-10-2003 2205 IU/ml (Reference range = less than 30)
Result = Negative
xiii- R. A Factor 25-09-2003 Negative
Recently Tb by PCR and Non-Tuberculosis Mycobacterium by culture has also been done by very good lab at Lahore, but still unable to find any clue of disease.
By reading the medical literature from internet , my elder brother and i think that this disease is caused by some species of Non-Tuberculosis Mycobacterium because :
1- Symptoms respond to anti Tb treatment and test so far done for the detection of TB are -ve. Symptoms reappear too early i-e 5 to 6 days after stopping the medicine as for tb it should take atleast about a month. after stopping and restarting the medicine for so many times it may have become drug resistant TB?
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